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California Considers Changing Watchdog Role Of Nursing Home Inspectors

Cover image for podcast episode

Pictured above is Rob Halliburton, May 31, 2021.

COURTESY ROB HALLIBURTON

The nursing home industry is pushing a plan to have state public health inspectors double as advisors for the industry in an effort to improve care. Critics argue such a plan would weaken oversight, detracting from the inspectors watchdog role. Meanwhile, state lawmakers are considering reducing how many out-of-state and international students are admitted into the University of California system. Plus, new guidance has been given to national park managers in a response to climate change conservation efforts.

Good Morning, I’m Annica Colbert….it’s Wednesday June 2nd.

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Nursing home inspectors as potential advisors to the state

More on that next, but first... let’s do the headlines….

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150 thousand Scripps Health patients may have had their data stolen during the cyber attack that started about a month ago. In a Tuesday statement, Scripps Health says medical records weren’t specifically impacted, but quote “health information and personal financial information was acquired.” Scripps says they’ll be sending out letters to patients so they can take steps to protect their information.

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The recall campaign targeting San Diego City Council President Jen Campbell has failed. Backers of the recall campaign say they gathered more than 10,000 signatures. That's about 4,000 short of what they needed by Wednesday to force a special election. Recall backers from opposite sides of the political aisle accused Campbell of being, on the one hand, too close to special interests and, on the other, being an unreliable ally on racial justice. Campbell is up for reelection in 2022.

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The Sea Lion pupping season at La Jolla Cove kicked off on Tuesday, and city officials are asking the public to please keep a responsible distance from the pups if you go to see them. Here’s City Councilmember Joe LaCava.

“The era of social media and posting selfies is making people get too comfortable and up and close with these animals.”

The city is working with parks and recreation to add signage at La Jolla Cove and Boomer Beach in the coming weeks.

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From KPBS, you’re listening to San Diego News Now.

Stay with me for more of the local news you need.

California health regulators have long been faulted for doing too little to ensure that the state’s 88,000 elderly and disabled people in nursing homes receive proper care.

Now an idea is being floated that critics say would gut nursing home oversight: Having state inspectors act as advisors. KPBS’s Amita Sharma reports.

"I'm still dealing with the effects of what happened."
Rob Halliburton landed at Palomar Vista nursing home in Escondido last spring needing care for a foot wound. The 57-year-old says it turned out to be the worst place for him.
[00:03:25.050] “I almost got my foot amputated because they weren't taking care of my wound and my treatment.”
And Halliburton says his experience was just one example of poor treatment at the facility.
[00:02:32.890] “I witnessed everything from the wound care, to not being changed, to being treated unfairly, being not listened to, a witness to so many things that would make you cry, literally makes you cry.”
Felicia Barbato is a nursing home inspector for the California Department of Public Health. Barbato told state legislators last year that stories of inadequate care are commonplace.
“I’ve been well aware of the poor infection control and quality of care in many of our nursing homes prior to the pandemic. The high rates of death in these facilities during the pandemic, unfortunately comes as no surprise.”
Despite all of this, CDPH is now mulling a post-pandemic remodel of its oversight system being pushed by the nursing home industry. The agency’s draft plan would require inspectors to visit nursing homes a few times each month to advise staff on how to reverse substandard care.
Karl Steinberg, a medical director of Life Care of Vista and Carlsbad , says the idea would be a dramatic improvement over the current inspection system, which he says is adversarial and demoralizing.
[00:04:16.360]....”It's very much, you know, gotcha. I found the temperature of the breakfast was two degrees below what it should have been or those kinds of things.” (slow fade where pink begins)
Steinberg says his support of the new approach has nothing to do with his other role as chief medical officer of Mariner Health Care. The group is being sued by the state for understaffing its Northern California nursing homes, falsifying its ratings to boost profits and failing to report any of the numerous sexual assaults at its facilities.
Steinberg says his advocacy for revamping the state inspection system began long before the lawsuit.
[00:10:47.640] “I do think a little bit more of a sort of humanity and collaboration would potentially go a long way. I don't think we'll find out until we try it.”
CDPH declined an interview but in an email said the “principle was to establish a more frequent presence in nursing homes.”
The email goes on to say that if the new method is implemented, CDPH will still carry out its “distinct regulatory enforcement role.”
Advocates for nursing home residents call this an impossible promise.
[00:16:24.150]”What are they giving up? And I think the obvious answer is they'd be giving up enforcement, they'd be giving up complaint investigation.”
Tony Chicotel is a staff lawyer for California Advocates for Nursing Home Reform. He says it already takes CDPH an average of 636 days to investigate complaints against the facilities statewide.
Chicotel contends that having the agency’s inspectors take on consulting roles would also pose a giant conflict of interest.
[00:12:36.280]”The equivalent adopt a sniff would be if you got pulled over by a police officer for speeding and the police officer jumped in the car with you and said, OK, let's drive around and you show me your skills and I'll critique you.”
Advocates say inspectors have told them they are against the idea.
A lawyer for the CDPH inspectors’ union did not return phone calls.
Meanwhile, Rob Halliburton says his foot still hasn’t recovered. A CDPH investigation into his claims concluded Palomar Vista failed to provide him with proper wound care. It’s why he’s opposed to a change that would reduce CDPH’s watchdog role.
[00:06:51.900]....”That would be the worst thing ever, period, because we need them to be our police. almost like when you call 9-1-1, the police show up and take care of you.”
Amita Sharma, KPBS News.

