Washington long-term care ombuds: ‘This is a statewide problem, and it seems to be increasing’
By Alexis Weisend
The state of Washington prohibits nursing homes from kicking out residents without letting anyone know.
But legislators have failed to extend the same protections to residents of adult family homes and assisted living facilities, which generally provide a lower level of care but still house some of the state’s most vulnerable people.
“We can’t just leave people out,” said state Sen. Paul Harris, R-Vancouver, whose bill aimed at solving the issue died last session in the House, where he was serving at the time.
Attorneys and ombuds say the result is an undocumented surge of displaced residents that’s fueled by a boom in adult family homes, an aging population, and the state’s mental health and addiction crises.
By the numbers
The number of adult family homes in Washington increased by 45% between December 2020 and June 2024.
Number of adult family homes and assisted living facilities:
Washington: 5400
Clark County: 500
Number of complaints filed about discharges, transfers and admissions between Oct. 1, 2021, and Sept. 3, 2024:
Washington: 2,171
Clark County: 282
Number of citations issued:
Washington: 806
Clark County: 14
SOURCES: Washington Department of Social and Health Services
“This is a statewide problem, and it seems to be increasing,” said Patricia Hunter, Washington’s long-term care ombuds. Her office advocates for residents of nursing homes, adult family homes and assisted living facilities.
Assessing the scope of the problem is challenging. The state has no easy or reliable way to track the expulsions, and the lack of oversight means some go unreported, attorneys and ombuds say.
Expulsions from adult family homes and assisted living facilities are not filed in court like regular tenant evictions because the state’s Landlord-Tenant Act doesn’t apply.
The state requires nursing homes to send a copy of a discharge and
transfer notice to the state ombuds; residents have the right to appeal.
Adult family homes and assisted living facilities are left out of these
requirements under the law.
“People are really left in this kind of nowhere-land,” said
Elizabeth Landry, an attorney with Northwest Justice Project who works
on such cases.
Without involvement from outside parties, residents can be kicked out or transferred without proper notice or procedure with no one besides the resident informed, Hunter said.
As a freshman senator, Harris plans to introduce another, more targeted bill to protect adult family home and assisted living residents. Whether it passes is up to the rest of his colleagues.
“Some of these people are our most vulnerable, and we have an aging population. They need to be in the right place with the right services,” he said. “We’ve got to figure this out.”
Attorneys
In 2022, Landry received a call about a man in Vancouver whose assisted living facility would not let him return to the home after making a full recovery at a hospital, despite doctors’ insistence that he was ready and able to return.
“By the time he contacted us, he was homeless,” Landry said. “It’s definitely a problem because people really don’t like to be in the hospital, and it’s very costly for them to remain in the hospital.”
Landry was able to get the man, who has since died, back into the facility. But many people in his situation aren’t as lucky because they aren’t aware lawyers can help, she said.
Under Washington law, residents of adult care facilities must receive a 30-day notice before a discharge or transfer, unless the home sends them to the emergency room or they haven’t lived in the facility for 30 days. The only reasons someone could be made to leave are nonpayment of fees, care needs exceeding the facility, the facility closes, or the health and safety of other residents would be endangered.
The notice must include the reason for the discharge and provide phone numbers to advocacy organizations and the state ombuds.
Meredith Grigg, an attorney for Northwest Justice Project who has worked on these cases for the past two years, said discharge or transfer notices aren’t always given or correct.
“Many providers ignore these requirements and simply tell the resident to leave or give them an inadequate notice of eviction. Other providers send residents to the emergency room on some pretext and then refuse to let the resident return,” Grigg said.
Lacking tracking
Expulsions from adult family homes and assisted living facilities — unlike typical tenant evictions — are not recorded with any legal or governmental institution.
While experts debate what could be causing rising trends in tenant evictions, they’re in the dark about those kicked out of adult family homes and assisted living facilities. The only people required to receive a notice of a discharge are the resident and the resident’s legal guardian, if they have one.
It’s challenging to determine whether unlawful discharges have increased in these homes because the state lacks a reliable way to track them.
The state Department of Social and Health Services can only provide complaint numbers from the past few years due to a change in computer systems. Discharge and transfer complaints are challenging to separate from admission complaints, according to a DSHS spokesperson.
DSHS received 2,171 complaints of that nature statewide and 282 in Clark County between Oct. 1, 2021, and Sept. 3, 2024, according to data obtained by The Columbian. Meanwhile, DSHS issued 14 citations to facilities in Clark County for those kinds of violations.
Firsthand accounts from residents are scarce. Many of those discharged are older adults who have since died. Others slip through the cracks.
One woman, who called The Columbian in August alleging she became homeless after a Vancouver adult family home kicked her out without notice, couldn’t be reached again because her phone was disconnected.
“The state needs to better understand why long-term care residents are discharged from these settings,” Hunter said.
Mental health, addiction
Neil Degerstedt, Southwest Washington’s long-term care ombuds, said the most common reason he sees people discharged or transferred in this region is for their behavior. The second is nonpayment.
Washington’s mental health crisis and addiction epidemic are added stressors, especially for small adult family homes struggling with staff.
“I think our providers are trying to manage issues that are very different than we were trying to manage 10 years ago,” said Amy Abbott, director of Residential Care Services, the DSHS division that receives complaints, conducts investigations and issues citations.
