Abuse charges against four eldercare workers underscore gaps in state oversight

by Bryant Furlow

Four New Mexico caregivers have been criminally charged for abusing elderly residents at assisted living, group home and home care facilities in Rio Rancho, Las Vegas and Santa Fe, following investigations by the state’s Department of Justice (NMDOJ). 

In three of the cases, the alleged assaults were caught on video. Such dramatic evidence of alleged eldercare abuse is rare, one national expert told New Mexico In Depth on Wednesday, adding that abuse often goes unreported and unaddressed, in part because there are gaps in oversight of such facilities. 

The four defendants are Salomon Sanchez, 20, a worker at Community Options, Inc.’s facility in Santa Fe; Lee Carrizales, 64, an employee at Pacifica Senior Living in Santa Fe; Edwards D. Bonilla-Aguinada, 34, of MorningStar of Rio Rancho Assisted Living; and Linda Romero, 52, a paid home caregiver who allegedly repeatedly struck a developmentally disabled patient in front of witnesses, according to court filings.

Each of the four is charged with abuse of a resident, a petty misdemeanor punishable with up to six months in jail. Two of the facilities told New Mexico In Depth on Wednesday the charged employees had been fired. 

“These charges send a clear message that abuse of vulnerable New Mexicans will not be tolerated,” Attorney General Raúl Torrez said Tuesday in a press release. 

The NMDOJ disclosed videos of two of the incidents, involving Sanchez and Carrizales, but did not publicly release video of Bonilla-Aguinada’s alleged assault of an 89-year-old woman with Alzheimer’s, out of sensitivity for the victim, who had soiled herself, according to spokeswoman Lauren Rodriguez. The incident with Romero was not recorded. 

On May 11, 2024, two videos — one taken shortly after the other at Community Options, Inc.’s Camino Esquina group home for people with developmental disabilities, in Santa Fe — show a person identified as Sanchez slapping, grabbing and shoving a wheelchair-bound resident. At one point he grabbed the resident from behind, forcing their head down.

“No one’s taking you to the bathroom, fool – no one,” he can be heard saying in the video. “Play with your toys. No bathroom!”

In a May 5, 2024 video taken at MorningStar of Rio Rancho Assisted Living, which was not released by NMDOJ, a person identified as Bonilla-Aguinada is seen aggressively forcing an 89-year-old resident with Alzheimer’s to disrobe after soiling herself, according to a NMDOJ court filing: The defendant pushed the victim onto the bed, snapping her head backwards, then aggressively removed her clothes, forcing the victim off the bed and onto the floor.

Pacifica’s caregiver, Lee Carrizales, is charged with verbally assaulting two different residents on January 4, 2024. A video of the first incident shows a person identified as Lee yelling in the face of one resident who was sitting in a wheelchair at Pacifica’s Memory Care Unit. “Stop your (expletive) crying already, stop it!,” Lee can be heard yelling. “You’re on your own now, I’m not dealing with you anymore!” A second video shows Lee yelling and cursing at another resident in the Memory Care Unit, later that day. The first victim could not recall the incident and “seemed confused,” according to NMDOJ court filings; the second victim told an investigator she was scared of Lee.

“[S]omeone who is not going to be able to remember or is not going to be able to communicate well, is a prime target,” Richard Mollot, executive director of the Long Term Care Community Coalition (LTCCC), a New York-based patient advocacy group, said in a telephone interview Wednesday. 

Community Options and Pacifica have been sued by residents and their families, court records indicate. In an April 9, 2024 news story in the Santa Fe New Mexican, family members of another Pacifica resident described living conditions at the facility as substandard, alleging, the paper wrote, “constant staff turnover and a lack of medical care.” 

The publicly released videos are “horrific,” Mollot said. 

Mollot has testified before Congress on elder care, including testimony given before the Senate Special Committee on Aging in January. The committee’s hearings focused on quality of care, patient safety, and the assisted living industry’s lack of accountability or federal regulatory oversight. 

“It’s a nightmare to be in a situation like that,” Mollot said. “Living at these facilities, you are vulnerable and count on people that are paid and that are trained.”

The situation is worse at assisted living facilities than more regulated skilled nursing homes, Mollot noted. The federal government requires regular inspections of nursing homes. But no such requirements for assisted living centers exist, meaning oversight falls to states.

