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Home My WebLink AboutAgenda Report - April 5, 2000 E-19yOF� CITY OF LODI COUNCIL AGENDA TITLE: Resolution in Support of increased level of Medi -Cal Funding for long-term care facilities MEETING DATE: April 5, 2000 SUBMITTED BY: City Manager RECOMMENDED ACTION: The Council adopt Resolution 2000-51 supporting an increased level of Medi -Cal funding for long-term care facilities. BACKGROUND INFORMATION: Mayor Pro Tempore Nakanishi requested that Council consider adoption of a resolution supporting an increased level of Medi -Cal funding for long-term care facilities. The request was prompted by a letter from Vienna Convalescent Hospital, Inc., located in Lodi, describing their concern for citizens residing in nursing homes who are currently funded through the Medi -Cal system. Presently, 64 percent of California's nursing facility residents rely solely on Medi -Cal to pay for their care in a skilled nursing facility. Governor Gray Davis recently vetoed a bill which addressed comprehensive nursing reforms and which included funds to raise the wages of nurse's aides who care for the residents of long-term health care facilities. California currently ranks fourth from the bottom among all states in what it pays for subsidized nursing care. Attached for Council's review is the letter from Vienna Convalescent Hospital, Inc. with accompanying background information on the nursing facilities crisis. Funding: Not applicable Respectfully Submitted, H. Dixon Flynn City Manager Attachments cc: Cory Wright, Vienna Convalescent Hospital, Inc. APPROVED: H. Dixon Flynn -- City Manager VIENNA U CONVALESCENT HOSPITAL, INC. 800 South Ham Lane • Lodi, California 95242 • (209) 368-7141 March 17, 2000 Alan Nakanishi, M.D. 1136 Junewood Court Lodi, CA 95242 Dear Dr. Nakanishi, Thank you for your consideration in placing a long term care resolution on the City Council agenda. The California Legislature and the Davis Administration need to know that not only are they neglecting the state as a whole when it comes to nursing home operations but to individual cities as well. There are eight licensed skilled nursing facilities in our town with over 800 beds. There are well over 800 citizens employed in these facilities. Statistically speaking, two-thirds of the citizens residing in a nursing home setting are being funded through the medi-cal system. I have included for your review various newspaper articles, wage comparison data, human resource needs, statistics on facilities going bankrupt and a sample resolution. A similar resolution was passed by the Los Angeles County Board of Supervisors on March 7, 2000. I have contacted Phillip Pennino with the hope that he will work with you on this proposal. If I can assist you in any way or if you have any questions, please give me a call. Thank you for your time and energy. Very Truly Yours, i_. Corey Wrig CALIFORNIA FACILITIES • There are approximately 1,440 licensed long-term care nursing facilities in California. • In 1997, the average nursing facility costs range between $98 - $114 per patient per day ($35,500 - $41,600 per year). • Nursing facility occupancy rates in California are approximately 86%. • The average length of stay in today's long-term care facility is less than two months for over 70% of the resident population; with fewer than 13% of all resi- dents remaining in the facility for one year or more. • California's commitment to home and community- based care has resulted in a 22% lower rate of nursing facility placement than the national average. In California, Medi -Cal reimburses skilled nursing facilities an average of $94 per day. What does it buy? • 24 hours of care • A clean, comfortable room • Three nutritious meals and periodic snacks, special diets and dietary supplements • More than three hours of hands-on care • Assistance with personal hygiene, medications and activities of daily living • Daily activity programs including both physical and social activities • Housekeeping and laundry service • Over the counter medications, such a Advil, Tagamet, Nyquil, and supplies such as cotton swabs, bandaids, etc. • Use of wheelchair, crutches, canes or walkers and other assistive devices Who Pays? 8%) Private Insurance (less than 2%) Sixty-four percent of California's nursing facility residents rely solely on Medi -Cal to pay for their care in a skilled nursing facility. RESIDENT POPULATION • As many as 250,000 Californians are cared for annually in licensed long-term care facilities. • The U.S. Census Bureau estimates that the number of nursing facility residents in the United States will rise steadily until 2020 and then increase sharply for the next 20 years, growing to more than four times the 1990 level. By 2080, the Bureau estimates that the nursing facility population nationwide will rise to 5.6 million elderly (age 65+). • Three out of four nursing facility residents are women. • Approximately 85% of nursing facility residents in California are age 65 or older. + On average, residents require some level of assis- tance with 3.7 activities of daily living (ADLs), which include bathing, dressing, transferring, toileting, and eating. • Less than 2% of Californians currently pay for long- term care through private insurance. California Association of Health Facilities 08/99 Aiesseoeu eouepedxe ON JH/8$ equiBil. Japes Gj!JL JH/6$ jejueo lleo eoweS jewolsn:D pajinb9i BUIU184 ON JH4 L -1$ JGAIJO AJeAllea vu.,' R I L 1144 - ON "1"l 7777-7-_,_ JH/Ots SE"PiPed 14118914 jo U01jeloossv elujopleo -a— I 1 6, vom Ajessec)eu i93uGljadx9 ON JH/03 .ieqsem mopul .m JH/9 L$- £L$ JGAIJ(3 V SSej:D paiinbai Bulu'eJl ON JHISL,g$ (VOdg) J,91PUeH Boa ARIOLIS SWINGS P001 Mots -8S -punf Illm IvD-!pajV lin s jjgja 391gS jjgjqU - i 0, t ". '-, 1-1: MA918 AJIUJ Olga ivip asnviaq tnoyAk' iad I isn(si VND v .of 33veK agmatv 3q•Kf.L JRILS Y g gsjnN P91111jea jn�p - - r.z' JR/Zt 6S lSlUolldg3oV 1. ix 14pt Aw 141 