Bosses Ignored Her Concern, Care Home Inspector Testifies

A state inspector of board-and-care homes in north Orange County testified at a public hearing Friday in Santa Ana that her supervisors told her she “was not paid to care” when she tried to act as an advocate for residents of poorly run homes.

The worker, Fran Christine Guest, said that when she persisted in pushing for immediate action in cases she believed to be critical, her supervisors in the Orange County division of the state Department of Social Services took those cases away. They told her she “generated too much activity,” she testified.

“I created a problem that they couldn’t handle,” Guest told members of the Commission on California State Government Organization and Economy, a watchdog agency commonly known as the Little Hoover Commission. “I have difficulties putting in line the Department of Social Services’ goals and respect for human life.”

Fred Miller, deputy director of the state Department of Social Services, which regulates all types of board-and-care facilities statewide, told the commissioners Friday that Guest was not considered a proper spokesperson.

Miller said he had told Guest she could not testify at the commission’s hearing Friday but changed his mind after he discovered the commission has subpoena powers.

Never Made Statement

Guest’s immediate supervisor, John Grant, said after the hearing that he never made the statement about not being paid to care, which Guest attributed only to “management” and not to anyone in particular. He said the changes in Guest’s caseload were routine.

“About every two years, I make these changes so that the staff does not become overly comfortable working with the same care providers,” Grant said. “I also do it to equalize the workloads among workers.”

The nearly 5-hour hearing Friday was the first of two to be held by the Little Hoover Commission as part of its second statewide study in five years of what measures should be taken to correct problems of neglect and abuse in the board-and-care industry.

The commission chose Orange County as the site of its first hearing after the Orange County Grand Jury asked it to look into complaints it had received about board-and-care homes during the grand jury’s own inquiry.

When the Little Hoover Commission completes its study, probably in September, the panel will make recommendations to the Legislature and the governor.

Besides Miller and Guest, others who testified Friday were James Beisner, deputy coroner for Orange County; Pam McGovern, executive director of the Long-Term Care Ombudsman Services of the Orange County Council on Aging; Linda Dean, a Council on Aging ombudsman; Dr. Deborah Newquist of the Gerontological Services of Orange County; James Hahn, Los Angeles city attorney, and Rod Leonard, who represented Los Angeles County Dist. Atty. Ira Reiner and owners of board-and-care homes who have banded together into associations that they hope will weed the bad operators out of the industry.

Pat Marshall, who with her husband, Bill, operates a 118-bed board-and-care home in Torrance, said she had come to the hearing to “do battle with the Little Hoover Commission” but became a supporter of its study while listening to testimony.

In addition to reciting story after story of neglect and abuse, many who testified called for stronger laws to regulate the industry and strict enforcement of those laws. Some agreed with a suggestion that the same laws that govern nursing homes in California should be applied to board-and-care homes.

Dean, who monitors about 100 board-and-care homes for the elderly in south Orange County, at one point broke down and cried during her testimony.

She said she considers about 10% of the homes she monitors excellent, about 20% good, 40% fair and the rest either “high risk or really poor.”

Inconsistency Claimed

Part of the problem, she said, is inconsistency in the policies and practices of the Department of Social Services. But she also criticized what she called attitudes and actions that thwart those outside the department who want to help. In March, 1987, Dean testified, she began creating a computer file of violation statistics on each of the homes in her area, using as a base records that had always been routinely provided by the department.

After she presented a copy of the results to the Department of Social Services Community Care Licensing division in Orange County, she said, the department stopped distributing the records to the ombudsman services workers.

James Beisner, deputy coroner for Orange County, testified about how deaths in board-and-care homes are reported.

Beisner said his office received reports of 97 deaths in board-and-care homes in the county in 1987, some of which could have been hastened by neglect or abuse.

Currently, board-and-care homes are not required to report the deaths of residents who were taken to hospitals just before dying or who were under the care of a doctor when they died. That, Beisner said, means many suspicious deaths go unreported.

Beisner said board-and-care home operators should be required by law to report every death of a resident to the coroner, regardless of where the resident died or whether the resident was under the care of a doctor.

Miller, interviewed during a break in the hearing, defended his department and scoffed at the contention of Dean and others that few board-and-care facilities can be described as “excellent.”

“Actually, it’s probably the other way around,” Miller said.

Miller admitted there are long delays in the process of getting licenses of bad board-and-care homes revoked but said that was largely because of due process considerations and administrative law judges’ overloaded dockets.

“Once they have a license, they have a legal right to it,” Miller said. “You can’t just take it away.”

Asked if the rights of the operators superseded those of the residents of their homes, Miller said, “There is no forced placement; 70% of the population (in adult board-and-care homes) are private pay.”

Miller said the Department of Social Services takes administrative action against less than 1% of licensed board-and-care operators.

Operators of board-and-care homes defended their industry at the afternoon session of the hearing, telling the commission that there are few homes that are poorly operated. They readily agreed that these kinds of homes should be shut down by the state.

But they warned the commission against recommending more regulations for board-and-care homes because they would be costly and force operators of good homes out of business.

Barbara Scott, who has operated a board-and-care home in Santa Cruz for 21 years, said, “My blood turned cold when I read in the paper today about the things that go on in the homes the commission visited yesterday (in Orange County).

Bad Homes ‘the Minority’

“And I would join with those who want to close them down. But they are the minority. The majority of us operate homes that provide top quality care.”

O. V. Smith, president of the Society of California Care Operators, told the commission that homes that are providing inferior care do so because of the low rate of government reimbursement.

She told commission chairman Nathan Shapell that there are few homes that collect the $2,500 a month he has said some homes charge. Smith said private patients who pay those rates are in a minority and that most board-and-care residents are elderly people who depend on $572 a month in Supplemental Social Security to pay for their stays.

Smith said: “We feel all the people in our homes should be safe and well-cared-for. But what can you do with $500 a month?

“And you people keep running the cost up with all your demands, fire regulations and paper work that have nothing to do with the care and treatment of people.”

Piling On Regulations

Smith added: “If you keep piling regulations on us, you’re going to drive the good people out of the business and only leave the bad ones that are willing to cut corners and go underground.”

Charles W. Skoien Jr., executive vice president of the California Assn. of Residential Care Homes, said he disagreed with board-and-care inspector Guest’s claim that the Department of Social Service’s Community Care Licensing division does not adequately protect residents.

“A few years ago, I might have agreed with Miss Guest,” said Skoien, who said his trade group represented 3,000 of the estimated 5,000 board-and-care homes in the state.

“But in the 1 1/2 years since Fred Miller has taken over, I feel that the evaluations have become more responsive to the community and residents.”

However, David Valdez, who identified himself as a former inspector for the San Jose office of Community Care Licensing, told the commission, “I experienced much the same problems that Miss Guest talked about earlier.”

He said that because of manpower limitations, the evaluators often could spend no more than 10 minutes inspecting a home and that rigorous enforcement was discouraged by supervisors.

“On more than one occasion when I wanted to do something about a problem, my supervisor told me: ‘Pretend that you didn’t see that.’ The attitude was to clear your desk of the paper work and to get the statistics out.”

Valdez said that he had referred four homes for investigation during 1987, but that none had been prosecuted for criminal or civil penalties.

Still, Valdez acknowledged, “The majority of homes are good and are providing adequate care.”

There are more than 340 licensed board-and-care homes in Orange County and about 8,000 residents. Officials say there are probably even more unlicensed facilities in the county.