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Nursing Home Profits While Residents Suffer

Cover image for podcast episode

A young Irma Easton, who choked to death on doughnuts in June at Avocado Post Acute, is pictured in this undated photo.

An El Cajon nursing home provided its residents with far less care than regulators expected while reporting millions in yearly profits, according to a KPBS analysis of its finances. Plus, Governor Gavin Newsom reveals more ambitious goals to fight climate change -- meanwhile one of his staff members tests positive for COVID-19. And, the state is adding a new metric to how it calculates the Covid-19 tiers in it’s colored rating system for counties.

Governor Gavin Newsom set ambitious climate change mitigation goals on [Wednesday]. As part of an executive order, policymakers must come up with a plan to preserve roughly a third of the state’s land and coastal waters by 2030. Newsom says the goal is to bring farmers, landowners and conservationists to work together. He says the plan would make California the first state in the nation to try such a plan.

“We're incentivizing the kind of behavior that I think resides in each and every farmer and rancher. That’s a desire to leave a legacy.”

The order directs the state’s Natural Resources Agency to come up with an initiative by 2022. Said initiative must have a plan to take carbon out of the air and put it into farm soil and other landscapes. Newsom says he also wants to thin forests to reduce wildfire risk, restore bee populations and wetlands.

The state of California is introducing a new way to measure progress in fighting the coronavirus. It's called the "health equity metric.” County public health officer Wooten says the idea is to decrease the disparities in health among people in wealthier neighborhoods versus those in more economically challenged areas. She says health equity is based on a number of factors.

"These areas include economics, education, transportation, social factors, neighborhood or environmental factors as well as housing conditions."

The metric can only be used to move the county to a lower, less restrictive tier. For now, the county remains in the red tier…we’d still have to see less coronavirus cases per 100-thousand people to move into the next less restrictive tier.

For months now, food pantries have relied on a federal government sponsored food box program to deliver food to needy families. But the latest boxes included a letter on White House stationery, in English and Spanish, from President Trump. Now two of California's largest school districts are removing those letters from grocery boxes.

San Diego Unified says they're doing it because the letter downplays mask-wearing to prevent COVID-19. It only asks people to consider wearing face coverings in public.

SD Unified board president John Lee Evens says that’s misleading and potentially deadly.

“We felt this was really giving misinformation from what needs to be done in terms of protecting citizens from covid-19 so they are being removed from the lunches.” (:10)

Face coverings are mandated in California and in San Diego Unified.

Los Angeles Unified is also pulling the letters. Its superintendent says they may violate a federal law prohibiting elected officials from certain political activities.

Last night the Padres lost again to the LA Dodgers 5-6. Padres are down two games in the best of five National League Division series.

It’s Thursday, October 8th. This is San Diego News Matters from KPBS News...a daily morning news podcast powered by everyone in the KPBS Newsroom. I’m Anica Colbert. Stay with me for more of the local news you need to start your day.

A staff member in Governor Gavin Newsom's office has tested positive for the coronavirus.
Capital Public Radio's Nick Miller has more.

The governor's office learned of the positive test earlier this week. A spokesperson says it is following state guidelines, including working on contact-tracing with the Department of Public Health.
The employee is quarantining, and the governor's office says this person did not interact with Newsom or his immediate colleagues.
There was also a separate incident of a state employee at a different workspace having COVID, and this staffer did work near the Governor's Office team members.
Newsom's office learned of this case on Monday. The staffer did not come in contact with colleagues who work with the governor.
Mask are mandatory in the governor's office, and many workers are either off-site or attending meetings via video conference.
In Sacramento, I'm Nick Miller

California is observing clean air day at a time when San Diego's air quality remains among the worst in the nation when ranked by ozone pollution. KPBS’ Erik Anderson reports.

San Diego air quality is ranked the six dirtiest in the nation when it comes to ozone pollution. Ozone is a key component in the creation of smog. County supervisor Nathan Fletcher sits on the state's air resources board. He says the impact of pollution depends on where people live.
"A child in Barrio Logan is eight times more likely to have asthma than a child in La Jolla. And that is morally wrong. I think we can all agree that no one's child should be that much more likely to develop asthma. We know it leads to respiratory and heart ailments and know from a study out of Harvard University that you're much more likely to die of COVID, a respiratory illness, if you live in one of these communities with higher levels of pollution."
Fletcher praises the call to stop selling gas powered vehicles by 2035. He also says the local transit agency is helping by getting rid of its diesel powered busses.
Erik Anderson KPBS News

San Diego scientists have discovered that calorie-restricted diets could be successful for an unexpected reason: a reduction in body temperature.

KPBS science and technology reporter Shalina Chatlani says scientists think the discovery could be used for life-prolonging drugs.