uosijedwoC) oBeM/qor 18AG-1 Aj4ug 112qj fo spoau iisvq js0tu 21j) gulwui .sof ajqjsuodsaA ajv saijill-mf JR/Ols es 3AV3 UU3j-9U0j Ul ioeisissv siuvisim asAnu p�ajlfjjiaD A119481UIMPV, JDAJQ iUGAjj9u uosijedwoC) oBeM/qor 18AG-1 Aj4ug ATTACIUv ENT I Projected 2000 direct -care staff needs: SNFs, by county • Free-standling'pure' SNFs at current occupancy. Does not include hospital DF's, or SNFs which also include other levels of care. Counties not appearing here had no SNF cost reports meeting those criteria. OSHPD FTEs adjusted by a county factor (1.1 to 1,7) for part-time employees. OSHPD turnover was adjusted to reflect the fact that some staff leaving one facility move to another SNF rather than finding work in another field. New Staff needed due to staff due to staff due to 3.2 Direct Care County SNFs" Staff ** vacancies turnover— requirement Total Statewide 1054 60,706 9,690 17,506 4,086 31,282 Alameda 67 1� 5.3.2 9.73 1.44 1.1"9 ......... 96 .............. .. .. .. ............................ 15 .. ..... ............................ 48 ........................... 13 Butte 12 765 122 211 68 401 . ................... . ..................................................................... Calaveras 2 79 ............................................. 13 7 26 10 ....................... ..................... 2 5 ................. 41 22 Colusa 1 41 b"o-n-ir'"a, Costa il'a .................. 0** '5", ...... '6- '0"6' ... ........... 3*"8'* ---------- ** ......... g;ib ............ Del Norte 1 64 10 5 0 15 El Dorado 3 175 28 63 13 104 .�iis4o ................................ id ..................... 1654 ........ .... 264 .......................... 457 .......................... i.�� ............. Humboldt ....................................................... 5 363 . .68 ...............................:i6............................... 57 0 115 ......................... ii i5 .............................. id .............. Ingo 1 30 5 18 0 23 Kern 1 . 4 ............... §66"- ...... Tp-- ... * ........... 9�i� ............. 56 ... ......... .K'90 ...................................3........................ 2.26 3.6 6.1 11 1.0.8 Lake 3 ............. 176 ............... ............................... 28 ................................ 83 ................ .............. 0 ............. 111 Lassen 1 64 10 8 8 26 Los An eles 323 1 8 255 2 914 4 725 1 852 9. 491 Madera 4 261 42 57 23 122 Merin *c* * * *"* **"** 16 ...... * 871 *** **i4;f-,**"*""'*,*"",-,**'5*i 139 **'*"*'***"*"***"**"'*"i��'*** 213 * ..... 0 352 MendoWWa6 cino �* ... * ................. iW .......... . *'--"*-W-'- ', Merced 7 313 50106 10 186 Montere 14 689 110 6 317 .A. Napa ............................... 9 ............................... 430 69 -"4J ........ ..... * 152 -129 1}.,.......................232......_...... Nevada 5 ...... ----- -.T . . ii Oranp .............................57 ..................... M§5 .......... .............. 620 .................................... 1 157 I ....................................................................... 202 1 979 t ...... ...... Placer a 574 92 179 42 313 Plumes . ........................ 1 34 5 6 7 18 . Riverside. ..... - 42 ...................... ... .... .. 2, - 26 . 8 ........... .. ..... ............. 3 . 62 ............................ .. ..... . 27 ... 7 164 ............ 1.263 Sacramento 32 2,144 .......... 342 ...................... 622 ........ * 121 1,085 San* Benito 60, ........ 6 .................. �i San Bernardino 40 2,276 363 921 169 1,453 San .D-ie- g.......................75 ...................... ......................................................... 727 1.. I 37...3.. .................. .........79 ...........................RJ79I. . ...........Francisco San 17 760 i�i 128 �4 278 San.Joa.pin 25 .............................. 11513 242 378 148 768 8 52 5 ..... 84 .. .... 1 31 3 8 25 3 San Mateo . li�Wii.Barbara 22 1,180 188 273 65 526 a r bar a 12 619 9 9 172 8 .......... . . ..... ....... 279 Santa Clara 46 2,782. ............. 4.4.4 ............................ 8.21 ............................. 1.92 ............ . ............ 1,157 ... Santa Cruz 11 559 89 147 54 266 Shasta 4 354 56 97 0 163 ............ T66 ............ ............... i.6 ............................... N ................................ 6 ............................... �i .............. Solano 10 537 86 175 39 300 Sonoma ............................ .us 20 ..................... 165 327 59 551 I §iii@i T� 1,071 171 360........ .......59...... 590 Sutter .... ............. * ........... 4 234 37 82 130 Yw�ii�i Y--- , 1, 2** '8'* ......... 2' *0*' * ...... ......... .... 6"5"'"* ... ....... 7 92 Tulare ..................... 13 ....................... 800 128 376 65 Beg Ventura i.� Wfl .......... .............. i.g� ............................ 5iA .......... . .................. 6.6 ............................. �jd ............. Yolo ** ** * 7 **'*'*i'*'*'** **""*'*" 406 65 123 19 207 Y�6i 0- **"* .... * ..... , ..... � *, .......... * ....................... j ... * .......... ***"*"*****'4 ...... * .......... .. • Free-standling'pure' SNFs at current occupancy. Does not include hospital DF's, or SNFs which also include other levels of care. Counties not appearing here had no SNF cost reports meeting those criteria. OSHPD FTEs adjusted by a county factor (1.1 to 1,7) for part-time employees. OSHPD turnover was adjusted to reflect the fact that some staff leaving one facility move to another SNF rather than finding work in another field. California Counties with Nursing Facilities in Bankruptcy February 4, 2000 •�'. . , tq ; E i:� r�t,i: �R Ej �sra. °�, 5 ',�e�. Alameda 71 . ..lh�F', �4 :�.. � i yP 16 ,, �. „q � ,..-.