New Mexico has struggled to fill that gap. A New Mexico In Depth review of complaint investigations, inspection reports, and court filings for 215 facilities with nearly 6,000 beds found that many assisted living centers across the state have fallen short of the mark on resident safety, and instances of neglect and delayed medical attention are prevalent.

An agency spokesman told New Mexico In Depth in March the Division of Health Improvement is tasked with inspections when a new facility applies for a license or when ownership changes hands, or to investigate complaints. The division also requires facilities to report critical incidents, which then spur investigations. 

But unlike their approach with skilled nursing homes, state inspectors do not conduct regularly scheduled onsite compliance inspections of assisted living centers. 

Administrators at Pacifica Senior Living in Santa Fe and defendant Romero, the paid caregiver accused of striking a developmentally disabled patient repeatedly in front of witnesses, could not be reached for comment. 

A spokesperson for MorningStar said in an email that immediately after learning of the assault, the facility investigated, and fired Bonilla-Aguinada the following day.

“When in July the [state] Department of Justice called our executive director as part of its continuing investigation, we cooperated fully,” the spokesperson said. “There is no higher priority at MorningStar than that of resident safety and quality of compassionate care.”

Noemi Rivera, New Mexico state director for Community Options, responded to an email from New Mexico In Depth, writing that the company is “committed to providing safe and supportive housing for people with disabilities and has a zero-tolerance policy for abuse or mistreatment of any kind.” 

“Upon learning of the incident, the employee was immediately suspended and subsequently terminated,” Rivera’s email stated. “We are fully cooperating with authorities to ensure that justice is served.”

But changing systemic problems at eldercare facilities can require more than firing an abusive caregiver, Mollot emphasized. “You have to go up the chain of command because that’s what is going to make a difference,” he explained. “Too often, we see something horrific and they get rid of an employee, but that doesn’t solve the problem by itself. What helps address the problem is when you are actually going after the operator [administrator]. They have ultimate responsibility.”

For now, the NMDOJ is focusing on prosecuting the defendants for their behavior, not pursuing additional investigations into their employers, according to Medicaid Fraud and Elder Abuse Division Director Joseph Martinez, in a phone call Wednesday. 

It’s also crucial that the state conduct unscheduled on-site inspections at eldercare facilities, Mollot said.

“There’s nothing more important,” he told New Mexico In Depth. “It’s critical that you have inspectors coming in, in a way that it’s not predictable for the provider, because you want to see what is going on there. You don’t want it to be sugar coated or problems including abuse or neglect being covered up — and we know those happen.”

The NMDOJ separately charged a fifth caregiver of abuse earlier this year, Rodriguez said. She did not have the details before New Mexico In Depth published this story. 

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Abuse charges against four eldercare workers underscore gaps in state oversight

Assisted living’s real problem: Staffing and acuity, not lack of regulation

by Neville M. Bilimoria 

Dec. 17, The Washington Post published a special investigation highlighting dozens of assisted living resident deaths across the country due to wandering or elopements.

As a result, Sen. Bob Casey (D-PA) scheduled a hearing before the Senate Special Committee on Aging, which he chairs, to look into why those deaths were happening, with at least a handful occurring in Casey’s home state of Pennsylvania. This was the first hearing of its kind for the assisted living industry in almost 20 years.

Well, the Senate Special Committee on Aging held its hearing on Jan. 25, eliciting testimony from advocates, industry leaders and families. It didn’t go so well for the assisted living industry, pointing once again toward increased fervor over possible federal legislation for assisted living communities nationwide:

• “Unfortunately, what I heard today makes clear that we have a long way to go when it comes to guaranteeing the level of care that older Americans in assisted living facilities deserve.” — Sen. Bob Casey (D-PA)
• “This has gone on long enough without federal oversight.” — Sen. Elizabeth Warren (D-MA).

Those hearings were not too surprising, because the Post painted a very dire picture of assisted living today in its expose. The Post had documented 2,000 assisted living wandering incidents since 2018, with more than 100 of them fatal. But the Post article, and what occurred at the hearing, highlights the big question: Is federal regulation the answer? No, I posit to you.

We all know what federal regulation did to the nursing home industry and how it currently affects that industry through increased enforcement, driving up costs, and even today, leading to nursing home closures. In today’s environment, and with the assisted living industry post-COVID-19, the last thing folks need is federal regulation as senior living communities are struggling to get back to their pre-pandemic staffing levels, all while dealing with residents’ greater health needs and an aging population in their homes at the same time.  