State-certified training classes on caring for people with dementia, mental illness or developmental disabilities are available but only go so far. Not every staff member of an adult family home is required to take that training, which is typically eight hours. Degerstedt said the state does not know if the specialized training for providers is filtered down to direct care staff.
“Our guess is some of the time,” he said.
Degerstedt said some homes might kick residents out onto the streets but that doesn’t happen often. Homes more frequently drop residents off at hospitals.
“We had probably the most calls from local hospitals in the last 2½ years than we have in the prior 10 years,” Degerstedt said.
Adult family home boom
Adults older than 60 now make up a quarter of Washington’s population, according to the Washington State Plan on Aging. As the number of older adults grows, so does the need for affordable options for care that accept Medicaid.
That’s driving the increase in the number of adult family homes in Washington, which rose from 3,337 in December 2020 to 4,844 in June 2024, a 45 percent jump.
Adult family homes make up most of the state’s long-term care facilities and most of the complaints regarding discharges, transfers and admissions. Unlike the more institutional setting of an assisted living facility, adult family homes are small businesses, each with fewer than eight residents.
“I speculate that some of the issue is new providers eager to fill their beds and not understanding the conditions of some of the residents,” Hunter said. “They may be new to the business and not have the skills to care for some of these complex residents with behavior challenges.”
A gray area
John Ficker, executive director of the Adult Family Home Council, said staff of adult family homes often do everything they can to help a resident before discharging or transferring them.
“There were very few cases that we could speak to personally where the issue was that the resident’s level of care was appropriate and the provider was for whatever reason discharging them without following the appropriate rules,” Ficker said.
More often, Ficker said, the adult family home made a technical error, such as giving a discharge notice with a missing piece of information.
Ficker said adult family homes are often run by families and help fill a gap in Washington’s long-term care system.
“The level of care that we’re doing in adult family homes is significantly higher than we see in assisted living or even in-home care. It’s not uncommon that I could go visit an adult family home and meet five or six residents with significant Alzheimer’s,” he said.
Degerstedt said long-term care facilities are some of the most regulated agencies in the country because they care for people with complex needs.
“We’re seeing a much more intense level of care in adult family homes than ever before. So because of that, there should be protections for the residents that they’re caring for,” Degerstedt said.
Overwhelmed hospitals
If a placement at a home doesn’t work out, sometimes due to social factors rather than medical ones, residents often end up at the hospital, said Zosia Stanley, vice president and general counsel of the Washington State Hospital Association.
“We are acute-care providers. We are great at that. We’re not long-term care providers, and we’re not home settings,” Stanley said.
When assisted living centers and adult family homes push residents into hospitals, that takes beds from people who need medical care. Washington already has the lowest number of hospital beds per capita in the country, according to KFF, a policy research organization.
“If we’re able to discharge people timely who are ready — who no longer need hospitalization — for the most part we would have enough beds in the state,” said Chelene Whiteaker, senior vice president of governmental affairs for the state hospital association.
Transfer trauma
People being inappropriately discharged or transferred happens far too often, said Grigg, the attorney. It can sometimes land people in unsafe environments or have lasting negative effects.
“The problem only seems to be getting worse,” Grigg said. “It’s especially concerning because people who need long-term care are inherently vulnerable and can experience serious transfer trauma when they are evicted without planning.”
In 2023, AARP wrote about a nursing home closing down in Virginia. Half of the relocated residents died within less than a year of moving, AARP reported.
Transfer trauma is part of the reason Harris introduced House Bill 1859 last session to give residents of adult family homes and assisted living facilities the same rights as nursing home residents.
A few years ago, his mother-in-law with dementia was moved from one floor to another in an adult care facility.
“That might not sound like it was that big of a deal, but … when they already have confusion, when you move an individual to a different setting, it confuses them even more,” Harris said.
Since then, Harris has heard from 10 Clark County families about loved ones being kicked out of adult family homes and assisted living facilities.
Harris’ bill died in committee after major pushback from adult family homes.
The language of the bill mirrored federal rules for nursing homes, many of which are impossible to implement in an adult family home setting, said Ficker of the Adult Family Home Council.
For example, the bill required that a medical director sign off on discharges and create a grievance panel of residents. Adult family homes don’t have that level of staffing.
“This isn’t like a large facility with nurses and administrators. This is a family that has opened their home and taken in between two and six residents to provide them with care and services,” Ficker said. “We just need the rules to reflect the size and scope of our operation so that we can implement them successfully.”
Extending rights
Some states, including California and New Jersey, require assisted living facilities to follow the same eviction procedures that apply to tenants generally, including going to court.
Washington has no plans to implement such a change. However, DSHS is working on revising the rules to ensure that Medicaid clients are informed of their right to legal counsel, and the state ombudsman, as well as the resident’s Medicaid case manager, are notified of any transfer or discharge, said Abbott of Residential Care Services.
DSHS does not have the power to extend these rights to all assisted living facility and adult family home residents — just Medicaid clients because it’s a federal program.
The state Legislature, on the other hand, does have that power. Legislators could also enshrine in law the right to appeal an expulsion, a right nursing home residents have.
Harris said he will consider a bill specifically focused on discharges and transfers, extending the protections DSHS is considering for Medicaid clients to all residents. Changing the law would require careful consideration to ensure homes aren’t keeping residents they cannot care for, he said.
“But at the same time,” he said, “I don’t want them releasing (residents) to the street either.”
Full Article & Source:
Vulnerable people quietly kicked out of Clark County’s adult family homes and assisted living facilities
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