�� 23% 5,492 1,768 32% Amador 1 1 100% 199 199 100% Butte 11 2 18% 1,130 283 25% Contra Costa 34 5 15% 3,189 677 21% Fresno 34 3 9% 3,256 176 5% Glenn 1 1 100% 76 76 100% Humbolt 6 4 67% 540 341 63% Kern 14 1 7% 1,630 160 10% Los Angeles 375 21 6% 37,903 3,062 8% Lassen 1 1 100% 96 96 100% Marin 17 3 18% 1,345 258 19% Mendocino 5 1 20% 387 70 18% Monterey 16 4 25% 1,096 357 33% Napa 10 2 20% 746 156 21% Orange 65 14 22% 7,598 1,542 20% Plumas 1 1 100% 57 56 98% Riverside 48 4 8% 4,448 396 9% Sacramento 38 11 29% 3,862 1,457 38% San Benito 2 1 50% 122 70 57% San Bernardino 49 5 10% 4,891 352 7% San Diego 87 11 13% 8,649 1,186 14% San Francisco 19 6 32% 1,427 651 46% San Joaquin 27 6 22% 2,850 735 26% San Luis Obispo 7 1 14% 791 162 20% San Mateo 23 5 22% 2,145 658 31% Santa Clara 57 4 7% 5,751 711 12% Santa Cruz 12 5 42% 1,023 522 51% Shasta 7 2 29% 823 228 28% Siskiyou 2 1 50% 158 59 37% Solano 13 3 23% 1,312 364 28% Sonoma 20 2 100/0 1,611 202 13% Sutter 4 1 25% 408 59 14% Tehema 3 1 33% 180 58 32% Ventura 17 2 12%1 1,594 1 222 14% Yuba 1 1 100%1 Be 1 86 100% Totals 1,098 152 14% 106,877 1 17,455 1 16% Data Source: CA Dept. of Health Services, Licensing & Certification ACCLAIMS Data 10/30/99 f:\data%Qprolke11eylbankruptcy.wb3 e1he New V"k &mcs Monday, December 13, 1999 Editorial CHANGE AND CRISIS IN NURSING HOMES As the American population ages, more and more of its oldest and frailest members spend their last years in nursing homes. In Florida, a laboratory of old age, it is estimated that one-fifth of the deaths in the state each year occur in nursing homes. But the American nursing home industry today is itself in uncertain health, and some of its biggest operators may be in terminal financial shape. Homes for the aged in the 19th century were often founded by churches and towns as small, not-for-profit institutions. The trend in the last decades, however, has been toward ownership by large, publicly traded, for- profit chains. Wary of how the profit motive can compete with the cost of giving good care, New York State blocks publicly traded companies from operating nursing homes in the state. But Wall Street helps finance them in other states, and two of the biggest of those national chains, Vencor and Sun Healthcare, have filed for Chapter 11 protection in the last three months. Two others, Mariner and Integrated Health Services, are trading at pennies a share. Five of the largest chains, with almost 20 percent of all the nursing home beds in the country, are now operating at a loss. Another big chain, Beverly Enterprises, recently agreed to reimburse the federal government for more than $170 million in Medicare billings after a federal audit. The crisis and turmoil among the chain operators are not typical of the industry as a whole, but the changes and pressures they face are. Many of the chains in trouble specialized in the kind of therapeutic and rehabilitative care that Medicare once freely reimbursed but now does not. With stricter reimbursement standards imposed in January, federal dollars for long-term care could fall by 20 percent this year. At the same time one part of the federal government was tightening its payment policies, another began cracking down on recurrent evidence of abuse and neglect of residents in nursing homes, much of which has occurred in chains. Better, more attentive care costs more in time and labor than does indifferent care. But about two-thirds of nursing home patients are indigents whose care is subsidized by Medicaid, and state legislatures, which set Medicaid reimbursement rates, have been determined to hold down those already huge costs. Only recently, in such states as California, have efforts begun to appropriate dollars targeted to raise the wages of the nurses' aides who give residents most of their care. In California, that money was included in the most comprehensive nursing reforms passed by the legislature in 20 years, but the bill was vetoed in October by Gov. Gray Davis. The changes and crises in the nursing home industry are occurring without national debate and the participation of those most affected, the homes' 1.6 million residents. They do not, for the most part, vote. They often cannot walk or talk. As the handsome new assisted living facilities that have sprung up everywhere in this decade have attracted the youngest, most vigorous and affluent of the elderly, nursing homes have become filled with the poorest, sickest and neediest. The change has come about very quickly. In Florida, where there are 70,000 nursing home residents, there are now 66,000 others in assisted living facilities, with new facilities being licensed at the rate of 85 each month of last year. Assisted living facilities have been popular with developers because they are not burdened by the licensing requirements or regulations that govern nursing homes, and the elderly are glad for an alternative. There are signs, such as vacancies and depressed stock prices, that the assisted living market has now been overbuilt. But the one demographic certainty is that the number of the very old and infirm will continue to grow, and that the nursing home industry will have to change to accommodate them. All those with aging relatives, or conscious that their own years are passing, need to pay attention. = AI i vv. NORTHERN CALIFORNIA'S LARGEST NEWSPAPER MONDAY, DECEMBER 13, 1999 EDITORIALS Nursing Home Neglect URSING homes that care for 120,000 patients in California are feeling the financial pinch. It's Gov. Davis' tum either to come up with his own financial reform package or accept one devised after long negotiation by contending forces of labor, business and health care advocates. Davis went part way in October by approv- ing $36 million in state payments to upgrade pay for nursing home workers. But he vetoed a second measure that used a carrot -and -stick approach with fines for neglectful manage- ment, more staffing and increased money for nursing homes operators. Currently, •Califomia ranks fourth from the bottom among all states in what it pays for subsidized nursing care. No wonder that I I percent of the nursing home beds state- wide are threatened by bankruptcy. Last year, Assembly Majority