But what was interesting about the Senate hearing were the seemingly ignored comments of industry leaders from the American Health Care Association / National Center for Assisted Living and Argentum, and particularly Julie Simpkins, a member of the NCAL Board, who made a good point during the hearing:

“When we talk about assisted living, it’s important to note that every state, every facility and every resident is different. …Efforts to standardize all assisted living communities would be both unworkable and irresponsible for resident care.”

I think Simpkins is right. What happened to those residents is truly tragic (also acknowledged by Simpkins), but the call for increased state regulatory oversight is not just a veiled attempt by AHCA/NCAL and the industry to avoid more regulation. Most assisted living companies are operating and providing a good quality of care. Punishing a majority of assisted living communities with greater federal regulation isn’t necessarily the answer. Why not try, as advocates suggested at the Senate hearing, to allow state regulators to continue regulation, and also crack down on the poor-performing providers.

Further, allowing greater state oversight makes real sense for those of us who have been in the nursing home/assisted living industry; after all, more regulation at the federal level is only going to muck things up further, perhaps adding to or, even worse, exacerbating, the real problem: staffing shortages. Increased federal regulation only makes it more costly for facilities to achieve compliance, and that money could be better spent on workforce programs to attract more and better assisted living workers.

We can’t just look at staffing statistics for assisted living and open positions to really encapsulate the full gravity of the staffing shortage problem. The other problem is the pool of caregivers that operators have to choose from and the need for better caregivers to insert themselves into that hiring pool. 

After all, if you fill your staffing positions with undedicated, uneducated or unqualified individuals, then you are not helping the situation. As Simpkins said, we need to address programs that will bring workers — good workers — back to assisted living environments. Simpkins commented that addressing caregiver shortages through workforce programs could make a difference.

In all, a fix to this elopement problem may not be as simple as federal regulation. Maybe the better intervention is to help improve staffing, allow states to further crack down on poor-performing assisted living communities, and see how that goes before instituting federal regulation. Otherwise, federal regulation could make the situation worse. 

Neville M. Bilimoria is a partner in the Chicago office of the Health Law Practice Group and member of the Post-Acute Care and Senior Services Subgroup at Duane Morris LLP.

The opinions expressed in each McKnight’s Senior Living guest column are those of the author and are not necessarily those of McKnight’s Senior Living.

Full Article & Source:
Assisted living’s real problem: Staffing and acuity, not lack of regulation

Woman Asks For Help After She's Charged $35 An Hour To Visit Her Elderly Mom In Assisted Living Facility That Costs $8K A Month

by Mary-Faith Martinez

How is this legal?

Caring for elderly family members is never easy. There are so many questions to consider, like what’s really best for the individual, and how accessible are resources.

One woman is discovering just how difficult it is to be there for her elderly mother thanks to some strange financial challenges.

A woman in Ohio shared that she has to pay to see her mother in an assisted living facility.

Las Vegas-based realtor Carrie Meyer recently went to visit her 90-year-old mother in an Ohio assisted living facility with her daughter, Chloe. She was shocked when she arrived at the facility and was asked to pay for her visit.

“$35 an hour,” said Meyer. “That’s what I had to pay to see my 90-year-old mother in an assisted living facility in Ohio.”

As if having to pay for the visit wasn’t bad enough, the facility insisted that Meyer pay before she actually had the visit. “Prepayment was required or I was denied visitation,” she said.

Of course, assisted living facilities aren’t free. Meyer’s mother is already paying to stay there each month. “The estate guardian is charging her $8,000 a month rent,” she explained.

It seems that there is more drama than just the price of the facility and the required prepayment. Meyer stated, “My sister, brother, and I are prohibited from taking her anywhere. She doesn’t want to be there and wants to live with my sister; however, a downstairs bathroom must be added and is not financially doable.”

Full Article and Source:
Woman Asks For Help After She's Charged $35 An Hour To Visit Her Elderly Mom In Assisted Living Facility That Costs $8K A Month

Senate to Review Assisted Living in Response to Recent Washington Post Articles

by Tim Regan

A committee of the U.S. Senate is slated to hold a hearing soon to study assisted living, a move spurred by a recent Washington Post investigation.

