By Peter Schurmann<\/p>\n\n\n\n
Amid acute staffing shortages made worse by Covid advocates for older adults say more needs to be done to protect the rights of residents in California\u2019s long-term care facilities.
Do residents of long-term care facilities have rights? The question gained new urgency for elder care advocates in the wake of the Covid pandemic, which led to prolonged quarantines and isolation for residents amidst soaring infection and fatality rates.<\/p>\n\n\n\n
Today, advocates worry residents\u2019 basic rights \u2014 from proper health care to voting and even when and what to eat \u2014 are not being met amid acute staffing shortages.<\/p>\n\n\n\n
\u201cEvery individual has rights that must be honored and protected,\u201d says Blanca Castro, California\u2019s Long-Term Care Ombudsman, a title Castro says originally comes from the Swedish word for \u201cadvocate.\u201d<\/p>\n\n\n\n
\u201cJust because you go into a long-term care facility, you are still the same person you were before you entered. You still have a name; you have a family\u2026 you still matter,\u201d said Castro.<\/p>\n\n\n\n
She spoke during a Nov. 16 media briefing organized by Ethnic Media Services, in partnership with the California Department of Aging and the California Department of Health\u2019s VaccinateAll58 campaign.<\/p>\n\n\n\n
More than 400,000 people receive care in long-term care facilities in California annually. Their stays can be a short stint \u2014 after a hip replacement or knee surgery \u2014 or long-term advanced care for memory-related illnesses or other ailments.<\/p>\n\n\n\n
Castro\u2019s office received more than 40,000 complaints last year<\/a>, ranging from inappropriate discharges to medications not being given. Among the complaints, many had to do with residents not being allowed to see visitors during Covid lockdowns.<\/p>\n\n\n\n \u201cWe are social animals,\u201d said Castro. \u201cWe need voice, touch, contact. Facilities locked down during Covid, turning residents into prisoners\u2026 it did not have to be that way.\u201d An estimated 10,000 people died from Covid in California nursing facilities in 2021. Social isolation contributed to many of those deaths, she stated.<\/p>\n\n\n\n New laws put in place since the start of the pandemic now require care facilities to have infection control plans \u2014\u00a0which dictate basic procedures like hand washing and mask-wearing \u2014\u00a0that Castro says can help ameliorate the isolation many residents experienced.<\/p>\n\n\n\n Castro, whose office is supported through taxpayer dollars, explained that while not an enforcement agency, one of the state\u2019s more than 700 long-term care ombudsman \u2014 along with 35 related programs \u2014 will come to communicate with the resident and their family and can refer cases to relevant departments that are tasked with enforcement when necessary.<\/p>\n\n\n\n Dignity and independence are priorities for her office, Castro adds. \u201cThe main question we ask is: what do you want? What does resolution look like to you?\u201d<\/p>\n\n\n\n Hagar Dickman, a staff attorney with the non-profit Justice in Aging, said The Nursing Home Reform Act lays out the full range of rights to which long-term care residents are entitled. Under the Act, facilities are required to provide the highest level of care they are functionally capable of.<\/p>\n\n\n\n \u201cPerson-centered care guided by what each resident needs and wants,\u201d she said.<\/p>\n\n\n\n The Nursing Home Reform Act, originally passed in 1987, applies to facilities that accept both Medicare and Medicaid (MediCal in California), which a majority of facilities do. Among the rights it lays out is the right to consultation with residents and families in drafting healthcare plans. \u201cFacilities cannot create care plans without discussing them with residents and their families first,\u201d explained Dickman.<\/p>\n\n\n\n Other rights revolve around daily and otherwise mundane activities that most people outside of care facilities take for granted: waking times, mealtimes, and what kind of food one is offered. All of these must be flexible.<\/p>\n\n\n\n But enforcing these rights often falls first to residents and their families: Dickman said they have to be aware that these rights exist. She also pointed to longstanding disparities in who is afforded these rights and who isn\u2019t.<\/p>\n\n\n\n \u201cBlack Americans are three times more likely to reside in poor performing facilities,\u201d she said, noting that her work as an advocate begins with that perspective of where the disparities are greatest and who is suffering most by being denied these fundamental rights.<\/p>\n\n\n\n Still, while long-term care facilities came under intense scrutiny during the pandemic, Castro was quick to note the difficulties of working in these settings, particularly for staff, many of whom come from communities of color and often receive subpar wages. \u201cIt is a challenging job\u2026 but people do it because they want to help.\u201d<\/p>\n\n\n\n Castro said California is currently working to improve wages for care facility workers amid an increasingly severe shortage<\/a> that was exacerbated by the pandemic.<\/p>\n\n\n\n \u201cUnderstaffing in some of these settings worries me,\u201d said Dr. Anna Chodos, associate professor of medicine at Zuckerberg San Francisco General Hospital. She pointed out that during the height of the Covid crisis, data showed that as nursing ratios increased, infections dropped. That became especially apparent once vaccines became available. \u201cWe want to keep our eye on ensuring residents\u2019 access to life-saving vaccines.\u201d<\/p>\n\n\n\n Staff training was another issue that came up often during the one-hour briefing.<\/p>\n\n\n\n Jerry Kirouac is a long-term care ombudsman based in Redding, in northern California. \u201cOne of the biggest problems we have (in terms of ensuring residents\u2019 rights)\u2026 is lack of facility knowledge. It is that training and the quality and consistency going into that training,\u201d he said.<\/p>\n\n\n\n Kirouac spoke from a veterans\u2019 care home in the largely rural city, located about 4 hours north of San Francisco. He was joined by several residents of the home, including Billy Thomas, 79 and a Marine veteran, who said communication was a problem at the facility. \u201cConcerns and complaints don\u2019t reach the administration,\u201d he said.<\/p>\n\n\n\n Linda L., 77 and a Navy veteran, said the center needed to work on conflict resolution, citing an experience with a fellow resident that she said, \u201cgot swept under the rug.\u201d Billy Ball, 84, has always voted as a veteran and cares most about that right, which the Centers for Medicare and Medicaid Patients stressed in an October 5 memo<\/a> that all facilities must ensure.<\/p>\n\n\n\n Speakers also urged residents and families to form councils, to work together to advocate for their rights. \u201cThere is power in numbers,\u201d Dickman said.<\/p>\n\n\n\n\u2018Dignity & independence\u2019 for patients<\/h2>\n\n\n\n
The Nursing Home Reform Act<\/h2>\n\n\n\n
Acute shortage of care workers<\/h2>\n\n\n\n