I know this as a former newspaper reporter, a former elected official, and as a continuing consumer of news. It takes blood and guts or sex and sleaze or at least some kind of scandal to get attention from the media.
So, I know that when ODCA produces an audit report that does NOT call for someone to be drawn and quartered it will be a very tough sell to the journalism outlets that routinely cover District news.
And so it was with this one: D.C. Department of Health Has Systems to Monitor Nursing Homes But Some Risks Remain published on September 30, 2019. No press.
Same with this one: Modeling the D.C. Economy, Revenues and Debt Service Obligations published on November 13, 2019. A snoozer.
The one that did surprise me in not getting any press attention was this one: Residents Give District High Marks for City Services published November 4, 2019. It was a public opinion survey, for Pete’s sake, with information not to be found anywhere else. (Except on the pages of The Washington Post a couple of weeks later when the Post began running daily stories from its own survey of D.C. residents with some but not all of the same or similar findings. Surely the Post did not ignore our survey because they had one of their own in the works? Surely not.)
And, of course, there are those who believe that auditors are only looking for problems and don’t care about good stuff.
Not so at ODCA!
Anyway. Each of these non-newsworthy reports had some good news going for it and I’m going to share those good things now!
Lookin’ good, D.C.!
Even though it didn’t get any press attention, we’ll use the resident public opinion survey to help set ODCA priorities for the next few years. This new survey followed up on a survey conducted for the financial control board in 1997, and we asked residents what their priorities are, and to rate the quality of 26 specific city services.
We learned District residents are mostly happy campers: half rated services generally as either good or excellent while only one in eight said the services are poor or very poor (13%). And that’s a huge difference from the 1997 survey when only 15% rated District services as excellent or good and a whopping 48% said services were poor or very poor.
The two top-rated services are public libraries and fire protection. The only service that dropped since 1997 in the number who rated it as good or excellent was the Washington Metropolitan Area Transit Authority (Metro)–a sign that Metro’s troubles are noticed by the District’s residents. Still, 52% continue to rate Metro positively, down from 79% in 1997.
In 1997, crime dominated responses about the most important problem facing the city, but the next highest response–offered by more than one in 10–was that the D.C. government itself was the top problem (11%). This year the District government did not register as a problem or an issue. On the same question in 2019 the top issue cited was a combination of affordable housing and gentrification at 33 percent–and those issues did not register for respondents in 1997.
A closer examination of attitudes toward three city services among direct users of those services shows another mixed review:
The survey was conducted between July 13 and August 12 by Belden Russonello Strategists and Emma White Research and asked 1,210 residents 18 and older to rate satisfaction with and priorities for District services.
One hand, other hand
“Overall,” I said on our nursing home report, “we found that HRLA had systems in place to monitor each aspect of the oversight process” while at the same time “we identified steps HRLA can take to improve those processes and reduce risks that could seriously impact people’s lives.”
That ODCA found that the Health Regulation and Licensing Administration is doing pretty well in overseeing nursing homes serving some of the city’s most vulnerable residents is remarkable when you put our report alongside nursing home news from around the country. Worst such news in recent years: the drowning deaths of several dozen bedridden patients when Hurricane Katrina struck Louisiana.
The challenge of protecting vulnerable elderly citizens has prompted a robust reporting system at the federal Centers for Medicare and Medicaid Services. Every nursing home reimbursed by these federal health care programs has reports online describing its current rating and any history of individual complaints.
To assess the District’s own oversight, we reviewed samples of nursing home complaints, staffing records, and resident discharge and transfer notices, and looked more closely at six of the District’s 18 nursing homes.
We found instances when HRLA had identified a problem with patient care but the problem was subsequently repeated. Nursing homes are required to provide a Plan of Correction that outlines how they will fix problems identified by inspectors; out of 42 such plans, ODCA identified eight that did not clearly identify the root cause of the problem as a step to prevent recurrence.
We recommended a “root cause” analysis—that HRLA train staff with responsibility for reviewing Plans of Correction on how to be sure that the correction plan identifies the underlying cause of the problem.
The report also found HRLA investigated some complaints late because it did not always prioritize complaints accurately and in a timely manner. We recommended that HRLA design, implement, and train staff in policies and procedures for all complaint intake methods.
In their written comments on the report HRLA agreed in whole or in part with six of our 10 recommendations. Department of Health Director Dr. LaQuandra S. Nesbitt wrote she was pleased that we recognized her agency’s efforts to provide “an effective regulatory framework.”
Checking on the money
Whenever the District goes to the bond market the D.C. Auditor is required to certify the revenue estimates produced by the Office of the Chief Financial Officer (OCFO)–a step ODCA took on three occasions in FY 2019. To underscore that we take this responsibility seriously we contracted with the District Economics Group (DEG) to design and build a revenue forecasting model to serve as our own independent assessment for future revenue certifications. We used the model for the first time when I signed a certification letter December 4, 2019, with the issuance of Income Tax Secured Revenue Bonds.
To be fully transparent we issued a report November 13, 2019, in which DEG described the forecasting model: just how they analyzed the District’s economy, all sources of revenue, and our ongoing debt service obligations. It includes a forecast of what the next recession could look like in the District. It recounts the impact of recent legislation on revenue sources. The report’s Table 10 counts the number of changes made to the District’s tax code since 2002. The magic number? A hundred and seventy-eight! Individual tax code changes. Nineteen changes in 2016; only three in 2004.
The bottom line in the modeling report? Our independent assessment produced annual forecasts of the District Gross Domestic Product that are not identical to the OCFO numbers but are close.
And that’s it for the non-news news from the Office of the D.C. Auditor.
Wishing everyone a news-free new year!
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