CARR Contributes to CHCF Think Tank

California Healthline recently asked CARR and other experts in the field "How should California regulate its growing RCFE industry?".  Provided here is CARR's submission.  You can read all of the submissions by visiting http://www.californiahealthline.org/think-tank/2014/how-should-california-regulate-growing-changing-assisted-living-industry.

The Need for Data-Driven Practices

The primary focus surrounding California’s RCFE industry is policy reform.  In CARR’s view, modification of regulatory language may do little to affect the performance of facilities without accompanying improvements to the oversight and enforcement practices of California’s Department of Social Services (DSS).  CARR’s five years spent reviewing the public documents strongly suggests a department significantly weakened by the absence of evidence-based practices. 

DSS does not make use of facility compliance data or LPA performance data to inform their policies or practices.  CARR’s analysis of this data suggests this is a major shortcoming that impacts departmental operations and jeopardizes safety within RCFEs.  The resultant patterns, frequencies and trends reveal current compliance and accountability issues have just as much to do with outdated regulations as does the organizational culture of DSS.  This raises questions about the Department’s effectiveness as a regulator. Samples include:

  • How does one LPA’s number of unfounded complaints reach 78% when the average of others rests closer to 30%?  This data proved to be predictive of the San Diego Regional Office’s bribery scandal.  Without this data, these nefarious practices went undetected by the Program Manager. 
  • How do some LPAs repeatedly cite unstageable decubitus ulcers as Incidental Medical Services while others cite them as a Personal Rights violation resulting in serious injury which triggers a $150 penalty?  This lack of consistency is problematic as it prohibits the state from issuing a penalty for a 2nd violation within a 12-month period and further restricts the Department’s ability to proceed with license suspension or revocation for poor performing facilities.
  • Why does DSS not modify educational requirements for LPAs to include a background in social services or healthcare when 73% of facilities[1] are authorized to care for a medically-needy resident?  How can LPAs oversee medical conditions without medical backgrounds?

These illustrate the tip of the iceberg, but highlight the deleterious effects of DSS operating blindly.  It was confirmed during the Senate hearings, that DSS operates with a non-integrated IT system that is not designed to track individual pieces of data.  As long as data is not the driving force behind policy and practice, policy reforms will continue to be based on anecdotal evidence, resources will be mis-allocated and the discretionary and random application of state law will persist.  If California is to elevate and sustain quality in residential care, evidence-based practices must become an integral component of DDS operations. 


[1] Within the San Diego & Imperial Counties Region