Leader Kevin Shelley, D -San Francisco, thought he had c•1,. WH �. achieved the impossible. Patient advocacy groups, labor representatives of nurses, and home operators agreed on a pact that would answer many of the cost and care problems. The governor balked, indicating he was concerned that the $75 million cost of the plan would obligate the state to higher costs in the future. It's a legitimate concern, but he needs to explain what he will do instead. Shelley plans to reintroduce the package, It's a starting point and the various interest groups will be pushing hard to grab Davis' attention. With a strong economy and grwAng num- bers of needy elderly, the time is right for change. If nothing is done, the situation will only worsen: financially weak rest home op- erators, a scarcity of low -paid workers, and the likelihood of patient suffering. Gov. Da- vis must focus on an issue that needs his attention, not just another veto. 1. ,. A M C 'I ntit/;i'1.,1 t;, '� I 1 I P+ * Q�' t41 �M1YttG!1� �},{►1Qt� �R.l.�.�' A 1llYlfl'' • I /Ti! 1. f • :I1': i 1 THE PRESS BOX Bankruptcies' stalk nursing homes N Sacramento County, 19 percent of the beds in nursing homes are owned by companies that have filed for bank- ruptcy. In Amador County, the bank- ruptcies involve 80 percent of the beds. Humboldt, 64 percent. Yuba and Plumas counties, with one skilled nursing home apiece, 100 percent. Much of the financial deterioration is attributable to the bank- ruptcies of some large chains, yet the trend is worrisome. Financially unhealthy homes don't translate into healthier residents, particu- larly senior citizens who are sometimes too frail, too sick, too alone to demand and re- ceive appropriate care. Nursing home reform was among the is- sues that eluded Gov. Gray Davis and the Legislature this past year. Lawmakers started with a get -tough strategy to punish unscrupulous operators rather than pro- vide meaningful carrots to encourage im- proved quality. After legislators worked with the nursing home industry, the result was a more balanced bili, but it came with inevitable additional costs to increase staffing and improve training. The governor's staff, unfortunately, had little direction as the reform effort evolved. Engaging late into the legislative process, T)Avia hA1kP#i of the ens} nP na..;. r-- staffingincreases beyond whatwas already in the budget and vetoed the bill. Meanwhile, the nursing home bankrupt- cies mount. Sun Healthcare Group, with 369 facilities and'40,000 patients nation- wide, filed for bankruptcy last month, join- ing other troubled chains with names such as Vencor, Frontier, Newcare and Iatros. It. is difficult *to conclude how much these bankruptcies are attributable to inade- quate government payments or how much is due to poor management. Regardless, bankruptcies raise concern about the qual- ity of care. This is -no easy problem to solve. Unlike other safety nets such as Medicare and So- cial Security, government -subsidized nurs- ing home care is only for those who are poor — 4nd who intentionally become poor by shifting assets to others. In California, most nursing home resi- denta are the financial responsibility of the government, which pays the homes about $91 a day per resident. In turn, the homes pay nursing aides about $7 an hour. No wonder the caliber of these aides can be so poor that California nursing home residents complain about their care at twice the national average. No wonder many homes are in financial trouble. 6q. Z� ; l 9C)C� P I J SATURDAY November 27, •1999 Jm*W Dunne. s certmed nurse assistant at Somerset Nursing Center In West Swra- mento, shifts a resident from bed to a wheeM char on Friday morning• eeepwwplepv tads saraa At $ 7 an hour; tough, staff jobs go begging in nursing homes id 1 guess it would be easier to work at a Jack in the Box. ii Jackie Dunne By Cynthia Hebert Bee"Writer aerie Dunne just might have the toughest $7 - an -hour job in Califor- nia. On the morning atter Thanksgiving, Dunne began her work day at 6 a.m. at Somerset Nursing Center in West Sacramento. She had 11 elderly and disabled people counting on her to keep them clean, fed, com- fortable and content. Before her shift ended, she would walk the equiva- lent of several miles and help lift residents who out- weighed her. She would empty bedpans and wipe bodies. She would prepare heieelf at every turn for the possibility of getting cursed, slapped or tapped with a flying food tray or water pitcher courtesy of an angry or unstable resident. She would do it all cheerfully. "It is very difficult work. It's sensitive work. It's physically and emotionally draining," said William Hu4t, Somerset's adminis- Please see. MlnaRa ... I lNursesiep Workers #r say. thatgood car e be casuals uld co Y Continued from page Al trittor. _ - -- And'it is work that fewer and fewer people are willing to do in a booming economy that of- remso many other options for entry level workers. California and the rest of the Vuntry are dealing with a crit. cal shortage of care givers like 3i me, a owed nurse assis- 4RL •'"It's the most important jab n the health facility, without iuestion," said Kristina Smith, hief of aide and technician cer- iflcation for the state Depart. mint of Health Services. And has never been in bigger de - land. 'Mesa apecialists, who need 50 hours of training but not high school diploma to qualify it caring far-aociety's most vul- arable people, are eschewing is field for better -paying jobs warehouses, retail stores ad even fast-food restaurants. The situation has left nurs- . ggbornes in a bind. They con - ad they cannot afford to pay rtified nurse assistants more cruse of stagnant govern- snt reimbursement, rates and ;daft margins. 