Approximately one in eight Californians who died of COVID lived in a nursing home.

They are one of the weakest residents in the state: Californians entrust nearly 9,400 mothers, fathers, grandparents, aunts and uncles to nursing homes. Another 56,275 confirmed COVID cases among nursing home residents are not fatal.

“The number of COVID infections and deaths in California’s professional nursing facilities is truly shocking,” Jim Wood, a Democrat who chairs the State Assembly’s Health Committee, said at a nursing home hearing he convened recently. “I hope we can do better.”

The unrelenting spread of COVID-19 has exposed deep-rooted and systemic problems in the quality or lack of care in nursing homes across the country. In the most populous state of the United States, the industry’s track record during the pandemic has prompted leaders to fundamentally rethink how it pays and monitors them.

The government of Governor Gavin Newsom is drafting a proposal to link state funding more directly to performance: Of the approximately 1,200 skilled nursing facilities in the state, those that meet the new quality standards will be better than none. Compliant institutions receive a larger share of state funding.

However, how Golden State will measure quality care and allocate the approximately US$5.45 billion that nursing homes receive each year is far from certain — and is expected to trigger one of the biggest healthcare struggles in 2022. When the legislature debated these details as part of state budget negotiations, the nursing home industry vowed to oppose any proposal linking Medicaid payments to quality indicators such as staffing levels, salaries, and turnover.

In fact, the industry plans to argue that it needs more money to provide better results—and it has tremendous power in the Capitol.

According to KHN’s analysis of campaign financial records, in the past ten years, it has spent at least $10 million to influence lawmakers and provided Newsom and at least 105 current members of the legislature one or more times. Donate.

But advocates and family members of patients who lost their loved ones in nursing facilities during the pandemic are launching a counterattack to convince lawmakers that it is time to reform the system.

“People have complained about a lot of problems for a long time,” said Charlene Harrington, emeritus professor of social and behavioral sciences at the University of California, San Francisco, and nursing home expert. “This is an opportunity to correct these problems.”

According to the latest data from the Centers for Disease Control and Prevention, at least 140,790 COVID deaths have been reported in nursing homes in the United States. The elderly are at higher risk of dying from COVID, and the coronavirus is more likely to spread in institutional settings such as nursing homes and assisted living facilities.

This is one of the reasons why Craig Cornett, CEO of the California Association of Health Facilities, believes it is unfair to attribute the high COVID infection rate to nursing homes, especially in the early stages of the pandemic. He said that not only their residents are naturally at higher risk than other members of the public, but these facilities are also forced to accept hospitals that have not been tested for the virus to transport patients. They cannot obtain sufficient supply of personal protective equipment. When staff are infected with COVID in the community Then when they put it into work, they suffered.

Konet also pointed out that federal statistics show that California has one of the lowest COVID mortality rates in nursing homes in the country and one of the highest employee vaccination rates.

However, multiple studies in California and elsewhere have found that nursing homes with fewer nursing staff have significantly higher rates of COVID infection and mortality. This devastating result is supporting the two-year-old argument put forward by patient advocates that nursing homes must hire more workers.

“If the nursing homes were adequately staffed, some of the problems we saw in the pandemic could have been avoided,” said Harrington, a co-author of the California Medical Foundation in December 2020. The study showed earlier that year At that time, the rate of COVID cases with lower staffing levels in nursing homes was twice that of cases with higher staffing levels. (California Healthline is an independent editorial publication of the foundation.)

Some legislators and patient advocates believe that the best way to improve care is to increase staffing, and the best way to achieve this goal is to change the complex formula that determines the daily cost of nursing homes, which is paid by Medicaid, which is covered by the government insurance plan Approximately two-thirds of residents of nursing homes.

Currently, Medicaid reimburses part of the nursing home’s expenditure on staff, administration and other expenses, and the staff costs paid to them are higher than the administrative costs. Facilities can receive bonuses for meeting quality standards—although bonuses are limited and criticized for not improving the performance of the facilities that need it most.

The California Department of Health Care Services is responsible for managing the state’s Medi-Cal Medi-Cal program. The Department is drafting a plan that will eliminate bonus payments and incorporate quality measures into the Medi-Cal payment rate that nursing homes receive each day middle. The department is considering a variety of methods to measure quality. Spokesperson Anthony Cava said in a statement: Nursing homes that provide more employee education and training can get a higher daily allowance, and those with more employees and less employee turnover The same is true of the nursing homes.

For the nursing home industry, this is not the beginning. It does not consider staffing to be an appropriate measure of residents’ performance. Conversely, Cornett’s lobbying group represents more than 800 nursing homes, and he said that facilities should be graded based on the number of patients’ falls and infections and their ability to perform daily activities.

“We need more employees and want to pay our employees,” Connet said. “But we need the state to change the system so that we can get more funding for staffing. And this will require more funding.”

The nursing home warned that excessive attention to staffing would neglect other critical costs of operating the facility safely. They said that even under the current reimbursement system, the facilities are barely maintained.

“Not all costs in the facility are borne by employees. Like other healthcare providers, professional nursing organizations have various costs, including medical supplies, consulting, real estate, taxes, administrative services, management fees, etc.,” Mark Johnson Said, an attorney for Brius Healthcare, one of California’s largest care chains.

It is questionable whether legislators will sympathize with the industry’s request for more funding. They are increasingly demanding transparency in how skilled nursing organizations make money and spend money. Like hospitals and other health care providers, nursing facilities have received billions of dollars in federal COVID relief funds to help offset the cost of hiring temporary workers, testing, and protective equipment. Legislators have not forgotten that this $12 billion industry is attracting more and more private investors to buy ownership shares in its facilities.

“This tells me that there is money there, and there is profit,” said Wood, who is also a member of the budget subcommittee, which will review the government’s proposals. “If they don’t have a chance to get a considerable return, private equity will not enter the facility.”

The state’s approximately 400,000 nursing home residents face many risks, and the industry is Sacramento’s large and powerful force.

According to records submitted to the California Secretary of State, the California Health Facility Association provided more than US$2 million in donations and spent US$5.67 million in the past 10 years from January 1, 2011 to September 30, 2021. Lobbying legislators. office. Its chief executive, Cornett, is a veteran of the State Capitol and served as the highest budget assistant to four former Speakers of the House and two Senate leaders.

During this period, the owners and operators of the 50 largest individual and corporate nursing homes in California directly provided a total of $2.6 million in funding to legislators, Republican and Democratic state parties, and voting measures. This number may be underestimated because it is difficult to determine that everyone owns the nursing home or chain store. Facilities are usually partly owned by real estate investors, venture capital companies, and other business interests not included in government records.

Konet played down the influence of his industry and said that trial lawyers are financially strong participants and are funding patient advocates, and these groups dispute the allegation.

But a 2018 report by California auditors found that the three major private operators—Brius Healthcare, Plum Healthcare Group, and Longwood Management Corp.—are very profitable. By 2015, the most recent year analyzed by state auditors, their net income in 2006 was US$10 million, which had increased to between US$35 million and US$54 million.

Patience advocates say these profits negate the argument that the industry needs more taxpayer funding.

“In a way, the state is confused by the idea that the money they are paying now is not enough to do the work we ask them to do,” said Tony Chicotel, an attorney for the California Nursing Advocate. Family reform. “The most important thing is that it can be profitable.