Regulating facilities where Arizonans receive services is a key, one might say cornerstone, function of a state health department. When a state health department is doing a good job regulating facilities like nursing homes, assisted living centers, behavioral health facilities, outpatient treatment clinics and the like, journalists’ stories are generally about how a facility did poorly on an inspection and highlight agency enforcement actions.
It’s an altogether different story when an agency deprioritizes their assurance and licensure mission and journalists end up writing about how lax or even nonfeasant and agency becomes. When that happens, stories become not so much about noncompliant facilities, but about poor regulation and unchecked substandard care.
That’s precisely what happened toward the end of the Ducey Administration. On former Director Christ and Herrington’s watch, ADHS licensing programs continued to atrophy until the Arizona Auditor General exposed gross nonfeasance on the part of the agency.
See:
- Arizona Department of Health Services—Department did not investigate or timely investigate some long-term care facility complaints | Auditor General
- Arizona Department of Health Services 30 Month Review
- Arizona Department of Health Services LTC followup\
Following each of those reports, journalists weren’t writing about substandard facilities, but about substandard performance of the entire licensing and regulatory system.
- AZ did not properly investigate nursing home complaints; report says (azcentral.com)
- Auditor General’s Report of the Arizona Department of Health Services Nursing Home Complaint Investigation Performance
That 2019 Arizona Auditor General Report found, among many other things, that ADHS (during the Director Christ/Herrington era) failed to investigate long-term care facility complaints. They even discovered Christ lowered the priority level of 98% of their open high priority nursing home complaints, giving the appearance they were making improvements (high risk complaints need to be done in 10 days vs months for the others).
A core reason why the agency failed the people of Arizona during the prior administration was its leadership (leadership which is now gone from state government). Among the reasons, perhaps THE CORE reason for their terrible performance was a hiring freeze that was imposed on ADHS by former Governor Ducey’s team.
Each agency received a ‘cap’ on the number of personnel they could have. That led agency directors (Christ/Herrington) to decide what jobs to fill and not fill as people retired or left the agency. A smart and ethical director would recognize that she or he should prioritize filling posts in clear core regulatory areas – like the positions responsible for regulating care facilities like nursing homes, assisted living centers and the like.
Sadly, filling those types of positions weren’t a priority for Christ or Herrington – and the agency became less and less effective at regulating care facilities over the course of time – resulting in the terrible outcomes identified in the Arizona Republic’s The Bitter End Series by Caitlin McGlade Melina Walling & Sahana Jayaraman:
How The Arizona Republic reported on resident harm in senior living facilities
The Legislature Intervenes
The shocking Auditor General findings finally got the attention of the state legislature, and in 2022 they distributed an additional $1.6M for ADHS to hire licensing staff. Sadly (but not unexpectedly) Herrington failed to hire any staff with those funds.
The attitude of the agency finally changed in early that things need to change with the departure of Herrington and the advent of the Hobbs administration. Tom Salow, new chief of the Licensing Division, posted a blog that reflects a new attitude at the Agency committing to fix their problems rather than sweeping them under the rug as had occurred during the Ducey era.
“There were significant changes to the ADHS Division of Licensing leadership team prior to the release of the 2022 Report. Our current leadership team agrees with the Auditor General that no excuses can justify the additional findings in the 2022 Report, and the failure to implement the recommendations from the 2019 Report. We recognize the importance of correcting these issues to help ensure the health and safety of the vulnerable populations that reside in Arizona’s LTC facilities.”
The Agency is now in the midst of a months-long effort to recruit, train and keep inspectors to fill the talent void left by the Christ and Herrington administrations – but the minimum qualifications are robust and the training time significant, and the process of filling badly needed positions hasn’t been fast.
In the meantime, legislators of both parties are acutely aware of the shortcomings of the department’s licensing performance (despite recent positive leadership changes and a culture that now embraces quality improvement rather than denying bad performance).
In this year’s budget, Governor Hobbs proposes to appropriate funds to add 16 employees to follow up on complaints, general inspections, and enforcement. However, even if those funds are appropriated, the Department would still need to increase their licensing fees to ensure a stable funding source for long-run success.
Legislators are rightfully frustrated by what they’re hearing from constituents and reading in the newspaper and are proposing several bills that would help the ADHS do a better job regulating institutions over the long run including:
- HB2111 licensed facilities; transfer; sale; prohibition – Prohibits the ADHS from acting on an application for licensure of a currently licensed health care institution while any enforcement or court action related to their license is pending. Passed House Committees.
- HB2249 – residential care institutions; inspections – Adds behavioral health residential care facilities to the list of places for which ADHS can’t accept accreditation in lieu of a compliance inspection (eliminates deemed status). Passed House 57-0.
- HB2653 – assisted living care; reporting; monitoring; injury – Greatly enhances incident reporting requirements for assisted living facilities and establishes optional electronic monitoring options (with limitations). Requires staffing registry checks. Passed House Health 8-0.
- HB2764 – long-term care; enforcement; memory care – Raises the cap on ADHS imposed civil money penalties to $1000 per patient per day. Requires ADHS to develop a separate certification for assisted living facilities or nursing care institution that wants to provide enhanced memory acre services to residents. Passed House Health 9-0
- SB1655 – health care institutions; regulation – Increases the cap on civil penalties for violation of health care institution statutes from $500 to $10,000. Establishes the Indigenous Peoples Protection Revolving Fund with money from civil penalties. Passed Senate Health 7-0
But remember, even if all these new policy changes pass and are signed, real improvements will only come if ADHS continues to rapidly improve their processes and recruit, train, and retain inspectors. In short – they need to continue to dig out of the 8-year hole they were left by Christ & Herrington.