Caption: Supervisor Mark Ridley-Thomas

Acting on a motion by Supervisor Mark Ridley-Thomas and Board Chair Kathryn Barger, the Board of Supervisors unanimously voted to appoint – for the first time – an Inspector General to oversee skilled nursing facilities, which account for more than half of all deaths from COVID-19 in Los Angeles County. The Board also approved bringing in the Auditor-Controller to ensure closer monitoring of skilled nursing facilities immediately.

The Board tasked the Inspector General with developing recommendations on how to strengthen oversight for skilled nursing facilities, and how to improve their operations long-term. Many skilled nursing homes have a history of getting low marks for quality of care, patient satisfaction, and employee pay.

Last week, an analysis by the New York Times found that facilities with a significant number of black and Latino residents have been twice as likely to be hit by the coronavirus as those where the population is overwhelmingly white. These disparities are heartbreaking, and emphatically underscore the need for better testing and infection control.

“While some skilled nursing homes may be doing their best to respond to COVID-19, we’ve seen hundreds of deaths at these facilities, tragically exposing the urgent need for stronger oversight across the industry,” Supervisor Ridley-Thomas said. “Now, more than ever, we must act to address any questionable operations and substandard conditions in the facilities that care for some of our most vulnerable residents – the elderly, the low-income, and the disabled.”

“Skilled nursing facilities provide critical care and support for many of our most vulnerable populations,” Supervisor Barger added. “As the County fights the COVID-19 public health crisis, we must greatly improve our ability to assess and oversee these facilities to ensure the safety and well-being of all those who have been entrusted to their care.”

Serving thousands of residents to who tend to be older and medically fragile, skilled nursing facilities have become the epicenter of LA County’s COVID-19 epidemic. As of May 22nd, 5,218 residents and 3,140 staff from these facilities have tested positive for the virus.

Across LA County, 53 percent of all deaths from COVID-19 have been in institutional settings, particularly in skilled nursing facilities.

LA County Department of Health Services Director Dr. Christina Ghaly said, “It is our collective responsibility to protect and support the most vulnerable among us. Prioritizing the health and safety of those in our County’s skilled nursing facilities is the right thing to do and will also help protect the availability of hospital resources for all those who need them.”

In their motion, approved by the Board today, Supervisors Ridley-Thomas and Barger said it was critical that LA County learn the lessons of this crisis; identify the internal and external factors that have contributed to inadequate conditions within skilled nursing facilities; and provide oversight, accountability and resources as needed.

They described the proposed Inspector General as a “much-needed accountability measure” appointed to conduct an exhaustive review of LA County’s capacity to regulate skilled nursing facilities, recommend structural and operational changes, and outline a plan for ensuring adequate and sustainable oversight.

They also called for charging the Inspector General with recommending regulatory and policy improvements at the local, state and federal levels, with the goal of enhancing quality of care, ensuring adequate infection control measures, and supporting healthcare workers.

To increase transparency, Supervisor Ridley-Thomas and Chair Barger’s motion also called for directing the LA County Auditor-Controller to take the lead in designing a publicly accessible dashboard with information about their COVID-19 case totals, testing frequency, mitigation plan status, and other information. The motion also sought to find ways to enhance LA County’s ability to assess the adequacy of mitigation plans and to oversee their implementation.