'I have worked my entire life provide care for the most edy in our society, and I have ver seen a staffing crisis as •rare as this; said Judith Ry. , a registered nurse and 3sident of the American alth Care Association. cyan and others fear that +d care could be a casualty. �tafl'Ing shortages translate 3 longer working hours, irter tempers and less indi- ual attention to patients,_ ustry observers said. Such umstances can lead to se and neglect, marginal and even closure of homes. n this economy, all indus- s are struggling to fill jobs," `. Debby Friedman, adminis- orof Saylor Lane Convales- Hospital in east Sarra- to. 'The difference here at this type of shortage can :t human lives." At Somerset, Dunne moved at a whirlwind pace from the moment she arrived at work on Friday morning. She had no time for casual oonversa- tions with co-workers, leisurel} coffee break or scanning the newspaper. "I have people de- pending on me," she said mat- ter-of-factly. She helped get residents out of bed and dressed. She fed, weighed and showered pa- tients. She changed linens, combed hair and brushed teeth. Lifted people into wheel- chairs and helped residents to the bathroom. Gently turned the bodies of patients who were confined to their beds. Wearing a back -support belt around her waist, Dunne an- swered constant requests for assistance as she moved torna- do-like through the hallways, greeting residents by name. "I guess it would be easier to work at a Jack in the Boa," ishe shrugged, adjusting the foot rests on one woman's wheelchair. "But I'd rather be giving love to people. These people need someone to love them." The industry could use a lot more people like Dunne, said Betsy Hite of the California Association of Health Facili- ties. Hite said nursing homes in the state would have to recruit, train and hire about 30,000 new certified nurse assistants by the first of the year to meet staffing needs. While nursing homes and CNAs are often criticized for poor care, neglect and evert abuse of residents, a larger is- sue has been all but ignored, Hite said. Nursing homes, which are tending to sicker and older patients than ever before, are chronically under -funded by both the state and federal government, she said. — California nursing homes receive $90 per patient per day to care for residents who quali- fy for Medi -Cal, the state's in. surance program for the poor. The actual cost of caring for those patients is about $120 per day, said Hite. Medicare, the federal health insurance plan for the elderly, also "sig -underpays nursing . homes, she said. The result has been a rash of bankruptcies. Six of Sacra- mento's 36 nursing homes, and 109 facilities statewide, have filed for Chapter 11 protection in recent months, according to the association's figures. "So when people ask us why we don't pay CNA& more, my answer a, `Where is the money going to come from?".said Hite. Certified nurse assistants - earn an average of $7 an hour in California, and even veterans rarely earn more than $9 per hour. The turnover rate among CNA9 was a stunning 93 percent in 1997, figures show. _ _ "Why would someone do this job when they can scoop ice cream and make the same amount of money?" asked Friedman of Saylor Lane. "At least when you serve someone ice cream, they go home with a big smile on their face." Nursing homes in Sacramen- to and elsewhere are going to unprecedented lengths to lure and keep CNAs. Some are of- fering "signing bonuses" to new recruits, and trips to Hawaii for aides who retrain on the job for six months or more. "We offer $25 in cash just to get someone through the door to fill out an application," said Friedman. 'Before, you could afford to be picky." Some nursing homes have had to hire registered nurses, at $15 per hour, to fill CNA slots in emergencies. A few homes around the state have been forced to shutdown wings because they were unable to staff them, said Hite. "We have nine vacancies right now, so we have had to stop admitting patients," said Linda Michael, nursing direc- tor at Folsom Convalescent Hospital. Hunt said Somerset, a fami- ly-owned facility with 99 beds where nearly everyone's care is subsidized by the govern - Why would someone do this job When they can scoop Ice cream and make the same amount of money. At least when you serve someone icg cream, they go-. home with a big smile on their face. 91 Debby Friedman, adminisWor of Saylor Lane Convalescani Hospital went, cannot afford to boost wages for certified nurse assis- tants because the home's profit margin is "little to none." "My income is directly con- trolled by the state and federal governments, my costs are go- ing up and I have no way to keep up with the competition for employment," he said. "Warehouses and trucking firms are paying people $11 an hour to move boxes around, ,and we're asking our CNAs to accept $7 an hour to do this very sensitive work." Gov. Gray Davis recently vetoed as too expensive a bill that would have boosted reim- bursement rates for Medi -Cal patients in nursing homes. A] though Congress last week in- creased payments to nursing homes for some Medicare pa- tients, care for most will still be underfunded, said Hite. The California Association of Health Facilities has launched a public education campaign designed to rally Congress and the state Legisla- ture to increase funding. The association is pushing for a $2 "living -wage increase" for certi- fied nurse assistants. Dunne said that would make life a lot easier -for CNAs. - "It's very mwarding work," she said. 