That was KPBS’ Amita Sharma. In a statement, Palomar Vista said it couldn’t discuss Halliburton’s claims, but added it “earnestly disagrees” with the suggestion that anyone at the facility was ignored or mistreated and said its staff is well-trained in wound care.

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State lawmakers are considering a plan to reduce how many out-of-state and international students are admitted into the University of California system. The goal is to make room for more Californians. KPBS reporter Jacob Aere says it comes in a record-breaking year for the U-C, with more than 200-thousand applicants vying for 46-thousand freshman seats.

The state Senate has unveiled a proposal to reduce the proportion of nonresident incoming freshmen to 10% from the current system wide average of 19%. The cuts would come over the next decade, beginning in 2022.
Gaurav Khanna (GAR-iv CUN-uh) is an assistant professor at UC San Diego who specializes in high-skill immigration, including international students.
Gaurav Khanna | UC San Diego Assistant Professor
“What’s been happening is that more revenue from international students has allowed universities to expand.”
“The revenue from one more international student can actually help fund, what we call cross-subsidize, more local students to these universities.”
The increasing difficulty of accessing a UC seat at many campuses has frustrated thousands of California families after they’ve supported the university system with their taxes for years.
Esther Barcoma has been a counselor at Escondido High School for 27 years. She says the college admissions process across California universities is growing more competitive.
Esther Barcoma | Escondido High School Head Counselor
“I feel like they have a lot more pressure than even 15 years ago as far as what’s expected from the college.”
“They’re getting in at the same rate, but not necessarily at the places they would like to get in.”
The plan would replace the lost tuition from nonresidents and cover the cost of additional California students to take their spots through state funds, beginning with $56 million next year and growing to $775 million by 2033.
Khanna (CUN-uh) says part of the proposed plan is a good idea.
Gaurav Khanna | UC San Diego Assistant Professor
“The current plan has certain attractive features, including expanding aid to local students. The current plan also has certain unattractive features which is the part when it comes to capping international student flows.”
UC officials say they share the goal of enrolling and graduating more California students and have added 19,000 more of them since 2015. But they oppose the 10% plan. Jacob Aere, KPBS News.

And that was KPBS’ Jacob Aere.

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There is a battle underway in Sacramento over how much utilities should pay for rooftop generated solar energy. A San Diego lawmaker is pushing for major changes. KPBS Environment Reporter Erik Anderson has details.