The Post revealed on Jan. 16 that Sen. Bob Casey (D-Pa.), chairman of the Senate Special Committee on Aging, is launching a new review of safety within the assisted living sector in light of the newspaper’s reporting last month. A hearing entitled “Assisted Living Facilities: Understanding Long-Term Care Options for Older Adults,” was also scheduled for Jan. 25.

In a letter to executives of the three largest operators of assisted living in the U.S. – Brookdale Senior Living (NYSE: BKD), Atria Senior Living and Sunrise Senior Living – Casey asked for more information on the number of elopements in their communities and how they inform families of other incidents such as falls, injuries and violent interactions with other residents.

Casey also is asking for more information on the costs incurred by residents and their families in light of a recent New York Times investigation on the high cost of assisted living.

Casey told the Post that he was focused on “a set of cascading crises” related to staffing, oversight, how operators inform families and quality of care.

“It’s terribly disturbing,” Casey told the Washington Post. “It’s a basic violation of trust when you’re making assertions about a service you’re providing and you’re not providing that.”

In December, the Post found that nearly 100 senior living residents have died after wandering away from their assisted living and memory care communities since 2018. The investigation also detailed chronic understaffing in senior living communities.

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Senate to Review Assisted Living in Response to Recent Washington Post Articles

Senator Casey Demands Three of the Largest Assisted Living Facility Owners Answer Concerns About Workforce, Cost and Quality of Care

Today, U.S. Senator Bob Casey (D-PA), Chairman of the U.S. Senate Special Committee on Aging, sent letters to the CEOs of three of the largest corporate owners of American assisted living facilities—Atria Senior Living, Brookdale Senior Living, and Sunrise Senior Living. The letters address significant concerns about workforce shortages and expensive and inadequate care in assisted living facilities raised by recent reporting in the Washington Post and New York Times. In the letters, Chairman Casey requests a series of information from the companies about these concerns.

“The Senate Special Committee on Aging has jurisdiction over the problems older adults face, including matters of maintaining older adults’ health, their ability to secure proper housing, and their ability to obtain care or assistance when needed. Since its formation in the 1960s, the Committee has frequently used its authority to examine private companies when concerns arise about potential health and safety, as well as financial risks posed to older adults. As Chairman, I have an interest in ensuring that older adults and people with disabilities are receiving high-quality care, have access to proper housing, and receive good value for their hard-earned dollars,” wrote Chairman Casey.

In addition to sending the letters, Chairman Casey will hold an Aging Committee hearing on January 25th entitled “Assisted Living Facilities: Understanding Long-Term Care Options for Older Adults,” where the challenges faced by assisted living facility residents will be examined in further detail.

Full Article and Source:
Casey Demands Three of the Largest Assisted Living Facility Owners Answer Questions About Workforce, Cost and Quality of Care

Caregiver Bound Over to Face Trial in Freezing Death of Elderly Woman

Today, Colleen Kelly O’Connor, 58, of East Lansing, was bound over to face trial in the 29th Circuit Court in Clinton County on one count of Second-Degree Vulnerable Adult Abuse, announced Michigan Attorney General Dana Nessel. O’Connor was charged in November in connection to the December 2022 death by exposure of an 82-year-old woman. The charge is a 4-year felony.

At the time she died, the victim was under O’Connor’s care at Vista Springs Imperial Park at Timber Ridge, an assisted living facility in Clinton County where O’Connor was employed.

“Caregivers have a responsibility to act when a vulnerable person in their care faces a dangerous, potentially fatal, situation,” said Nessel. “I want to thank the Bath Township Police Department for their partnership during the investigation of this tragic case.”

The People allege that during the very early morning hours of December 23, 2022, O’Connor twice observed the victim attempt to go outside without appropriate attire into a blizzard with single-digit temperatures, subzero windchill, and blowing and drifting snow. A snowplow driver found the victim in the parking lot around 7 a.m., partially buried in snow. It is unknown precisely how long she was outside before she was found. The victim was transported by ambulance to a nearby hospital but died due to hypothermia shortly after arrival.

The charge against O’Connor alleges that, as a caregiver, O’Connor recklessly failed to act to prevent the victim from going outdoors into the storm, resulting in her death.