'But the cost of living keeps going up, and we get nothing for that. It would be nice to be able to pay your bills and buy an outfit once in a while without_having to work overtime to pay for it. That would be really nice." The Sacramento Bee • _ rION-i r S&NWV,, Norembwm low Nursing home woes Bankruptcies reveal a troubled system In Sacramento County, 19 percent of the beds in nursing homes are owned by com- panies that have filed for bankruptcy. In Amador County, the bankruptcies involve 80 percent of the beds. Humboldt, 64 percent. Yuba and Plumas counties, with one skilled nursing home apiece, 100 percent. Much of the financial deterioration is attributable to the bankruptcies of some large chains, yet the trend is worrisome. Financially unhealthy homes don't translate into healthier residents, particularly senior citizens who are sometimes too frail, too sick, too alone to demand and receive appropriate care. Nursing home reform was among the issues that eluded Gov. Gray Davis and the - Legislature this past year. Lawmakers started with a - get -tough strategy to punish unscrupulous operators rather than pro- vide meaningful carrots to —_- encourage improved quality. After _ working with the nursing home industry, the end result was a more bal- chains with names such as Vencor, Frontier, Newcare and Iatros. It is difficult to conclude how much these bankruptcies are attributable to inadequate government payments or how much is due to poor management. Regardless, bankruptcies raise concern about the quality of care. This is no easy problem to solve. Unlike other safety nets such as Medicare and Social Security, government -subsidized nursing home can is only'for those who are poor _ — and who intentionally become poor by shifting assets to others. e In California, most nursing home residents are the finan- cial responsibility of the govern- ment, which pays the homes about $91 a day per resident. In turn, the homes pay -nurs- ing aides about $7 an. ha=. • _ No wonder the caliber of these aides can be so poor that California nursing home residents complain their care at twice the nation- Q- .� t-. al average. No wonder many - anoed bill, but it came with inevitable homes are is financral trouble. additional ousts to increase staffing and .Nm dW ID The On To improve care, should lawmakers improve training. The governor's stait unfortu- nately, had little direction as the reform effort evolved. Engaging late into the legislative process, Davis balked at the out of paying for staffing increases beyond what was already in _ the budget and vetoed the bill. Meanwhile, the nursing home bankruptcies mount. Sun Healthcare Group, with 369 facili- ties and 40,000 patients nationwide, filed for bankruptcy last month, joining other troubled focus on increasing the number of aides or increasing their pay? Meaningful improve- ments will cost the state tens of millions of dol- lars. This poses another inevitable tradeoff — is nursing home reform a higher priority than other pressing needs? It is hard to imagine a more appropriate time for California, with its healthy economy atrd- aging population, to finally face up to the sorry _state of its nursing homes. The status quo is not acceptable. And it is getting worse. Fresno Bee Editorial - — Friday, November 12, 1999 -NURSING HOME WOES: BANKRUPTCIES REVEAL A TROUBLED STATEWIDE SYSTEM In Fresno County, 5.3% of the beds in nursing homes are owned by companies that have filed for bankruptcy. In Kern County, the figure is 9.8%. Those aren't bad numbers by comparison to other parts of the state, but Valley residents should be aware that the problem is growing. In Sacramento County, the bankruptcies involve 19% of the beds. In Amador County. 80%. In Humboldt, 64%. In Yuba and Plumas counties, with one skilled nursing home apiece, it's 100°/x. Much of the financial deterioration is attributable to the bankruptcies of some large chains, vet the trend is worrisome. Financially unhealthy homes don't translate into healthier residents, particularly senior citizens who are sometimes too frail, too sick, too alone to demand and receive the appropriate care. Nursing home reform was among the issues that eluded Gov. Gray Davis and the Legislature this past year. Lawmakers started with a get -tough strategy to punish unscrupulous operators rather than provide meaningful carrots to encourage improved quality. After working with the nursing home industry, the end result was a more balanced bill, but it came with inevitable additional costs to increase staffing and improve training. The governor's staff, unfortunately, had little direction as the reform effort evolved. Engaging late into the legislative process, Davis balked at the cost of paying for staffing increases beyond what was already in the budget wd vetoed the bill. Meanwhile the nursing home bankruptcies mount. Sun Healthcare Group, with 369 facilities and 40,000 patients nationwide, filed for bankruptcy last month, joining other troubled chains with names like Vencor, Frontier, Newcare and latros. It is difficult to conclude how much these bankruptcies are attributable to inadequate government payments or how much is due to poor management. Regardless, bankruptcies raise concern about the quality of care. This is no easy problem. Unlike other safety nets such as Medicare and Social Security, government -subsidized nursing home care is only for the poor - and those who intentionally become poor by shifting assets to others. To improve care, should lawmakers focus on increasing the number of aides or increasing their pay? Meaningful improvements will cost the state tens of millions of dollars. This poses another inevitable trade-off - is nursing home reform a higher priority than other pressing needs? It is hard to imagine a more appropriate time for California, with its healthy economy and aging population, to finally face up to the song state of its nursing homes. The status quo is not acceptable. And it is getting worse. L Eunft. CA Tkfwlf (Gr. Satf u L 24,200) -- _ •. OCT � A Zymes -Standard editorial oS a . ursing home woes are troubling e bankruptcy of the corporate owner of four of Humboldt County's nurs homes Is worrisome, despite Sun Healthcare Group's assurances that it will make no difference to the quality of cane Its patients receive. Relatives of people in the homes are worried, especially as Sun Healthcare has reportedly dis- missed some 10.000 of its employees nationwide. The chain, one of the largest of its kind. says it's not alone in its difficulties. Changes in the way federal Medicare payments are made. company officialssay. have reduced income for all nursing homes. One might question whether this hilly accounts for the loss of 81.4 billion in nine months. The chain had been expanding very rapidlyand may have overextended Itself. It also is involved in a welter of lawsuits. 