Investigation: Medical Errors Plague Assisted-Living Facilities
Medical errors are prevalent at assisted-living facilities across California, and many facilities that have been fined for such problems have remained in operation without paying the penalties, according to an investigation by U-T San Diego.
The investigation was conducted in partnership with the California HealthCare Foundation's Center for Health Reporting. CHCF publishes California Healthline.
Details of Investigation
For the investigation, U-T San Diego acquired 7,000 state records of assisted-living center inspections and examined them for medical errors.
Problems discovered at assisted-living facilities included:
- Employees being discouraged from reporting medical mistakes;
- Failure to schedule medical appointments for residents when ordered by a doctor;
- Housing residents who needed a higher level of care than staff could provide;
- Insufficient staffing;
- Medication errors, including administering incorrect medicine or dosages;
- Staff ignoring or not treating residents' symptoms; and
- Unsafe medicine storage.
The investigation found that most errors were caused by:
- Poor oversight by staff; or
- Lack of training for staff (McDonald, U-T San Diego, 12/14).
Facilities House Sicker Patients
Consumer groups say the state in recent years has allowed sicker patients to be housed at assisted-living facilities without increasing staff training requirements.
For example, the facilities are allowed to house residents with:
- Colostomy bags;
- Deep bedsores;
- Serious communicable infections;
- Staph infections;
- Tracheotomies; and
- Other conditions.
According to the investigation, assisted-living centers are not required to employ medically trained staff to deal with such conditions (Schoch, U-T San Diego, 12/14).
In addition, the investigation found that many workers at assisted-living facilities did not primarily speak English, which can limit communication with residents.
Investigators noted that the California Department of Social Services -- which licenses and regulates assisted-living centers -- does not track medical errors at the facilities.
Furthermore, the state has no way to track trending or systemic mistakes at such facilities, according to officials (McDonald, U-T San Diego, 12/14).
Few Fines Collected
The investigation also found that only half of the $2.9 million in fines levied against assisted-living facilities since July 2007 has been collected by the state.
Meanwhile, hundreds of facilities that have unpaid fines remain licensed and continue to operate (McDonald/Clark, U-T San Diego, 12/14).
U-T San Diego reports that there is no penalty for late payments and that the maximum fine for an assisted-living facility is $150, compared with $100,000 for nursing homes (AP/Sacramento Bee, 12/15).
State Sen. Leland Yee (D-San Francisco) has called for a hearing in response to the investigation (McDonald/Clark, U-T San Diego, 12/14).
In response to the investigation, DSS officials defended the agency's oversight of assisted-living facilities.
Michael Weston, deputy director of DSS, said the department is "extremely vigilant" about ensuring that assisted-living employees undergo 16 hours of required training and pass a written exam to become licensed (McDonald, U-T San Diego, 12/14).
DSS said it is taking steps to ensure that fines for violations are collected but noted that:
- A pilot project to privatize collections has stalled; and
- A recommendation to impose late fees still requires legislative action (McDonald/Clark, U-T San Diego, 12/14).