Full Article and Source:
Caregiver Bound Over to Face Trial in Freezing Death of Elderly Woman

Life and Death in Assisted Living (Originally Aired in 2013)

​​More and more elderly Americans will be faced with the decision as to whether to spend their later years in assisted living facilities, which have sprung up as an alternative to nursing homes. But is this loosely regulated, multi-billion dollar industry putting seniors at risk? (Aired 2013)

Source:
Life and Death in Assisted Living

95-year-old charged with first-degree murder in Lafayette assisted living shooting

by Julia Cardi

FILE - This booking provided by the Boulder County Sheriff's Office shows Okey Payne, a 95-year-old resident of an assisted living facility accused of shooting and killing a maintenance worker. Payne has been charged with first-degree murder, on Wednesday, Feb. 10, 2021. .

Courtesy of Boulder County Sheriff's Office

Okey Payne, the 95-year-old man accused in the fatal shooting a maintenance worker at the Lafayette assisted living facility where he lived, appeared Wednesday in court in Boulder County to face charges of first-degree murder and felony menacing. 

The murder charge could bring a mandatory sentence of life in prison without parole if Payne is convicted.

Payne has a preliminary hearing to air evidence in the case scheduled for May 5.

He claimed he shot Ricardo Medina-Rojas because he took $200 from Payne’s wallet, a probable cause arrest affidavit states.

He told police he waited in the lobby on the morning of Feb. 3 for Medina-Rojas to arrive for his shift and shot him with a .45 caliber gun, court papers said. 

The arrest affidavit states Payne allegedly admitted to shooting Medina-Rojas and apologized for his actions, but said “he’s glad the thievery will stop.” 

During his interview with police, he made a number of allegations against employees at the facility, saying they had been stealing from him for more than a year and that he believes his ex-wife has been working with employees to steal from him. 

Payne also claimed he woke up with needle marks in his big toe and said employees were trying to drug and kill him, court papers said. 

His claims have not been confirmed by investigations by Lafayette police and Adult Protective Services.

Police said Payne appeared to be lucid and clear-headed when questioned after the shooting, according to an arrest affidavit. 

But after the charging hearing, Boulder County District Judge Andrew Hartman held a hearing for requests to appoint an emergency guardian and special conservator to make medical and financial decisions for Payne.

An attorney for the nominated guardian referenced a doctor’s letter attesting Payne has severe cognitive impairment.

“We feel the need for an emergency appointment, which under the statute can go for no longer than 60 days, arises out of the abrupt change in circumstance for Mr. Payne from the matters being addressed in the criminal case,” said attorney Brandon Fields.

He referenced Payne’s advanced age and his sudden change in living circumstances.

“And it seems unlikely he'll be able to return to his assisted living in light of the allegations and events that have taken place, and he may not have access to the same health care providers, and he may need other assistance with decision making,” Fields said.

Kay Jones, who serves as a guardian professionally, was nominated as Payne’s emergency guardian. She has had medical power of attorney for him.

But attorney Martha Ridgway, who appeared on behalf of the person requested to serve as Payne’s special conservator, said she believes a guardian for Payne is needed because Payne can revoke Jones’ power of attorney at any time.

Ridgway said Payne received a substantial settlement from a previous domestic relations case, but that he owes $32,000 to the Legacy. She said there is uncertainty about where Payne’s money is. 

“The concern, obviously, is that someone needs to marshal his assets and … manage them and pay off this extraordinary expense to the Legacy assisted living facility,” Ridgway said.

Attorney Christina Ebner was nominated as Payne’s special conservator. 

By law, emergency guardianships and special conservatorships last up to 60 days. Ridgway said she intends to petition for a permanent conservatorship for Payne.

Public defender Kathryn Herold, one of Payne's defense attorneys, objected to the appointment of a guardian, saying Payne is receiving good-quality medical care in the Boulder County jail by being housed in his own module and given around-the-clock care by two trustees.

She said she is concerned appointment of a guardian could negatively impact his criminal case.

“I do appreciate that everyone is here to help Mr. Payne, but not everyone is as well-versed in the criminal law, and that's where my specialty comes in and my concerns come in,” she said.

Hartman said he will issue a written order on the emergency requests.

Full Article & Source:

95-year-old charged with first-degree murder in Lafayette assisted living shooting

Ohio Assisted Living Builds "Hugging Wall" for Residents

At Dayspring Assisted Living and Care Facility in Richland County, strict policies are in place to keep everyone safe. 

"They used to go out to places and so forth. They can't do that. And who knows when that will happen," said Dayspring maintenance worker, Michael Barretta.

