New laws aim to better protect California nursing home residents, essential workers from infectious outbreaks

When the coronavirus pandemic struck, some health care workers resorted to wearing trash bags over their clothes and bandanas around their faces in a desperate effort to protect themselves.
And as the unfamiliar virus ravaged nursing homes, it became clear these facilities needed all the infection control guidance they could get.
The pandemic has spawned a couple of new California laws that aim to better prepare the state and health care facilities, including nursing homes, for future infectious disease outbreaks. But as the state faces a new surge of infections, some of the provisions of these laws won’t go into effect for nearly a year or longer.
State Sen. Richard Pan, D-Sacramento, in Sacramento, Calif. September 2019. (AP Photo/Rich Pedroncelli) 
One of the laws requires the state to create a personal protective equipment stockpile for health care workers and other essential employees for use during emergencies starting Sept. 30 of next year. It also requires health care providers, including hospitals and nursing homes, to maintain an inventory of PPE for all their workers enough for 45 days of pandemic-level consumption starting in 2023.
“The cost of not having that buffer is very high, both financially and in terms of lives,” said Sen. Richard Pan, D-Sacramento, who co-authored the bill with Sen. Connie M. Leyva, D-Chino.
More than 20,000 COVID-19 cases among essential workers in the state may have been avoidable if proper PPE had been available before the pandemic, a UC Berkeley Labor Center study found in August. Moreover, it’s “likely that dozens of deaths” among these workers could also have been avoided.
While a state stockpile was created after the 2009 H1N1 swine flu pandemic, it wasn’t maintained. Meanwhile, when overseas capacity was disrupted during the coronavirus pandemic, President Donald Trump did not use his authority to reorganize manufacturing to build domestic capacity, said Pan, a pediatrician.
Dr. Michael Wasserman, immediate past president of the California Association of Long Term Care Medicine, said that while having a state stockpile sounds great, the “devil’s in the details.”
“We don’t want (the state) stockpiling PPE to get in the way of every nursing home and assisted-living facility in the state having an abundance of PPE,” he said, adding that the state should also manufacture such equipment for itself in the future.
Dr. Michael Wasserman, immediate past president of the California Association of Long Term Care Medicine. (Photo by Michael Owen Baker, contributing photographer) 
A second law recently passed requires nursing homes, in the event of a declared emergency related to a communicable disease, to report each disease-related death and suspected death to the California Department of Public Health within 24 hours.
“It’s important from a standpoint of being able to monitor and track the progress of disease so the state knows what’s going on in facilities very, very quickly,” said Assemblyman Jim Wood, D-Santa Rosa, who authored the bill.
While the state began requiring nursing homes to report COVID deaths within 24 hours in March, the new law codifies the new approach and applies it to any communicable disease, according to industry representatives. Before COVID-19, nursing homes reported communicable disease cases and deaths to their local health departments.
The law, which goes into effect on Jan. 1 of next year, also requires nursing homes to notify residents and their representatives about cases of communicable diseases in compliance with privacy laws.
Finally, it requires skilled nursing homes to have a full-time infection preventionist who is either a registered nurse or a licensed vocational nurse. The state started requiring full-time infection preventionists amid the pandemic, but the law makes this a requirement year around.
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Tony Chicotel, a staff attorney at the California Advocates for Nursing Home Reform, called requiring a full-time infection preventionist “a good step.”
There’s still not a federal requirement to have a full-time IP and it’s not a requirement in most states, making California a leader, he said.
“It’s the difference between wearing lots of different hats in a facility rather than someone dedicated to that mission,” Chicotel said. “From my expectation, there would be a lot of better habits because of that focus.”
The bill could have gone further, however, by requiring the infection preventionist to be at least a physician or a registered nurse since they are “better trained” for the job, he said.
Meanwhile, the nursing home industry was neutral on both reform bills. It initially had concerns about ensuring adequate state reimbursement for a full-time infection preventionist and criminal penalties attached for noncompliance, said Deborah Pacyna of the California Association of Health Facilities.
“In both of these cases, we are okay with the final versions and recognize the importance of policies concerning adequate PPE and infection prevention,” she said by email.

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