Previous studies have shown that calorie restriction can have life-prolonging benefits by delaying age-related diseases like cancer. That's because calorie restriction also causes a reduction in body temperature. With less food, the body adapts and tries to use less energy.
Scripps Research biologist Bruno Conti wanted to see just how much body temperature mattered. So, he studied one group of calorie-restricted mice that was kept at normal temperature and another group that was put in a hotter area, where they couldn't reduce their body temperature.
CONTI: We found out that actually between 40 and 70 per cent of the changes that occur during calorie restriction are actually due not to the reduction of nutrients, but to the reduction of temperature itself.
Conti suggests scientists could produce a drug that could mimic the effects of reduced temperature in the body to get the same effects as dieting. Conti warns that no one should try to reduce their body temperature. Shalina Chatlani, KPBS news.

Do they have the money to do better? That’s a key question hanging over the tragically high number of Covid-19 deaths at nursing homes.

KPBS Investigative Reporter Amita Sharma reviewed the finances of a local nursing home with a poor care record. SHe has this report.

Old photos of Irma Easton show a young dark-haired, luminescent beauty whose life brimmed with promise.
Decades later, her life ended June 8 when paramedics failed to revive the 66-year-old after she choked on powdered doughnuts in her room at Avocado Post Acute in El Cajon.
"She didn't have to die this way. There are trained medical staff there. What are they doing?
Easton's daughter Beatriz Barrios says an Avocado nurse had given Easton a pack of the doughnuts...then left her alone to eat them....despite the fact that Easton was a diabetic and needed her food mechanically softened due to a swallowing disorder and a history of choking.
…."Obviously, they're not providing proper care."
Delivering proper care has been a challenge at Avocado.
KPBS reviewed Avocado's financial reports, with the help of lawyer Ernie Tosh. He is a nationally recognized expert on nursing home finances. We found the for-profit facility has failed in recent years to provide the level of nursing care expected by regulators.
The regulators -- the Centers for Medicare & Medicaid Services -- published the expected level of staffing and reimbursed Avocado based on the needs of the facility's residents. Yet in 2018, the records show Avocado shortchanged its residents 184 hours of registered nursing care per day.
Tosh 1…."And they're not making it up tomorrow or the next day. It is never going to be made up."
Tosh found the 2018 registered nursing care deficit at Avocado was part of a pattern. Avocado shorted its residents more than 170 hours in registered nursing care per day in both 2016 and 2017.
Avocado's lawyer Jon Cohn argued in a written statement that the facility's staffing ratios of registered nurses were in line with California and national averages.
But he never addressed why they weren't in line with what federal regulators expected.
Tosh says CMS's expected RN staffing levels were meant to ensure that residents received the care they needed.
Ernie Tosh Part 1 "The RNs are the front line top medical providers in the facility. When you don't have them there, you don't have anybody that can assess the patient, that can determine if they're developing an infection, et cetera. It just goes on and on and on and on. If you don't have RN's, your health care system breaks down in a nursing home."
Avocado's complaint history shows that the facility might have systemic problems.
From 2017 through Oct. 5 of this year, 462 complaints were filed against the nursing home, according to the California Department of Public Health. Fifty-six of those complaints were filed this year alone, four times the statewide average.
Cohn, Avocado's lawyer, said many of those complaints were self reported. He added that given the large size of the 256-bed facility compared to other nursing homes, "it logically follows that it will have more incidents to report."
But nursing home reform advocates say complaints against Avocado are still high even when factoring size.
Over the years, inspectors have cited Avocado for lax infection control, abuse of residents, falsifying records and failing to keep the place free of hazards.
Avocado has also had the second highest number of residents who tested positive for COVID-19 among nursing homes in San Diego County.
(Brian Lee Part 1) "The core issue is that there's inadequate staffing in this facility."
Brian Lee is executive director of the Texas-based nonprofit Families for Better Care. "The residents end up suffering."
By understaffing registered nurses, Tosh calculated that Avocado has saved $1 million or more annually from 2016 through 2018.
Yet, Avocado has brought in more than $3 million dollars in profits in both 2017 and 2018.
TOSH 2 "Clearly, when you're making three to three-and-a-half million dollars in profit, you could staff properly.This is not a facility that can stand up and say, `We didn't have the money to do it.'"
Meanwhile, the California Department of Public Health investigated Irma Easton's choking death and told her daughter Beatriz Berrios that Avocado was not at fault.
Berrios doesn't understand that conclusion.
Beatriz Part 2 "They let her die there. They didn't help her in the moment that she needed most. She died in the most painful, horrible way that I can imagine that she would die."
Amita Sharma, KPBS News.

Coming up on the podcast…..taking a quick break from the news...KPBS’ Arts Editor Julia DIxon-Evans has five tracks from local bands to get you through October.

