Dear NASW-CA News Editor:
With skepticism, I read your July 22, 2020 newsletter feature commentary, “Insights on a Virus: State dashboards show COVID-19 cases and related deaths much lower in residential board & care than nursing homes in California,” by Jason Bloome, who concluded “With fewer cases and related-deaths due to COVID-19, residential assisted living homes are safer than nursing homes for seniors who require 24-hour custodial care.” I would like to address the following “insights”:
- Headline refers to residential “board & care”, while Bloome’s article refers to “residential assisted living homes (or residential facilities for elderly – RCFE)” (sic). RCFE stands for Residential Care Facilities for the Elderly (“Care” is important), and often referred to as “assisted living” or “board and care”; “board & care” refers to smaller facilities with six or fewer beds, while “assisted living” refers to larger facilities with more beds. This distinction based on facility bed count is important to California Department of Social Services (CDSS), which regulates RCFEs.
- Bloome states “…residential assisted living homes have much lower rates of COVID-19 cases and related-deaths than nursing homes.” Yet, Bloome merely compares numbers (not rates) of positive COVID-19 cases of residents and staff for each type of facility.
- Meaningful comparisons of COVID-19 cases and deaths between nursing homes and RCFEs have been compromised by lack of universal testing for an asymptomatic disease like COVID-19. In late May, California Department of Public Health (CDPH) called for universal testing in nursing homes; however, similar calls for testing have not come from CDSS. On June 26, CDSS issued limited testing protocols for RCFEs.
- COVID-19 reporting of cases and deaths in RCFE industry has lacked transparency. CDSS does not identify names of RCFEs with six or fewer beds (board & care) that have COVID-19 cases due to privacy concerns. Last week, CDSS attempted to delete names of RCFEs with COVID-19 deaths and even removed COVID-19 deaths in RCFEs from its website—until advocates protested and RCFE COVID-19 data returned on July 21. As noted by Sacramento Bee, this data scrubbing appears to be part of an alarming trend of the largely for-profit long-term care industry having a disproportionate amount of influence on California’s regulators.
- Bloome writes, “Many California nursing homes have low star ratings from Medicare Compare for poor staffing.” In contrast, RCFEs have no ratings from a regulatory body (no Centers for Medicare and Medicaid Services coverage because they are not health care facilities), no specific staff-to-resident ratio requirements, and minimal staff training.
- State incentives for facilities to accept COVID-19 patients: Bloome writes, “California has ordered nursing homes to accept COVID-19 patients discharged from hospitals…the reimbursement rate for a COVID-19 patient can be up to $800/day…” However, he fails to disclose CDSS’ May 1 offer to RCFEs with six or fewer beds (board & care) $1,000 a day from the time the first COVID-19 resident is placed, and a negotiated rate for RCFEs with more than six beds. In addition, Bloome appears to refer to CDPH order that was superseded in March; nursing homes, like RCFEs, now volunteer to accept COVID-19 patients at higher payment rates to cover additional costs of staffing and preparation for COVID-19 units. 
Bloome identified himself as owner of Connections – Care Home Referrals, described in its website as a “no-cost care home referral agency for the family (we charge a placement fee from the facility if you select one of the homes we have recommended).”
Instead of publishing a shill piece promoting the RCFE industry, which has its own systemic problems (see Residential Care in California: Unsafe, Unregulated, and Unaccountable), please feature newsworthy articles from non-profit advocates like California Advocates for Nursing Home Reform (CANHR)https://canhrcovidnews.com/, National Consumer Voice for Quality Long-Term Care https://theconsumervoice.org/, or Justice in Aginghttps://www.justiceinaging.org/resources-for-advocates/, where staff fact-check their work and promote social work values and ethics. Further, geriatricians, gerontological social workers, long-term care ombudsman and advocates might have better insights into the quality of facilities.
The COVID-19 deaths of residents and staff at long-term care facilities (both nursing homes and RCFEs) have been a continuing tragedy, reflecting systemic problems such as ageism (overlooking unique COVID-19 symptoms presented by older people and provider bias in how older lives are valued when faced with scarce resources), racism/classism (nursing homes with the highest percentage of non-white residents are more than twice as likely to have COVID-19 cases and deaths as those with the lowest share; devaluing underpaid caregivers who are mostly people of color, exploited by employers who fail to ensure safe working conditions – CDC found patient safety at the first U.S. nursing facility with COVID-19 outbreak was compromised by staff who worked without PPE and while sick in multiple facilities, helping to spread coronavirus in a controlled environment), weak regulatory oversight, and underfunding of our public health system (limited COVID-19 testing, including failure to test its own inspectors sent to facilities).
Having worked at both non-profit assisted living (which had a wait list and did not partner with referral agencies that charge placement fees) and Medicare 5-star rated nursing home and rehab center facilities, I continue to advocate for residents and staff during this COVID-19 pandemic. As a former Meals on Wheels social worker, other home and community-based services also might be considered in the continuum of care for patients discharged from hospitals and needing rehabilitation.
 https://www.kpbs.org/news/2020/may/06/state-will-pay-assisted-living-coronavirus/ &https://www.cdss.ca.gov/Portals/9/CCLD/PINs/2020/ASC/PIN_20-17-ASC.pdf
 https://www.forbes.com/sites/howardgleckman/2020/06/30/we-are-having-a-national-conversation-about-race-and-policing-why-arent-we-having-one-about-race-and-long-term-care/ &https://doi.org/10.1111/jgs.16661
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