The Honorable Mariko Yamada, Chair
Assembly Aging & Long-Term Care Committee
1020 N Street, Room 360-A
Sacramento, CA 95814

RE: SB 345 (Wolk) Support

Dear Assembly Member Yamada,

I am writing on behalf of the Committee for an Independent State Ombudsman Office (CISO) to express our strong support for SB 345, which would establish a more independent and improved state long term care ombudsman office.

CISO is a grassroots committee made up of local long term care ombudsman programs, housed in non-profit organizations, and sympathetic advocates. Having witnessed for years, the utter silence and lack of action on the part of the state long term care ombudsman to address and seek remedy for very serious issues that affect vulnerable seniors in long term care facilities, we are seeking legislative action that would establish and ensure, through state law and in compliance with federal law, the independence and autonomy of the state long term care ombudsman office.

In order to understand why this is absolutely essential, we need to see the long term care ombudsman office through the lens of the historical setting and sheer tragedy that created it.

In 1971 a consumer watchdog, named Ralph Nader, petitioned President Nixon regarding a horrific nationwide problem involving elderly residents in nursing homes. Residents were being neglected and abused, and dying painful excruciating deaths. He recounted horrifying accounts where, due to lack of regulation and enforcement, 100% of the residents in two nursing homes died excruciatingly painful, agonizing deaths as a result of fire and e-coli. From these heartbreaking accounts of horrendous pain and suffering, the concept of a watchdog for this vulnerable population was born, and the word “ombudsman” was selected because it is the only word in our language that encompasses the whole spirit and letter of exactly the type of watchdog that would be required.

In 1978 the long term care ombudsman office was created. Its duties, responsibilities, and mandates, were written and clearly spelled out in federal law. Those mandates state that the Ombudsman program must have the ability to speak freely on behalf of care facility residents, and take positions on legislation without interference from licensing or other agencies. In each state the office for this watchdog would be formally known as the Office of the State Long Term Care Ombudsman (OSLTCO).

In California, the OSLTCO is located within the Department of Aging and answers to the Director of the Department of Aging and the Director of the Health and Human Services agency. The Health and Human Services agency also houses the Department of Public Health which licenses skilled nursing facilities and the Department of Social Services which licenses residential care facilities for the elderly. A conflict of interest (as determined by the Federal Older American’s Act) currently exists where the Ombudsman is in a shared agency with programs that license long term care facilities.

As a result, over the years, the State Ombudsman has not taken positions on legislation that affect care facility residents and local Ombudsman programs. This includes efforts to cut funding to the local Ombudsman programs and efforts to stop the overmedication of care facility residents. In both of these examples, the State Ombudsman was not able to provide public testimony or take a public position because its “sister” agencies (Department of Public Health) and the Governor’s office were not supportive of the State Ombudsman’s position. This failure to take action resulted in drastically cutting services to this vulnerable population, dangerous understaffing at the local Ombudsman programs, and the continued drugging of care facility residents.

In addition to its failure to speak up for residents, the state ombudsman office has a history of obstructing local ombudsman programs from addressing abuse and neglect of residents. These problems are well documented in the California Senate Office on Oversight and Outcomes 2009 report, California’s Elder Abuse Investigators: Ombudsmen Shackled by Conflicting Laws and Duties.

As amended, SB 345 would address the lack of independence and advocacy by codifying key advocacy duties established in the federal Older American’s Act, requiring the state ombudsman office to establish an annual advocacy plan in coordination with local ombudsman programs, directing the state ombudsman office to establish a consumer-friendly website, and creating a new process for selecting the state ombudsman.

The Committee for an Independent State Ombudsman Office strongly urges the Assembly Aging and Long- Term Care Committee to vote “yes” on SB 345 as amended.

Sincerely,

Sylvia Taylor-Stein
CISO Team Leader

Cc: Senator Lois Wolk
Members of the Senate Human Services Committee
CISO Committee & Advisors:

Clift Wilson, Manager, Program Services, Ombudsman & HICAP Services of Northern California
Eric M. Carlson, Directing Attorney, National Senior Citizens Law Center
Joan Parks, Administrator, Ombudsman & HICAP Services of Northern California
Karen Jones, Ombudsman Program Coord., Long Term Care Ombudsman Svcs., San Luis Obispo Cty.
Kathleen Johnson, Executive Director, Advocacy Inc., Santa Cruz County
Linda Robinson, Ombudsman Program Coordinator, Advocacy Inc., Santa Cruz County
Michael Connors, Advocate, California Advocates for Nursing Home Reform
Molly Davies, Vice President, WISE & Healthy Aging, Los Angeles
Nina Weiler Harwell, PhD, Associate State Director-Advocacy, AARP
Shirley Krohn, California Senior Legislature
Sylvia Taylor Stein, Executive Director, Long Term Care Services of Ventura County, Inc.,

I want to update you on our advocacy efforts to create a stronger and more effective state ombudsman office in California. The Bill SB345, author Senator Lois Wolk, sponsor CISO, was passed by the Senate Health and Human Services Committee and the Senate Appropriations Committee, and passed out of the Senate with a 26/9 vote in favor. It has been amended with the additional Older American Act Language. It is now in the Assembly and should be scheduled for hearing soon before the Assembly Aging and Long Term Care Committee. SB345 is a much needed bill as it aligns state and federal law, and utilizing the current federal law that governs the state ombudsman office, it helps ensure a much improved state ombudsman office. I also want to add that the cost of this bill is not impactful as it is underwritten by the over $1,000,000 of federal funds that currently flow into the state office every year.