With touring on pause and no bands coming to town, it's nice to know that local bands are still releasing new music. KPBS Arts Editor Julia Dixon-Evans sat down with KPBS Midday Edition Host Mauren Cavanaugh to talk about five tracks from bands in the San Diego and Tijuana region...and the one that got away. Here’s that interview...

5SONGS 8:00 First up is a solo work from an artist you may have heard of from the redwoods music band, Danny bill and the Taranto. Just what has Danny bell come up with on her own? Well, she's been working on some new solo work and just dropped a single, got hue. It's a quick ramp, just two and a half minutes that her vocals are hypnotic and delightful. And the track has a hopeful romance to it. Yeah,

Speaker 2: 01:15 [inaudible]

Speaker 1: 01:19 Was got you a new single by Danny bell. And if you want more from Danny, she just performed at the Casbah alongside low volts. This past weekend, the venue is empty, but it streamed live from Twitch. I've been really loving these shows and you can watch the saved videos still on their Twitch channel. And next, we have a track from emerging act Ingo noir from a benefit compilation. So tell us about alien boy. Yeah. So I've mentioned this compilation before it's by Craig Oliver's Volare records. It's called presence, not absence, a benefit with proceeds going to SD queer black housing and a few other regional organizations, but local RNB duo in Guidewire offered two tracks, including the summers alien boy

Speaker 2: 02:44 [inaudible]

Speaker 1: 02:46 Alien boy by England wire. Those vocal layers are really impressive and I love their production. It's both sparkling and raw, and the track feels somewhere between a love song and a surrender. It's really devastating song craning. That's kind of toe-tapping at the same time and the full compilations worth of listen. So check out all our records band camp. I also really love the take on Dylan's ballad of Hollis Brown by Cody Blanchard of Shannon and the clams. Okay. So moving on, she a born a Vanessa Samora has a new single let's have a listen to ya.

Speaker 1: 04:00 So that's air five, Vanessa Zamora, I air translates to yesterday and Zamora has a really unique mix of indie folk pop and RNB. And this track has it all. And I air is packed with longing regret and desire, and it's the third single she put out in 2020. So I'm watching out for a bigger release from her on the horizon. Next up is local band strange ages. The album cover on this on said piano music is very 2020 and abandoned piano in the Bay. And the band standing around it wearing masks. Is this a quarantine themed album in some ways, very much. It's a four song EAP and was conceived, written and recorded entirely during the pandemic, mostly at home, but they also drew upon everything else going on protests and injustice and how everyone's basically living on social media strain. Gauges is a guitar free indie band really and chanting and lyrically rich music. My favorite tracks, the albums closer your last day. It's a slow burn waltzing its way through the modern day.

Speaker 2: 05:40 [inaudible]

Speaker 1: 05:41 That was your last day by strange ages. And I should add that new new pianos were harmed by the band, a local piano repairment caught wind. That one was already unfortunately dumped in the base. So word spread and strange ages sees the opportunity as far time capsules go. It's pretty spot on. That's great. And finally, we have a new album from cults called host, but even though this is a New York band, apparently it has some San Diego roots. Yeah. Colts, Madeline fallen. And Brian oblivion were both raised in San Diego, but form the band after they moved to New York. And it's been almost a decade since they skyrocketed to fame with their first album, after an iTunes commercial featured go outside, which is kind of an ear worm and the new full length released a few weeks ago. It's really nice addition to their catalog. Lots of synth tinge, pop seventies aesthetic, and a really good dose of darkness. Let's listen to the opening Chak trials.

Speaker 2: 07:06 [inaudible]

Speaker 1: 07:09 That's trials by cults. It has this deceivingly cheery and timeless tune, but also feels kind of detached and resigned. A little heartbreaking. I personally really love a good, upbeat, sad song. You can find a playlist of these songs@kpbs.org or follow KPBS on Spotify. And we'd love to hear what you're listening to tell us in the KPBS art Facebook crew. I've been speaking with KPBS arts editor and producer Julia Dixon Evans. Thank you, Julia. Thanks Maureen.

That was KPBS Arts Editor, Julia Dixon-Evans speaking with KPBS Midday Edition Host Maureen Cavanaugh. You can find a playlist of these songs at kpbs dot org or follow KPBS on Spotify. And we'd love to hear what you're listening to -- tell us in the KPBS/Arts Facebook Group. That’s it for the podcast today, thanks for listening and have a great day.

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San Diego News Now

San Diego news; when you want it, where you want it. Get local stories on politics, education, health, environment, the border and more. New episodes are ready weekday mornings. Hosted by Anica Colbert and produced by KPBS, San Diego and the Imperial County's NPR and PBS station.