'Iho-bankruptcy of any firm is bad news, but if this were a chain of hardware stores or tanning salons it would mostly concern its stockholders and employees. Nurstng homes are a matter of real public interest -- anyone could end up in one. It would be naive to pretend that health care was ever anything but a profit-making enterprise, but the extent of its present is unprecedented. And _ with billions to be made (or lost) the growth of nation- wide chains is hardly surprising. The economic trend has long been toward concentration in every field. with formerly independent enterprises swallowed up or put out of business by ever -larger competitors. Tbat's not necessarily undesirable. Big chains succeed because they can control costs and operate more effi- ciently than smaller concerns. The nursing home Industry" had more than Its sbart'of scandal in the ' past, and a national corporation may be abk�'fo enforce _ - higher standards. Stfll, If something does go wrong with a large organizes- . tion, all its units are affected, whether they themselves were well-managed or not. We hope that the new owner - - of our four local homes will be able to resolve its f nan- cial difficulties, and that Chet clients win not m ffer from the parent corporation's money tra*es. ■ The Record NuRsma HomEs Crisis on the horizon? Elderly care in S.J. County facing lean timrifN fry Bruce SWnM - - Reoma staff wase: 1 Hndim trumpeting bank.ruptq Woes ft some ma* nutsing-beme companies, have ted Many of the Ceti- Mthat for � alling elftliy because B;ut mconaumer advocates a ewt%g- ome industry Itself said that thus far; ser. 'Ilse fwvs s utYrexuain stable. i4 awdler manly "We have had a Lew iedlides in the state int of dthe�CaB6otais A�ssodaticn of l� unities, a trade e�en 4) of the 1,400 pu enonprofit std fpr oft ordM homes In the aorta dose In the DW coupie, ~r -our z0ore monSts in nasi Northern CallfoMIN6 high Doi Your sees, Its d going to iaten- v, because of the bbw-Lome crisis we're chose in the nursing-home i WkWy my I undwt a ding by Medl-Cal, the states dth pmg�ram Lor the poor, and`tbatp donee creta have been potmdiag nes, which bane been to I keep the nee" higher salaries. staff beiaetx day omit Mwm*w pndkb tSat smieas ehae is a si®oi8caot.hrQea�e_m etatei ftmd'icog ioc nursing boom slat o wide wodt U `- abk m attract on admaoed AM nurdug staffm nmWbyoW Year toMANAM ftwe who gait Olid t0 meet Dew state atamng Vdne aut+eat average pay of shorn $7 per has for oerdfied nursing amts now. itg bard to dbaedDatandoisme� jwMinjj to take tor wages � a � be�m� d by a bus - In short, nuastog boom an staring at a teal aisK he said if its not hese, then itW atotad the oor- De6" y WWII- Ms Mb Outaft Pion for San logn Qunt . o A and canmu ty SWAM", said'th" wi i;MW news of smodug-home bankn4)4rr .msm the ombudsman prop= did getst ` tresh. of� ftm 4* d aabot porranda a mdodown five nursing homes "What wen been dWm is cafaniong POD* down beemrse d wbat they read in tie " the add.: many cwbq and some weR-nm AaasM Koreas In the am that fed d=wt do threaten the of camPhillips makIL "We have assn thequ ty of service dew - :M m ovens," she said, "btrt I think it% because of wanting to make profile." am only _ opTLe mosan t itmne tesidentt or laoaily aamba�a batt oleo ez�ge�y visiu the "If it's not here, then it's ---amara l-Owcorner." I Qaty Mecombo rs calitoemla Association of Health Faciltttes. I* can't know whether thews a reap casts, but uo are concerned Until you sw"mebody"s numbers ... jes hand to make a calla — PaWak Lub% Sacramento lobbyist for the American Assodabon of Refired Persona 31 facilities In San- Joaquin County (Only four are nonprofhL) The recent rash of care problems atone when a major company bought several nws- bg homes In the area, which resulted in less attention to care and an -immediate Zscab- tion of problems, Phillips believes. Ann Areida-Hintz, services coordinator for Indis senior-citizens-&xoter, said It was -bard for her to fed sympathetic for nursing homes "Tbe majority of people I see rant eves af%td nursing homes," she sald. h don't think nursing homes provide the quality of care they should Tbey hire minimum -mage employees so the turnover rates are high. I think administrators and owners do well. TbeyW making w a T nursing homfit e corporations have filed for Chapter 11 bank upxy within the past sic weeks, bots dig Cuts in government reiTwo weeks ago, the Albuquerque -based Sum Healthcare Group Inc., parent company of four nursing homes In San Joaquin County, filed for bankruptcy protection dur- Wa financial neo ayne Grigsby, administrator of one of those musing homes in Stoclaon, attributed the companyrs financial problems to deep ons in the Medicare reimbursement plans and what he called underfunded Medicaid programs (Mecil-Cal in Cali mia) at the state level. In mid-September, Vencor Inc., one of the nations largest nursing bonne chafoa = with facilities in 46 states — filed for federal bankruptcy protection. lite Louisville -based chain, which operates 300 nursing homes and 38 hosphaia, includ- ing a nursing home In Stockton, cited rising debts -due to declining bled(cm fern. Both companies declared that servloes wouldi t be affected by their reorganization CillffOflliB r>ll t 460 Although cuts in government reimburse- ments have hurt all musing homes, the for- profit sector is taking the heaviest hit, said Catherine Borg, associate director of public Policy for Califorula Association of Homes and Servkes for the A&& which represents nonprofit facWties Unto nursing homes rose960s,nursingpaynients bower moody were nonprofit emtWer. she saki. Vfth ;overnment payments, the for -prod[ sector towed, developing