The policies are working, as the facility is currently COVID-free. Still, workers here know the toll social isolation has taken on residents.

“We still get to see our loved ones. Unfortunately, because of COVID in the congregate setting, our residents can't," said Dayspring officer manager, Heather Knipp.

So, they got creative. Dayspring executive director Michelle Swank asked Barretta to build something so residents could safely hug their loved ones again.

"I built a wall to divide it, which I insulated and I put a 36 door in it. So then I got a wooden screen door, removed the screen and got a crystal clear, heavy mil plastic, and put it in place in the screen," Barretta said of his process. "I went to Hobby Lobby and took the rings for crocheting or whatever they do with them. And that's what I used to capture it through the clear plastic, as well as the arms."

The result? A hugging door. Finally, residents would get that embrace they had been waiting on for so long. 

Full Article, Video and Source:
Richland County Assisted Living Builds Hugging Door for Residents

Caregivers relieved, but cautious about eased restrictions for care facilities

By Lucinda Breeding

Amber Reynolds

For the families of Texans living in nursing homes and long-term care facilities, Gov. Greg Abbott’s decision to lift restrictions on visitation came not a moment too soon.

“Certainly it’s been difficult, regardless of what the level is with your abilities,” said Mike Danks, president of the Denton State Supported Living Center Family Association.

Danks and his wife haven’t seen their adult daughter, whom they preferred not to name publicly, since the first week of March. She has severe autism, and the Danks found the private homes inadequate to care for her. Without proper supervision and a careful medication schedule, their daughter has a tendency to have violent outbursts. The Danks said they found DSSLC a better fit.

Like other Texas families with loved ones in care facilities, the Danks have had to make do with video chats. Their daughter will interact by phone for a short time, and is accustomed to video calls with her grandparents.

“If you’ve got family and you can’t visit them, it’s difficult,” Danks said. “It’s been difficult for us because we haven’t been able to visit her. And it’s difficult because we haven’t been able to see mom and dad, either. I think it’s tough across the board.”

As of Thursday, Abbott’s orders allowed families to designate up to two essential family caregivers to get the necessary training to safely go inside a facility for a scheduled visit. The order allows the designated caregivers to enter the resident’s room.

The order is the first to allow designated caregivers this degree of access “to help ensure their loved one’s physical, social, and emotional needs are being met” since the state-mandated lockdown in March.

Designated caregivers don’t have to practice physical distancing, but only one caregiver can visit a resident at a time.

Angela Biggs made sure she had a negative COVID-19 test, which is required along with personal protection equipment training, so she could see her daughter on Thursday. She wore safety glasses and a mask. She arrived at the center with flowers and cupcakes.

“She definitely knew it was me,” said Biggs, whose daughter, Amber Reynolds, 29, has lived since at the center since 2014. Amber suffered a brain injury at birth and, after years of seeking treatment, was diagnosed with severe mental retardation and severe bipolar disorder with psychosis.

“I used that moment. I looked at Amber and I said ‘Amber, look at me eye-to-eye. I thought about you and prayed for you every day.’ And I made her say ‘day.’ I told her ‘I couldn’t come in, Amber.’”

Biggs said she was careful not to mention the staff, whom she praises and says give her daughter love and care. She didn’t want to risk Amber getting angry at the men and women who have taken care of her throughout seven months of lockdown. In March, the center was hit hard by the coronavirus that causes COVID-19.

Biggs said she was able to give her daughter the flowers — Amber loves yellow, and grinned over the bright, mostly yellow bouquet. The staff had to inspect the cupcakes to comply with pandemic health and safety rules.

Biggs could only stay for an hour and a half. She spent the short time chatting with her daughter, trimming her nails and inspecting her room for clues about how Amber fared without consistent, face-to-face contact with her mother.

“She’s not sleeping in her bed,” Biggs said. “She’s been sleeping on her couch. She’s not keeping warm. I can just tell this has been hard on her.”

Olivia Lilley and her husband, Bryan, have been caring for Bryan’s 88-year-old mother, Marylin, since she was diagnosed with Alzheimer’s Disease years ago. Marilyn lived next door to her son just outside of Aubrey for years — until her disease progressed to the point when round-the-clock supervision was needed.