Lorena Gonzalez says California needs to change how much investor owned utilities have to pay residents and businesses for rooftop generated electricity. She says the working class is subsidizing rooftop solar for people who can afford it. Gonzales says solar owners aren’t paying to maintain and access the grid.
That cost shift has gotten bigger and bigger and so in San Diego for example ratepayers pay about 230 dollars a year to subsidize rooftop solar folks.”
Solar Industry officials say the cost shift argument is spurious. And they say the bill will kill rooftop solar for all but the very rich because it will remove the financial incentives to build a system. A vote on the measure could come this week in the assembly.
Erik Anderson KPBS News

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The San Diego Public Library kicked off its Summer Reading Program on (Tuesday). KPBS Education Reporter Joe Hong spoke to one librarian about how reading can help children re-adjust to the post-pandemic world.

With this year’s reading challenge, San Diego’s librarians are hoping children will be able to explore new worlds after a year of being stuck at home. Emily Derry is the public library’s Youth and Engagement Coordinator.
DERRY.mp400:00:28:24EMILY DERRY /// SD PUBLIC LIBRARY YOUTH COORDINATORThe theme is “Reading Colors Your World.” It encourages readers to be creative, try new things, explore new art and find beauty in diversity.
Participants can earn prizes by finishing 10 books or reading for 10 hours. Or they can join a variety of activities like virtual storytimes.
DERRY.mp400:01:22:24They’re really literacy based activities, but they include writing a letter to someone, telling a story aloud to someone, appreciating oral storytelling, and watching a movie adaptation of a book read.
Prizes include books and free passes to several San Diego museums. Derry hopes this year’s program can boost reading skills, especially in those students who have fallen behind this year.
DERRY.mp400:05:02:11Before the pandemic we already knew that in the summer following third grade, for example, students lose nearly 20% of their school year gains in reading. And that loss can increase with age through elementary and middle school.
The summer reading program is open to children of all ages. Participants can sign up online or at one of 25 city library branches. Joe Hong KPBS News.

And that was KPBS Education reporter Joe Hong

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Coming up.... Conservation efforts at America’s national parks are changing in response to climate change. More on that next, just after the break.

As the accelerating effects of climate change become more apparent on our natural resources, the goal and scope of conservation is beginning to change. For America’s National Parks, that goal was once absolute conservation. Now, as rising temperatures transform the world’s ecosystems, the focus of conservation efforts has shifted. Some things can be saved in their historic range, and some things can’t. That’s according to new guidance handed down last month to park managers.

Gregor Schuurman (SKEER-mon) is an ecologist and researcher with the Park Service climate change response program. He spoke with Midday Edition host Jade Hindemon.

So Gregor, how has the goal of conservation efforts changed as the effects of climate change become more pronounced?

Speaker 2: 00:50 I'm keen to elaborate a little bit on that because I think it's important to understand that when we say absolute conservation, what we're really talking about is preserving everything exactly where it was as it was, is difficult and becoming more so because climate is a fundamental driver of ecological conditions. So if you turn the temperature up or you change the moisture regime, you're starting to favor different species than those that have historically existed in a place. And so this sort of broader way to think about this is to recognize that we are now managing a moving picture. Nature is always in motion, but because of our influence, that motion is fast enough that we can pretend we're managing a snapshot. And so when we talk about giving up, ideally what we're talking about is giving up on conserving perhaps as a population of a certain species in a certain place, but hopefully shifting our emphasis spatially elsewhere.

Speaker 2: 01:43 So that ultimately we're still committed and working towards the protection of our biodiversity heritage. But we're recognizing that we have to do it in the context of motion on the one hand, a fairly simple point, moving picture versus a snapshot. But in terms of practice, that's the difference between saying we're going to bring back everything that used to be here to this place, versus we are going to preserve everything that used to be here, wherever it is in motion. It's like the rug is shifting underneath conservations feet. And if we're going to continue to succeed, we need to learn how to dance. You've

Speaker 1: 02:15 Been quoted as saying the mission of the park services to conserve unimpaired. How has climate change complicated?

