Impact of Changes to California Nursing Home Oversight Policy on Quality of Care 2000-08

In the beginning of the decade changes were made to California nursing home oversight policy that had unintended negative consequences on quality of care, as measured by complaints, state citations and federal deficiencies. Facilities were required to self-report all incidents of abuse and, because of understaffing at the state's Licensing and Certification Program (L&C), inspectors stopped looking for violations of state requirements during inspections. Only violations noticed incidentally were given citations. Additional policy changes were made after consumers and advocates won lawsuits against the state for failing to investigate complaints on a timely basis and neglecting to enforce state law. Longitudinal analyses of data from L&C for 1/1/2000-6/30/2008 for complaints and 1/1/2001-6/30/2008 for deficiencies and citations will be used to evaluate the impact of policy changes on the quality of nursing home care. The number of citations decreased substantially while the number of deficiencies increased. Some state requirements are more stringent than federal law, therefore it is possible that serious problems were not being documented when inspectors failed to look for state violations. The number of complaints logged more than doubled and the complaint substantiation rate plummeted. The lack of staff to inspect complaints within the mandated time frame resulted in fewer substantiated complaints. Passage of time makes it difficult to substantiate a complaint, witnesses may be gone and evidence can be comprised. Additional effects on quality after legislation was implemented in 2006 to rectify the problems will also be evaluated and presented.