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Committee OKs ‘Culture Change’ Spending

A new bill aimed at changing the culture of long-term care in part by redirecting nursing home penalty fees passed a surprisingly controversial hearing yesterday before the Assembly Committee on Health.

AB 973 by Assembly member Sharon Quirk-Silva (D-Fullerton) would direct roughly $150,000 a year in state penalty funds collected from long-term care facility violations to be used to “change the culture” at nursing homes, Quirk Silva said.

” ‘Culture change’ usually makes you think, well, what is that?” Quirk-Silva said. In this case, she said, “Culture change means looking at a shift in how we operate in our nursing homes, toward a more person-centered change in our long-term care facilities.”

According to Joe Rodrigues, the State Long-Term Care Ombudsman and a board member of the California Culture Change Coalition, the penalty money would be combined with $250,000 of federal money to promote the themes of culture change in nursing homes.

“We’re putting the ‘home’ back in nursing home,” Rodrigues said. With a patient-centered approach, he said, “There are better outcomes for residents. They don’t have to constantly repeat how they want to be cared for.”

Opposition to the bill came from an unexpected source.

Deborah Doctor, a legislative advocate for Disability Rights California, said the bill has its heart in the right place, but its money in the wrong place.

“While we completely agree that culture needs to change, we don’t think penalty money should be used for anything besides benefit to residents,” Doctor said.

“I don’t see how $150,000 would change a culture when we’re paying nursing homes about $4 billion in payments,” she said.

Doctor said the absence of a nursing-home resident on California Culture Change Coalition board of directors was telling.

“There is no long-term care resident at the center of the culture change movement,” she said. “In a movement when they’re supposed to be at the center, they aren’t involved at all in the organization itself.”

Doctor said her organization’s main objection is that money raised through penalties for long-term care violations should more directly go to addressing long-term care violations.

“We don’t see how this affects people’s lives directly,” Doctor said, “and that’s what the money is for.”

Quirk-Silva said that the relatively small amount of money in AB 973 could actually go a long way toward making larger changes. “We’re not talking millions of dollars here,” she said, “and sometimes that can work best in promoting best practices.”

Quirk-Silva said she’d be happy to have a representative from the nursing homes involved, and that she would also include a committee suggestion for language that said the optimum choice for long-term care would be in-home care.

The committee passed the bill 11-5. It now goes to the Assembly Committee on Appropriations.

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