Florida continues to fund dangerous assisted living facilities

Dec, 30, 2011

Florida continues to fund dangerous assisted living facilities


By MICHAEL SALLAH AND CAROL MARBIN MILLER / McClatchy Newspapers


MIAMI -- When Florida regulators found that a 71-year-old man with mental illness died from burns after he was left in a tub of scalding water at a Hialeah assisted living facility, they could have cut off thousands in state dollars sent to the home each year.

Instead, they imposed a fine.

The next year, when inspectors discovered a caretaker at the facility punched a severely mentally ill man in the mouth, they could have stopped the public dollars to the home. But instead, they issued a warning.

At least four more times in the past four years, regulators turned up neglect cases at All-America ACLF - including failing to provide crucial medication to sick elders - but continued giving $1 million to the home even as caregivers were breaking the law.

Though Florida law gives regulators the power to stop giving Medicaid money to homes caught abusing and neglecting residents, McClatchy Newspapers found that regulators routinely funnel millions every year to some of the state's most dangerous facilities.

Since 2007, the Agency for Healthcare Administration has doled out more than $23 million to nearly 90 homes that could have been cut off from public dollars - including facilities where caretakers were caught beating and sexually abusing frail elders.

The failure of the agency to turn to one of its toughest enforcement tools more often comes after years of neglect and abuse cases rising in ALFs across the state - with nearly one resident dying a month at the hands of caretakers. Most of the money goes to the ALFs to provide a range of support services like feeding, bathing, medication supervision and health therapies.

"As a taxpayer, I'm totally shocked. I'm outraged," said Martha Lenderman, an expert on Florida mental health issues and member of the governor's task force on assisted living facilities. "That pattern is one that we can't afford in human or financial terms. These are vulnerable (people)."

As the top regulator, the Agency for Healthcare Administration says it can choose from a host of different punishments - not just cutting off state funds - to force ALFs to abide by the law. "The agency has broad authority and can impose any number of sanctions or disincentives," said spokeswoman Shelisha Coleman.

But McClatchy Newspapers found that fines imposed by the state were routinely decreased or dropped in the past five years against problem ALFs and homes were regularly allowed to stay open even after the agency threatened to close them.

In those cases when the agency did sever Medicaid dollars this year, the majority of the ALFs are now closed, McClatchy found.

Bentley Lipscomb, former secretary of the state's Department of Elder Affairs, said the failure to stop the flow of public dollars is one of the main reasons troubled homes stay open.

"They know they are not at risk, that's why they haven't changed anything," said Lipscomb, who pressed for the state's first elder abuse law in 1995.

At a Pasco County home, caretakers were supposed to be watching Charlene Webb more carefully because she had been falling. But when the 82-year-old woman fell on the floor in 2009 and urinated on a power cord, the electrical surges ripping through her body, there was no one to help her. Nine times she had pressed the call button, but no one responded until it was too late: Her burns were so severe, she soon died. The Agency for Healthcare Administration could have suspended public dollars to La Casa Grande, but instead ordered a $10,000 fine.

A month later, an 89-year-old woman died after falling a dozen times and was hospitalized nine times for head wounds, broken ribs and two fractured hips.

Again, La Casa Grande could have been cut off - even temporarily - but the money kept coming. Three months after the 89-year-old died, a caretaker struck an 88-year-old woman in the face with the back of his hand, prompting the worker to be fired. Still, the money kept coming.

At least four times between 2007 and last year, the state found abuse or neglect at the home, but continued to provide more than $200,000 a year to the home, records show. A spokesman for Emeritus, the corporate owner, said earlier this year the home had taken steps to resolve the problems, including improved training and staffing.

Year after year, the state had the power to stem the flow of public dollars to homes found committing neglect or abuse - to 18 homes in 2007 and to 62 by 2009 - and redirect the money to places with better track records. But the amount of dollars sent to troubled ALFs actually rose: from $1.4 million in 2007 to $7.6 million last year.

McClatchy Newspapers found that of the 87 homes that continued to reap state dollars after investigators found abuse and neglect, 24 had repeat cases that could have led to the homes losing their funding.

Lenderman said taking action to stop public dollars is not crucial for one case of abuse, but when "it re-occurs, then you have a pattern. This is a public trust. It's not just any business. (Regulators) not only have the authority, but a mandate."

In 2007, state agents found medical neglect in the death of 98-year-old Evelyn Butler, whose caretakers at Forest Lake Manor in Daytona Beach gave her an overdose of blood thinner and then failed to follow doctor's orders and get crucial lab tests for the ailing woman.

A month later, a mistake in dosage to another resident put her in danger when the facility gave her the wrong amount of diabetes medication, causing her to stagger and nearly drop over.

In addition, the state found that at least three other residents were not getting proper medication - including one woman who languished four days without drugs to relieve the symptoms of breast cancer.

Each time, the state continued to fund the home - and each time, the mistakes continued. Last year, just before the facility was sold, state inspectors found untrained workers at the home and no nurse on duty to care for sick and frail elders.

At Edwina Manor in Pasco County, a 79-year-old woman's oozing and rotted foot had to be amputated after caretakers failed to get her help in 2008. That same year, state agents found the home had failed to keep records on three more residents whose health had deteriorated - including one whose pressure sore was severe enough to force a hospital stay.

The next year, 90-year-old Dorothy Archer died after doctors found a gaping pressure sore on her back the size of a grapefruit. A month later, a woman was hospitalized after she had been given such a high a dose of blood thinners that she needed several transfusions.

Each time, the home promised to correct its problems, and every year, the state continued to send the facility money: an average of $300,000 a year.

Though the Agency for Healthcare Administration does impose fines on ALFs - with most ranging from $500 to $10,000 - the amounts pale in comparison to the public dollars collected by the homes to care for elders, records show.

State agents never stopped giving money to Boynton Beach Assisted Living Facility, even after a dozen residents were found roaming the streets, sometimes for days, and others were hospitalized after not getting crucial medications.

While the troubled home racked up 67 violations over the past four years - five times the state average - it was collecting more than $500,000 in state money.

Now, for the first time, the funding could be in question: The facility's longtime owner, Ramchand Ramrup, 35, pleaded guilty in November in one of the nation's largest Medicare fraud cases.

While the state can stop homes from getting public money, it also has the power to suspend payments - a temporary ban - but there's no record of any such actions since 2007.

Coleman, the Agency for Healthcare Administration spokeswoman, said her agency is not compelled to suspend money to homes either, since it can turn to other enforcement tools.

But Lipscomb, a longtime advocate for elders, said as long as homes repeat the same problems, the state has an obligation to strip the homes of public money. "If they (regulators) are not in the business of shutting them down, they should at least be in the business of suspending money to the facilities."

(Trevor Aaronson of the Florida Center for Investigative Reporting conducted the computer analysis for this story.)

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