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In California, Some Efforts to Toughen Oversight of Assisted Living Falter

Cost concerns may derail efforts by lawmakers and advocates to require more frequent inspections and a swifter response to allegations of abuse and neglect.

California legislators and activists say attempts to reform the state's troubled assisted living industry are being obstructed — and they are placing much of the blame on the administration of Democratic Gov. Jerry Brown.

Early this year lawmakers began crafting more than a dozen bills intended to strengthen California's oversight of the state's roughly 7,700 assisted living facilities, which provide housing and day-to-day help to seniors and people with disabilities. California has one of the loosest regulatory regimes in the nation, requiring inspections of facilities only once every five years and meting out tiny fines for abuse or neglect, even for fatalities.

The system's failings — notably the bungled closure of a facility last year that jeopardized the lives of 19 seniors — have been the subject of investigations by news organizations in California and nationally, including the San Diego Union-Tribune, ProPublica, and Frontline.

But as the legislative session draws to a close, some of the toughest reform measures have failed, while others are undergoing substantial — and controversial — revisions. Two proposals to step up inspections have died, as has a bill requiring the state to post more information about facilities online for consumers.

So far Brown has signed two bills: a modest measure mandating that facilities carry liability insurance and a low-cost proposal allowing the state to halt admissions to facilities that don't correct serious violations of the law or fail to pay fines. A state senate analysis of the admissions bill cited ProPublica and Frontline's reporting on Joan Boice, an 82-year-old woman who developed pressure ulcers and died after a brief stay in an Auburn, Calif. facility.

Assemblywoman Nancy Skinner, D-Berkeley, blamed the Brown administration's budgetary concerns for the demise of her bill mandating that state inspectors respond to complaints of elder abuse at assisted living facilities within 24 hours.

"The governor has made it very, very clear that he doesn't really want to incur additional costs" to the state budget, she said. Skinner called the current system, in which inspectors have 10 days to respond to abuse allegations, a "travesty."

The state Department of Finance, which acts as the governor's fiscal advisor, opposed the bill while it was in committee, said Brown spokesman Jim Evans, adding that the Governor's office would not discuss pending legislation.

The Department of Finance also opposed legislation requiring the state to inspect assisted living facilities on an annual basis, stating in a written analysis that it would cost California $20 million to $30 million yearly. The bill failed.

Annual inspections are "urgently needed as part of the oversight process," said Assemblyman Ian Calderon, D-Whittier, the bill's author, in a statement. "I will continue to pursue this critical issue."

The Calderon bill was perhaps overly ambitious — it would have instituted more frequent inspections in a broad spectrum of facilities for children as well as the elderly — which bumped up the costs.

But the Brown administration has also opposed a tightly focused initiative that would phase in annual inspections at assisted living facilities by 2018 — the Department of Finance puts the price tag at $3.4 million per year when fully implemented. That bill is still under consideration.

Pat McGinnis, executive director of California Advocates for Nursing Home Reform, said the state's cost concerns were overblown. Some expenses could be offset by upping licensing fees on facilities and levying larger fines on those that break the law, she said, ideas built into a pair of pending bills.

McGinnis, whose organization spearheaded the legislative effort, accused the Department of Social Services, which regulates assisted living in California, of "working behind the scenes to undermine the bills we're trying to pass."

"I don't think the department is interested in real reform," she added.

The Department of Social Services insists the allegations are unfounded. "Our role is to provide technical assistance to the legislature in developing legislation," spokesman Michael Weston said. "Other than that, we don't comment on pending legislation."

With the end of the legislative cycle approaching on August 31, lawmakers are busy reshaping the remaining bills — mostly by weakening them, McGinnis complained. "Some of these bills are being watered down to the point where they're meaningless," she said.

Not everyone is so pessimistic. Sally Michael, president of the California Assisted Living Association, a trade group representing the larger facilities, said she was "mostly pleased" with the bills emerging from the statehouse.

In recent years the group has grown increasingly critical of the state's lax regulatory structure and now supports bills that would increase the frequency of inspections, raise training requirements for assisted living employees, and boost facility licensing fees. "If we don't get annual inspections this year, then we'll be back next year to try again," Michael said.

An organization representing smaller operators, 6 Beds Inc., has spoken out against much of the legislation.

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