Speaker 2: 02:23 The way that is stated is in the legislation it's conserved unimpaired, it's also often stated as preserve unimpaired preserve unimpaired tends to lead people to think we mean conserve everything exactly where and how it was. When we say preserve. When we say conserve the way we interpret policy, it gives us a flexibility that we have a commitment to preserve biodiversity, to preserve our natural heritage, but it doesn't lock us into doing so exactly where and how it used to be done in the past. So it seeks flexibility.

Speaker 1: 02:56 As you mentioned, certain conservation efforts will have to be given up. So park managers can focus on more important goals. What are some of the criteria for prioritizing key conservation efforts in the near future?

Speaker 2: 03:09 Sure. What we try to think about is being strategic overall, the resources that we can devote to conserving our natural heritage always will be limited, uh, relative to the task. There is almost always more we could do with more resources. So the ultimate question is how can we get the most conservation return for our investment? If we want to use business terms or how can we achieve the most success with our limited resources and ultimately this means being strategic. And what this means is when we choose to resist change and restore a population exactly where it was, we ought to put that under some kind of a microscope magnifying glass, and just ask ourselves, is that going to work, given what we know about how our climate has changed in that place and how it will change in the future. Now, if we can ascertain that it will, right, that you can bring back the corner blue butterfly, let's say to a particular site and you've done your homework. You can show your work. Then there is nothing wrong with an approach that looks like traditional conservation, but increasingly we're becoming concerned with investing like we always have and perhaps not getting that return. And what managers then say is, gosh, in that case, I really would like those worker hours, those dollars back so that I can save some other resource that perhaps had a better chance. So it's a lot about allocation, about recognition of the finitude of our resources, and then doing the best job we can

Speaker 1: 04:43 Predictions for nearby Joshua tree. National park are particularly grim, rising temperatures and more aggressive fire seasons, uh, could result in catastrophic losses for the park. Can you tell us more about that and how the guidelines will affect conservation efforts there?

Speaker 2: 04:59 That is a difficult situation and it's one that's fairly well documented. And you've got a combination there of increasing temperatures and also exotic species that are changing that fire regime. That's a really difficult situation. What one hears when, when talks to the managers at Joshua tree is both a recognition that there are places where it's going to be tough to retain the Joshua tree within its former range. But on the other hand, there are some places Refugio, as they're called that are somewhat sheltered from these modern drivers. Um, it's important to recognize that across the landscape, not every acre has the same vulnerability context really matters. And so a lot of the discussion when we're here in that part of the world is about again, being strategic and investing perhaps very heavily to resist change where it's feasible. And at the same time, again, trying to avoid wasting dollars in places that are really unlikely to result in success. You

Speaker 1: 05:55 Know, I just asked you about this being a wake-up call for Americans, but how important is it that there be a global understanding of what's happening,

Speaker 2: 06:05 Uh, right to our peers and to managers in the peer reviewed literature and beyond, we often emphasize the global nature of this change. And we do that for two reasons. One is it's important to understand that this is global and it's not just for instance, in American problem. And so our colleagues and our peers who can help us think about this can be found around the world. So that's a huge resource in terms of a common problem with a great number of people, all thinking about it. It's also important to understand this as a global problem, because that's why we need to do the kind of thinking we do. And we can't just mitigate locally. You know, other sorts of problems. One can, as I talked about earlier, fence out the bad guys, so to speak, or, or at least in one way or another counteract, some of these stressors that climate change is a really tough one. And so on the one hand, as I've said, it's important to recognize nobody's alone. We're all in this together. And by that, I mean humanity. And on the other hand, it's important to realize these are big global problems that require again, a different approach than the historical approach to resource conservation.

That was Gregor Schuurman (SKEER-mon) is an ecologist and researcher with the Park Service climate change response program. He was speaking with KPBS Midday Edition host, Jade Hindmon.

That’s it for the podcast today. Be sure to catch KPBS Midday Edition At Noon on KPBS radio, or check out the Midday podcast. You can also watch KPBS Evening Edition at 5 O’clock on KPBS Television, and as always you can find more San Diego news online at KPBS dot org. I’m Annica Colbert. 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.