CARR Comments on Governor's 2015-16 Budget Proposal for CCL

Improvements to Community Care Licensing’s inspections of licensed care facilities are imperative.  However, to solely budget for an increase in inspection frequency may prove to be an overly-narrow approach to addressing the agency’s shortcomings.  Consumer Advocates for RCFE Reform (CARR) submits that the Governor’s current budget proposal does not adequately invest in Community Care Licensing’s (CCL) technical infrastructure, and, therefore, offers little to shield CCL and residents of licensed care facilities from the effects of future state budget crises.

Comparisons and Projections:

According to the 2001 LPA Work Study[1] cited by CCL in its 2015 budget, CCL was then responsible for 80,000 facilities with a combined bed capacity of 1.2 million, and employed 480 analysts.  Fifteen years later, CCL is responsible for 66,000 facilities with a bed capacity of 1.3 million and employs 460 analysts.  According to these figures, analysts today may have fewer facilities in their individual caseload (Figure 1).  

Figure 1: Comparison of CCL Facility Responsibilities 2001 vs. 2015

Source:  Copyright 2016. Consumer Advocates for RCFE Reform (CARR)  All Rights Reserved. 

In 2001, the number of exceptions and waivers processed by CCL far superseded the numbers reported today (Figure 2).  This discrepancy cannot be entirely attributed to the discontinuation of issuing Dementia Waivers.[2] 

 

Figure 2: Comparison of CCL Exceptions & Waiver Responsibilities for RCFEs 2001 vs. 2015

Source:  Copyright 2016. Consumer Advocates for RCFE Reform (CARR)  All Rights Reserved. 

*Data for 2001 from LPA Work Study, Table 5b.  Data for 2012-2014 provided by CCL, RCFE Evolution Stakeholder meeting February 18, 2015.

Complaints over the last 15 years have only reportedly increased by a third, rising from 10,149 in 2001 to 14,000 today (Barnes, 2001).  

While workload, especially the management of incoming complaints, appears to be what is limiting CCL’s success, it cannot be ignored that there has also been an expansion in analysts’ available working hours since 2001 given various programmatic changes (i.e. the introduction of laptops in the field, online training versus destination training, no annual inspections, centralized applications units, etc.), but CCL has been unable to effectively reallocate its resources to benefit the health and safety of the residents it serves.

Evidenced-based Practices:

CARR submits that rather than lack of personnel, it is the ongoing absence of data systems to direct and support efficient management and program practices that undermine CCL’s productivity.  Without the ability to examine their practices through aggregate data, CCL will never be nimble or informed enough to navigate the increasing oversight and enforcement demands of the agency.

The Governor’s current budget proposal commits to increasing CCL staffing levels through 2019, with the hope that this investment will improve oversight and enforcement practices.  However, there is no evidence to support this presumption; CCL has conducted no study, nor collected any data suggesting additional personnel will improve CCL’s performance.  Even the 2001 LPA Work Study did not look at work performance, so to recreate it to inform future budgets and agency staffing may prove limited.  

This is not to say that CCL would not benefit from additional analysts.   Extrapolation of the work study figures suggests that the current workload may exceed the inventory of available LPAs.  However, CCL has no data to support that hiring more personnel will produce better outcomes than investing in data and management systems to streamline processes, improve communication, and eliminate the legacy manual tasks still performed by the agency.  Without data, CCL is destined to remain an outdated and antiquated agency   In CARR’s view, data could significantly assist CCL in improving its programs and oversight in the following areas:

  • The use of KITs for facility inspections.  These evaluation tools, though used in the field currently, have never been validated for accuracy or reliability;
  • The proposal for hiring 1.5 nurses to address the entire state’s pressing need for medical oversight of all licensed care facilities – Is 1.5 nurses enough? Too few? If too few, how many nurses would be needed to address the complexities of medical issues in non-medical care settings?;
  • The unknown, but insufficient, number of SSI beds in RCFEs.  It would be useful for CCL to understand how big the SSI problem actually is, where the concentration of SSI beds are, etc., so it could craft thoughtful solutions to this persistent and growing issue.  Without data to quantify the scope of the problem, CCL will continue to be unable to craft a responsive legislative solution ;
  • Rather than using keyword searches to produce data necessary for policy research and program accountability, CCL should instead be employing comprehensive information management systems to produce aggregate data and other relevant metrics.

Recommendations:

CARR recognizes there are limits to how fast a state agency can pivot, but the slow pace underscores the need to invest today in 21st century technologies and systems that will streamline processes and provide data analysis.  CCL must have a 21st century data-driven approach to improve its responsiveness to the many serious challenges in regulation and enforcement it faces  if it intends to (1) remain relevant in 2019 and beyond, (2)  triage during unforeseen crises and (3)  proactively respond to oversight and enforcement challenges necessary to protect resident health and safety.

In the name of the most vulnerable among us, CARR requests the Committee intensify its investigation of CCL’s needs and establish a long-term budget proposal that more accurately reflects CCL’s need for evidence-based practices.

Read the Agenda for the Assembly Budget Subcommittee No.1 on Health and Human Services scheduled for 3.25.15 click here.


[1] Barnes, C & Sutherland S (2001).  Workload study of licensing program analysts: California Department of Social Services Community Care Licensing Division. Institute for Social Research, California State University Sacramento.

[2] Dementia care is now a standard care provision in Title 22 regulations.

Data & Research