PASADENA, Calif.—Skilled nursing facilities (SNFs) provide long-term care services to many of Pasadena’s frail, older adults with underlying chronic medical conditions. Despite regulation by the state and the county, substandard care is an ongoing and persistent problem in many SNFs throughout the region, including Pasadena. The COVID-19 pandemic magnified systemic deficiencies at SNFs that threatened the lives of many of Pasadena’s most vulnerable residents.
Unfortunately, the City of Pasadena does not have direct oversight of SNFs or authority to enforce SNF regulations and standards. Due to continued shortfalls in oversight and enforcement, the City has made it a priority to leverage resources to advocate for improved regulation and take action where possible. It was deemed that a multidisciplinary team was required to fulfill this objective.
In August 2021, the City established the Pasadena Elderly and Dependent Adult Liaisons (PEDAL) team. The mission of PEDAL is to improve the quality of life for elders and dependent adults residing in long-term care facilities through education, community outreach, code enforcement, and prosecution. PEDAL builds upon prior work performed by the City in this arena.
In June 2020, more than 60 residents were evacuated from Golden Cross Health Care (Golden Cross) in Pasadena after the skilled nursing facility’s license was suspended by the Licensing and Certification Program of the CA Department of Public Health (CDPH) due to ongoing quality of care issues reported to the licensing agency by the City of Pasadena Fire and Public Health Departments, and the local long-term care ombudsman. Less than four months later, more than 30 residents were evacuated from Foothill Heights Care Center in Pasadena due to excessively high indoor temperatures, again reported by City departments to the licensing agency and in response to resident complaints.
Although each evacuation was precipitated by different underlying circumstances, in both instances, the City of Pasadena tenaciously advocated for long-term care facility residents by demanding action from the regulatory agency then utilizing City resources to move patients to safety. Subsequently, the Los Angeles County Office of Inspector General conducted an exhaustive review of the county’s capacity to perform various licensing and certification, inspection, and investigative activities in long-term care facilities as it is contracted with CDPH to do, and found deficiencies that impeded state and county regulators from fulfilling their oversight responsibilities. The evacuations revealed issues with state and county mechanisms for triggering a crisis response, efficacy of LA County Health Facilities Inspection Division’s (HFID) oversight and enforcement actions, and problems with coordination and communication between HFID and partner agencies.
PEDAL has already completed coordinated inspections, escalating operational deficiencies to regulatory agencies and is actively addressing enforceable violations. Work is also underway for outreach and education with a new webpage to be released soon on the City of Pasadena website.
PEDAL includes representatives from the City Manager’s Office; Pasadena Public Health, Fire, Police, and Planning & Community Development Departments; Code Enforcement; City Prosecutor’s Office; WISE and Healthy Aging Long-Term Care Ombudsman Program; and Huntington Hospital.
PEDAL notes and applauds the recent release of the final report by the Los Angeles County Office of Inspector General entitled “Improving Oversight and Accountability Within Skilled Nursing Facilities.” The report contains a comprehensive analysis of the systemic problems in the SNF industry and in its oversight and regulations as well as 39 critical recommendations to be considered in the very near future by the Los Angeles County Board of Supervisors. PEDAL has reached out to Los Angeles County on this and looks forward to working with the county and other cities on these critical efforts.
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