beavlly into skdped- lu sing services, where the most government n'OOuur facilitiwas es aur being hit just as bard as me fdr-profits, bid becautse our members end to be more divesdW (into hxSeM. Wt- and assisted -living servicxsar forced Into ry . ocyubleeaast inch," she sold. According the the California Association of %I& Facilities, heady two-thirds of masing ,me Payments come frog Medl-Cala the wtA health -rote program. U. Medi-Calti gat -rate pay- nients . nm about 590a day for each messing -Mune rea[destt while a nursing home typirany needs at least SIOD per person just to cover espenses, Macomber said. _ That rate iron Med[-Cal puts California 46th in the nation in tame of apmding on bug-te:m cur, OWWW been at the bottom for a number of years, and we keep w The industry makes thatcg► pu* hon iia� coltish p apoaaotmu for about a quarter of mbeir to � homes,bla o "You have to charge them atbsomdady more," be said. "It may runt from $140 to $150 a day for prtvate pay." Vkdm of vdbo There seemed to be some rellef an the way In January vAth legislation by Assemblyman Kevin Shelleyt > r San Irrancis that called through both sides of the state That bill allowed for takeover of facilities and ' increased fuses for tare vbh- ' dans, but also had nwney to boost stalbrig and Warks tar ' nursing bona. That was vetoed, though, by Gov Gray DrAs. who in his veto oeseage aorninended the legisla- tion for [natty well-intatded fea- tures, but placed a ainnificant burden on the awe general hod. lie pointed outdud the 111"1999 budget already 8lod saW $72 bn In to Increase wages by S percent and Increase the un[nlmum staff-to- paesti from 2-9 to &2 Wu- a dry per patient. The measure also would have changed the way ninsing homes aur paW. chant from a Ant rate to one based on the nursing are needed by each teddem "Wte were pretty shodod by the veto actually" Bald Patsicit luby, le®ielative representative in Sacra mmm for the American .Association of Retired Persona. 'hio is a bM that would have helped neade In the beds by With the MdIDL Il sd hhov�ep blain, and became of fila v %% !tti not be On the other hand, he doesdt know whether the hdustrys pse- d[ction of ruioadon is solidly based. , -'We can't lmow whether there[ a teal crisis, but we ate maarn said. "Until you see somebody's numbers — and Obviously, were not privy to their balance sheets — it's hard to make a call on this [state." These [sit an soma problem now in the state because of musing -home dooves, Uft S" thwsglu Buse may be In the future in null areas. where nursing boom tend to be few ,Me legislation was pattiy Shellao Person eapaiatae of nyhug w dad a sultabfe nursing bonze for his mother and partly because of federal and state studks [tndicat- jing serioris.sare problems in the repo d effedaGeneral Aamunting ol5oe food that one of every titre nursing Mmes in Calltornia had se riocn or noten- dally life-drr=UninB case paob- Shetley's o®oe said the sae�- blyman will make another nm the the measure ap that win Bob Matra, an bmnanm add- sor at Hutchins street Square In LML said his family her been dea{lsrg with nursing homes seomtly became of an aunt. Sets heard neves and rmn- blings about M anclal trouble in the IndustrA but that hash t raised any adrsoedirtary con - corns, tough he wants to know that his aunt is well taken cars of, he sold. "Ib rue, that doeaft mean aanyy�tln!sn_gg,," Maus said. '"They either have bad ortpgemert or noL RESOLUTION NO. 2000-51 A RESOLUTION OF THE LODI CITY COUNCIL IN SUPPORT OF INCREASED LEVEL OF MEDI-CAL FUNDING FOR LONG-TERM CARE: FACILITIES --------------------------------------------------------------------------- --------------------------------------------------------------------------- WHEREAS, one-third of all Californians will spend at least some time in a nursing home or other long-term care facility; and WHEREAS, the demand for high-quality, long-term healthcare services is expected to balloon as the population ages; and WHEREAS, facility caregivers are dedicated and loving professionals who provide a vitally important service; and WHEREAS, more than 250,000 Californians receive care from 120,000 caregivers in a nursing facility each year, and thousands more in facilities for people with developmental disabilities and mental illness; and WHEREAS, the statewide average wage for a caregiver is $7.50 per hour; and WHEREAS, California nursing homes cannot recruit, train and retain the tens of thousands of new caregivers required to meet staffing needs; and WHEREAS, nearly two-thirds of all nursing facility residents rely on the government to pay for their care; and WHEREAS, nearly 100 percent of the care for individuals in facilities serving the developmentally disabled are dependent upon Medi -Cal; and WHEREAS, California's percentage of Medi -Cal spending on long-term care ranks 461h in the nation; and WHEREAS, it is in the public's best interest to fund nursing homes at a level sufficient to ensure quality resident care and a stabilized workforce. NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Lodi, that we urge the California Legislature and the Davis Administration to invest in the future of California's senior and disabled populations by increasing the level of Medi -Cat funding for long-term care facilities to ensure quality resident care through the development of a well-trained, appreciated and stable workforce. Dated: April 5, 2000 --------------------------------------------------------------------------- --------------------------------------------------------------------------- I hereby certify that Resolution No. 2000-51 was passed and adopted by the City Council of the City of Lodi in a regular meeting held April 5, 2000 by the following vote: AYES: COUNCIL MEMBERS — Hitchcock, Land, Nakanishi, Rennino and Mann (Mayor) NOES: COUNCIL MEMBERS — None ABSENT: COUNCIL MEMBERS — None ABSTAIN: COUNCIL MEMBERS —No e JAC UELiNE L. AYLO Intenjn City Ger 2000-51