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The pandemic highlighted the quality of care in some nursing homes and, in some cases, the lack of quality. Advocates say regulators aren't doing enough to root out serious problems. States grant licenses to nursing homes, which means they can deny a license to a nursing home operator. But in California, a company that's been denied a license can keep running the nursing home anyway while it appeals. Here's Elly Yu of member station KPCC in Los Angeles.
ELLY YU, BYLINE: There's a nursing home about 40 miles east of Los Angeles, and Cynthia Carrillo says she can't even drive by it anymore.
CYNTHIA CARRILLO: You know, there's too much. I get angry. I get frustrated.
YU: Last year, her brother David was a resident there. It's called Villa Mesa Care Center. David was 65 and had Down syndrome. He was living with Cynthia and her family. But months before the pandemic hit, he started developing dementia and couldn't use the stairs in their house. After a short hospital stay, the nursing home became a temporary place for David while Cynthia looked for a single-story home.
CARRILLO: But it was very difficult to have to leave him and go home. So our goal was to be able to get him out as quick as we could.
YU: Cynthia would visit every day but says his condition got worse. In a lawsuit she filed against the nursing home, she claims David stopped walking regularly and that staff gave him a psychotropic drug she didn't OK. Last March, Cynthia was ready to pull him out to a group home when the pandemic hit. COVID shut everything down. When she went to visit David through a window a couple weeks later, she says staff weren't wearing masks around him.
CARRILLO: It was very hard for us to see that and to see the staff walking around like nothing was going on, you know, regarding the pandemic.
YU: Ten days later, Cynthia woke up to a call at 1 a.m. It was the hospital from across the street from the nursing home. David was in respiratory distress and needed to be intubated. The doctor told her he was coherent.
CARRILLO: But at that time, they had to sedate him to place a ventilator. And I couldn't be there with him (crying) to even let him know that everything would be OK. He was probably wondering where I was.
YU: Cynthia never got to say goodbye. David died a week later from COVID-19.
Since last spring, at least 23 residents at that nursing home have died from the virus, according to federal data. The federal government pays a lot for nursing home care, but it's up to each state to license nursing homes. Advocates say that's created a patchwork of standards that can leave patients vulnerable. In California, determining who even runs a particular nursing home can be difficult. But according to public records, David's nursing home was connected to a chain called ReNew Health. That chain is involved with at least 26 nursing homes across California as either owner, operator or management or administration.
ReNew Health is owned by a woman named Crystal Solorzano. She had applied to the state for licenses to take over nine of the nursing homes. David's was not one of them. But last year, the California Department of Public Health told Solorzano no; all nine license applications were denied. But despite those license denials, her businesses continue to run those nine nursing homes. And in California, that's completely legal.
TONY CHICOTEL: The approval process, the licensure process is a farce.
YU: Tony Chicotel is an attorney with the California Advocates for Nursing Home Reform. He explains nursing home owners can take over facilities without first getting a license from the state.
CHICOTEL: It's a really bizarre, completely exploited process.
YU: The state denied Solorzano licenses based on a long track record of violations documented by the state. At one facility, a nursing assistant was charged with raping a 52-year-old patient. At another, a patient with schizophrenia went missing for weeks. Chicotel says the state's licensing rules don't protect residents.
CHICOTEL: California has, in a sense, rolled out the red carpet for bad providers. Hey, it doesn't matter if you're a bad provider in California; you can get in the building, you can be a squatter, and they can't get you out.
YU: In a statement, a new spokesman said the owner, Solorzano, is, quote, "fully qualified to own and operate nursing homes," unquote. He went on to say they took steps to mitigate COVID and protect nursing home residents.
Here's how the California Department of Public Health explains the licensing process. The agency says new owners of nursing homes can enter management agreements with the previous owners, even while the new owners' license applications are still pending. And if those applications are denied, they can keep running them while they appeal, even if it takes years. Solorzano isn't the only nursing home operator to do this in California. Advocate Richard Mollot says things need to change. He's the director of the New York-based Long Term Care Community Coalition.
RICHARD MOLLOT: There's really no federal involvement here, and there clearly needs to be because the states aren't doing a good job of handling it.
YU: He says that's especially true for nursing home chains that operate across state lines. He wants the federal government to establish stronger standards for vetting nursing home owners. Cynthia Carrillo wants more oversight, too. Even though Villa Mesa, where her brother got COVID, wasn't one of the nine homes denied a license, she felt the denials were a sign that ReNew Health was already troubled. And in October, Villa Mesa was hit with two serious violations related to patient care.
CARRILLO: There should be a line drawn in who they can even give a license to. Their lives are in your hands. They don't deserve to manage - not at all.
YU: Some legislators in California agree the current system may not be working. A bill introduced this year in the state Legislature would require nursing home owners to get their own licenses approved before they start providing care.
For NPR News, I'm Elly Yu in Los Angeles.
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INSKEEP: This story comes from NPR's reporting partnership with KPCC and Kaiser Health News.
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