Amid coronavirus crisis, L.A. County may create an inspector general to oversee nursing homes

Jaclyn Cosgrove
Los Angeles County Supervisor Mark Ridley-Thomas.  (Luis Sinco / Los Angeles Times)

Los Angeles County officials will consider on Tuesday whether to appoint an inspector general to oversee nursing homes, a new position that would bring "much-needed accountability" to the epicenter of the county's COVID-19 crisis, according to a motion filed this week.

If the Los Angeles County Board of Supervisors passes the motion at its Tuesday meeting, the inspector general would be selected by July 1 and begin providing interim reports every 60 days to the board until a final report has been completed. The inspector general would be tasked with conducting an "exhaustive review" of the county's current system for regulating and inspecting nursing homes and determine what must change.

Supervisor Mark Ridley-Thomas, who proposed the new role with Supervisor Kathryn Barger, said the position is unlikely to be temporary, noting that the county and state have for years had issues with compliance at nursing homes.

"It is not uncommon knowledge that these facilities operate at a less than desirable level, and that's why you have to have regular routine inspections and enforcement," Ridley-Thomas said. "You have to have all of that in order for them to treat the residents, the patients and the employees properly. There is a question whether or not profit motive drives the substandard conditions experienced in some of these facilities."

As of Monday, almost 4,800 residents and 3,000 staff members from such facilities have tested positive for the virus. Across L.A. County, 52% of all deaths from COVID-19 have been in institutional settings, particularly in skilled nursing facilities, many of which are for-profit, according to the supervisors.

For years, the county and state have struggled to address complaints filed against nursing homes.

In 2014, an audit of county skilled nursing facility inspections and investigations revealed a backlog of about 3,000 nursing home investigations. By 2019, that backlog had grown to 5,000, including 2,100 new complaints each year, according to the supervisors' motion.

The California Department of Public Health has the responsibility for licensing and monitoring healthcare facilities, including nursing homes. But in L.A. County, the state agency has historically shared the oversight responsibility of about 2,500 health facilities, including 400 nursing homes, with the Los Angeles County Department of Public Health.

Last year, the county's public health department entered into a contract with the state public health agency to fully transfer responsibility of healthcare facility investigation and monitoring activities to the county, "with the objective of creating more operational efficiencies and improving the quality of enforcement activities," according to the motion. Despite this move, thousands of complaints continue to be registered with the county each year, Ridley-Thomas and Barger said.

In mid-April, a Times investigation found that the vast majority of skilled nursing facilities battling outbreaks of the novel coronavirus in L.A. County have been cited in recent years for violating federal safety rules on preventing infections, raising questions about how prepared the facilities and regulators were to address a pandemic.

The majority of residents in skilled nursing facilities in L.A. County have very low incomes, with 62% of residents relying on Medicaid, and do not have the means to move or hire an attorney to advocate on their behalf.

The supervisors would also create an online public "dashboard" with data for each facility, including the number of COVID-19 cases among residents and staff, the number of tests performed each month and how far along the facility is in implementing its state-mandated COVID-19 mitigation plan.

Ridley-Thomas said the dashboard will hopefully increase public scrutiny of bad actors and allow residents and their families to make informed choices before selecting a nursing home.

"This is in the interest of consumer protection and patient safety," Ridley-Thomas said. "It would seem to me a patient's bill of rights as it relates to skilled nursing facilities ought to be the order of the day. There is no way I could ever be convinced that these facilities are operating as they could and should, and it is our responsibility to make sure that they do."