The California Department of Social Services (CDSS) does not know how many inspections of assisted living facilities it conducts in a year. It also doesn’t know how many allegations of abuse, medication errors and unusual injuries are reported by facilities the department oversees.
What is known, thanks to a study of department records by ProPublica, is that the CDSS failed to collect half the $2 million in fines it assessed those facilities between 2007 and 2012 for violations of state law. Even worse, it failed to collect any money in 39 of the 50 worst cases.
One facility in Shasta County ran up fines of $250,000 and paid none of it.
The federal government regulates the nursing home industry, but the assisted-living industry, which has sprung up the past two decades as an alternative form of care for 750,000 seniors nationwide, is overseen by the states. That oversight varies dramatically from state to state, but, generally speaking, it is lousy everywhere.
A study of assisted living oversight nationally by ProPublica in October concluded, “The jumble of state laws governing assisted living reflects, in part, the industry’s efforts to fight off tougher regulation.”
California has roughly 7,700 assisted-living facilities, an increase of 25% over the past 10 years. During that time, the state has cut its staff of inspectors by 9% and swapped its annual inspection routine for a five-year plan. Pat McGinnis, executive director of California Advocates for Nursing Home Reform, described the situation to ProPublica: “The current system is a recipe for neglect and abuse. Care standards are almost meaningless. Facilities can flout the law without facing serious consequences.”
The state recognized its shortcomings in tracking problems at the facilities and commissioned University of California-San Francisco professor Bob Newcomer to create a system for collecting the information in 2009. His team came up with a system that tracked inspections and problems and provided online public access to the information.
It was never implemented, which Newcomer called an “embarrassment.” CDSS Chief Deputy Director Pat Leary, a 2011 appointee, told ProPublica she was unaware of Newcomer’s work.
It is not the only embarrassment recently suffered by the department. Last month, a spotlight was cast on the CDSS shortcomings when 14 sick and elderly patients were abandoned at a facility after the department ordered it closed for violations. Three workers, including a janitor and a cook, stayed for days to help before finally calling 911.
A department spokesman said there are multiple reasons for the poor fine-collection record—operators go out of business, fines are paid in installments, and appeals reduce or delay their payment. Leary said fines were not a significant tool for controlling the behavior of facilities.
And, perhaps, with good reason. The fine generally assessed for injury or death is $150. That compares to the maximum penalty of $100,000 at nursing homes, which are policed by the California Department of Public Health under federal law.