It is time California long term care residents and disabled persons had the advocate at the state level that was envisioned when this program was created back in 1978.

I have attached the CISO letter of support for your review, and the roster of committee members for the Aging and Long Term Care Committee. Please help us give the elderly and disabled a stronger voice at the state level by faxinga letter of support to Chairman Yamada, and the Aging and Long Term Care Committee members by March 5, 2012. Please copy us on your letter.

Thank you so very much!

Sincerely,

Sylvia Taylor-Stein
Committee for an Independent State Ombudsman Office (CISO)

SB 345 has passed another hurdle. Vote on Senate floor 26 in favor 9 opposed. Yahhhhhhhhhhhhhhhhh!!

Now on to the Assembly.

So grateful for your support of this bill.

Sylvia

I want to let you know that SB 345, for which the Committee for an Independents State Office (CISO) is the sponsor, is scheduled for hearing January 10th at 1:30 PM before the Senate Committee for Health and Human Services.

I have attached the fact sheet for your review. Factsheet (75)

I have also attached CISO’s support letter of the bill.Support Letter (59)

As the CA Dept of Aging will be auditing our local ombudsman program next week, I am unable to attend the hearing, but two members of our CISO committee will be speaking on behalf of the bill.

SB 345 has gone through many revisions since we started back in February of 2009, and there have been many rewrites, but the most significant revision which was the cornerstone of the bill involves the outsourcing of the state ombudsman office to a private entity. We were forced to eliminate that section as the CA constitution prohibits the elimination of civil servant positions as a result of outsourcing to a private entity, and the bill, in its original form, would have eliminated about 8 civil servant positions.

The bill is not where we started, but the revised bill, SB 345, when enacted, will be a good first step toward strengthening the state ombudsman office in that it will mandate stronger advocacy and accountability from that office.

I wanted to share this with all of you as many of you have been on this long journey with us for the past three years, and we very much appreciate all your encouragement and support.

I also want to wish each of you a very Happy and Healthy New Year, and thank you for being such an integral part of our community and our team.

Warmest regards,

Sylvia

Sylvia Taylor Stein

Team Leader

Committee for and Independent State Office (CISO)

The state is one of only a handful in the U.S. that does not regulate in-home care agencies, which provide help with activities of daily living such as bathing, dressing, hygiene and eating. The oversight office discovered that a 2008 law intended to help seniors and their families do their own background checks has never been implemented. As a result, very few people who hire caregivers from on-line services such as Craigslist take advantage of their legal right to order a statewide criminal background check through the Department of Justice.

In its report, “Caregiver Roulette: California Fails to Screen those who Care for the Elderly at Home,” the oversight office examined Craigslist ads placed by people offering to care for elderly clients in their homes. The oversight office found caregivers with criminal backgrounds, including convictions for commercial burglary, methamphetamine trafficking, and prostitution in a home where a young child was present. One would-be caregiver, caught stealing $2,400 worth of merchandise from a garden supply store, described herself to a sheriff’s investigator as a “kleptomaniac” with “uncontrollable urges.”

 The report is available here.

 A review by the oversight office of 64 recent criminal cases involving caregivers found that 27 percent had previously been convicted of crimes, underscoring the potential value of requiring criminal background checks. In one case cited in the report, a woman convicted of stealing $43,000 from the church where she worked as a bookkeeper and $18,675 from her bed-ridden mother got a job as a caregiver through a newspaper classified ad. She moved into the master bedroom and started charging the client rent, bought cars on her client’s bank accounts and put the elderly woman’s house up for sale before she was caught.

 “Maybe there need to be some regulations that say you don’t get to just walk in off the street and live in someone’s home,” said Kellie Ikenberry, whose parents unknowingly hired a caregiver with a criminal background who stole from them. “Government has to protect these elderly people.”

 The report points out that, in the absence of regulation, many in-home care agencies claim to do criminal background checks voluntarily. But the quality of these checks varies widely, from instant Internet screening to thorough searches of county courthouse records or Department of Justice and FBI databases. Clients victimized by caregivers have sued in-home care agencies for shoddy background checks. Prosecutors have taken agencies to court for ignoring criminal backgrounds they discovered and placing felonious caregivers in private homes anyway.

 In a survey of states that include 83 percent of the U.S. population, the oversight office found that 24 regulate in-home care agencies, including requiring criminal background checks. Six, including California, do not. The report makes several recommendations, including some that would address the perils faced by consumers who hire caregivers without the help of an agency.

 Among the options are a registry that would allow clients to find independent caregivers who have voluntarily been screened and avoid those guilty of earlier transgressions; a public education campaign to let consumers know how to get and interpret a statewide Department of Justice background check; and a state law to allow consumer reporting agencies to disclose caregiver convictions older than seven years.

 The non-partisan Senate Office of Oversight and Outcomes was created in 2008 by Senate President pro Tempore Darrell Steinberg (D-Sacramento) to bolster the Senate’s ability to gauge government performance.

John Hill

Principal Consultant

California Senate Office of Oversight & Outcomes

(916) 651-1657

Fax: (916) 324-5927