DAVIS AIMS TO PROTECT ELDERLY `AGING WITH DIGNITY' CENTRAL TO PROPOSALS.

Byline: Terri Hardy Sacramento Bureau

SACRAMENTO - Dismayed by the state's dismal record of monitoring its 1,400 nursing homes, Gov. Gray Davis will propose a series of measures in his budget Monday to crack down on repeat offenders and improve the quality of care, administration sources said.

Davis will propose adding 133 inspectors, streamlining the process to revoke licenses and making sure nursing homes in California are financially solvent and patients are protected if a facility suddenly closes.

This beefed-up enforcement proposal is a component of Davis' centerpiece health care plan focusing on the elderly - a $271.5 million ``Aging with Dignity'' Initiative.

Of that total, $140.4 million would come from the state's general fund and the rest from federal coffers.

Although some lawmakers have criticized Davis' decision to focus narrowly on the elderly when there are large issues of HMO reform and uninsured Californians to consider, an administration official defended the governor's choice.

`` 'Aging with Dignity' affects every Californian. There is someone in the family, someone they know and love,'' the source said. ``It's important to show respect for those that came before us.''

But across the state, serious deficiencies have gone unchecked through a system of low fines that are frequently waived or not collected, once-a- year inspections that can be predicted by nursing homes, and a troublesome process for revoking the licenses of the most egregious offenders.

An administration source said no licenses were taken away in California last year, and only two in 1998.

In Los Angeles County, residents in nearly one in five nursing homes that receive federal funding suffer from bed sores, broken bones, waste-tainted bed baths, malnutrition or other serious violations, according to a congressional investigation released in November.

Davis' proposals would increase the number of unannounced inspections of nursing homes by spending $7.4 million for new inspectors. Also, the governor wants to spend $4.1 million to expand a pilot program of intensive review of nursing homes that fail to provide quality care.

The governor pledges that facilities ``repeatedly failing to comply with nursing home standards'' will be placed in receivership or have their licenses revoked, administration sources said.

In addition, the governor wants to ensure more rapid response to nursing home complaints by spending $3.9 million for more inspectors to investigate non-emergency problems within 48 hours. And nursing homes will be required to prominently post a toll-free telephone number for an ombudsman.

Under the governor's plan, fines for violations that result in death would increase from the current range of $5,000 to $25,000, to a new high of $100,000.

The administration also proposes legislation to increase fines for violations that can cause serious harm or death. The current range is $1,000 to $10,000, and the proposed range is $2,000 to $20,000.

In an industry plagued with insolvency - currently 11 percent of nursing homes are facing bankruptcy, according to the state - the governor wants to tighten fiscal standards. In 1997, the owner of a Reseda nursing home filed for bankruptcy and the residents were forcibly relocated late at night - a violation of state law that requires 30 days' notice.

Assemblyman Bob Hertzberg, D-Van Nuys, who authored a bill requiring patients to be notified if a nursing home is facing financial difficulty after the Reseda facility closed, said tougher enforcement proposed by Davis is needed.

``There's a big problem out there,'' Hertzberg said. ``You've got a fast-growing elderly population but a situation where it's hard to get qualified people to provide care. You have a pattern of nursing homes violating the law and a law that has little teeth or enforcement.''

Hertzberg called Davis' plan ``good ideas'' that could provide more protection as well as boosting caregivers' low wages.

Davis proposes establishing a state advisory board that would review and establish new standards and reporting requirements for nursing facility licensees.

For nursing homes with severe fiscal mismanagement, there are no intermediate sanctions short of receivership, so Davis will ask for statutory changes to allow the appointment of a temporary state manger - to be paid by the licensee - in such cases.

The governor also wants to help boost the quality of care in nursing homes, proposing to use $15 million in federal funds to train caregivers as well as $35 million in welfare-to-work dollars for recruitment, retention and training of those employees.

Often notoriously underpaid, workers at nursing homes would have their pay increased by 5 percent, to $6.25 per hour. The hourly pay would rise to $8 per hour over a five-year period.

The governor is also asking for the state's Department of Health Services to review minimum staff-to-patient ratios and make recommendations by the end of the year.

In his State of the State Address last week, Davis said he wants to provide a system where older people could remain at home or be cared for by their families.

He noted that Californians over age 85 are the fastest-growing segment of the population. The number over age 60 will increase from 4.9 million this year to 9 million by 2020, government figures show.

To keep the elderly out of nursing homes, Davis is proposing a $500 tax credit for families caring for seniors at home. And, he would change Medi-Cal provisions to put an additional 13,000 aged and disabled people on the rolls of ``no cost'' health insurance.

Other Davis health initiatives include spending $26.2 million to fight Medi-Cal abuses, and increasing outreach efforts to provide the working poor and their children with low-cost health insurance by spending an additional $10 million in advertising - for a total of $31.8 million.

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