In 2012, the Lilleys moved Marilyn into Willowbend Assisted Living & Memory Care in Denton. Olivia said her mother is still in the assisted living portion of the facility, where she has her own room. Marilyn’s condition causes her to self-isolate, and her memory seems to last for less than a minute. Lilley said she and her husband visited almost daily before the pandemic. Bryan works for Fox Sports covering the NFL, and when he travels for work Olivia takes over her mother-in-law’s care.

Olivia said her family couldn’t do without the love and care of the staff and director of Willowbend.

“They’re doing absolutely everything they can,” Olivia said. “We know that. Their hands are tied by the governor’s orders. It’s just so frustrating, and back at the end of August Byran and I were at the end or our rope. We were thinking about breaking her out.”

The Lilleys had good reason to be alarmed. Willowbend decided to close its dining room to protect vulnerable residents. The residents suddenly had to stay in their rooms at all times.

Olivia was glad she and her husband had mounted a camera in the living area of her mother’s room. But what she saw was frightening. Marilyn didn’t seem to understand her meals were being brought to the room. She wasn’t eating, and eventually, she was sitting on her floor, playing solitaire from 7 p.m. to 7 a.m. She was losing weight and growing agitated.

“She called my husband and asked, ‘When are you coming to get me?’” Olivia said. “He was so heartbroken. You have to meet people with Alzheimer’s where they are, and he told her ‘I’m coming, mom.’ Then we watched her pack up entire room. She took pictures off the wall. She found the camera and took it down. She did that a few times. She packed up her whole room and waited for him to come pick her up.”

The Lilleys have taken advantage of the gradual easing of restrictions. They’ve done window visits and porch visits.

“Before COVID-19, I’d take her to get her hair done once a week. It was a chance for her to get a really good shampoo, and it was with a hairdresser who loves her and knows how to talk to her. Like, she knows to talk to her and not just ignore her and talk to me,” Olivia said. “I’m sorry to get emotional, but it’s been hard to hear middle aged women talking about needing to get their nails done. My mother-in-law hasn’t had a haircut in seven months. It breaks my husband’s heart to see her looking so unkempt.”

Olivia said her family is trying to decide whether to leave Marilyn in assisted living. With flu season approaching, the Lilleys worry that Marilyn will once again be shut in her room, where she can’t see or hug loved ones.

Caregivers live with competing feelings: They praise the staff and directors of the facilities for doing their best to care for resident and comply with the state. But they and the government can’t satisfy infuriating questions that keep loved ones from the routines they need.

“I just want someone to tell me, how long is a negative test good?” Biggs said. “You do everything in your power to keep your child safe. You can’t do everything.”

Danks said the rules aren’t a guarantee.

“The way I look at it, the negative test is good until I walk out the door of the place you got the test,” Danks said. “But the negative test is a little better than no test at all. There’s no perfect world.”

Olivia said Abbott simply can’t understand what caregivers are going through, and they don’t seem to imagine what the lockdown has done to Texas’ most vulnerable residents.

“What would Gov. Abbott do if he was locked in a room and his wheelchair was taken from him? I want to know,” she said. “Because that’s what our loved ones have been living. Everyone wants to protect this group of people. I totally get that. ‘This is the Greatest Generation,’ they say. ‘They must be protected at all costs.’ But what is the cost? Because this is prison. I’m sorry, but it just is. And what’s going to happen this winter? We can’t do another lockdown with my mother-in-law.”

Full Article & Source: 

Caregivers relieved, but cautious about eased restrictions for care facilities

Legislature adopts sweeping reforms for senior care homes

By Carrie Teegardin

A bill to improve staffing, training and accountability in Georgia’s senior care homes is headed to Gov. Brian Kemp after the House on Wednesday approved a Senate version of HB 987.

The House unanimously signed off on the Senate’s version of the bill, which added requirements for handling COVID-19 to the bill’s reforms of the senior care industry.

“I am so proud of Georgia’s House and Senate for making the necessary changes to ensure the safety of our seniors who choose to live in assisted living facilities,” said Rep. Sharon Cooper, R-Marietta, the lead sponsor of the bill.

Kemp has said he strongly supports the legislation, which will bring dramatic changes to the state’s assisted living communities and large personal care homes. Memory care units would have to get certified and have more staff, directors would have to be licensed and homes that break the rules would face higher fines. Assisted living homes would be required to have nurse staffing. Homes would also have to disclose financial problems to residents and families.

Plus, senior care homes must plan for a pandemic, have a short-term supply of personal protective gear, test residents and staff and notify residents and families of an outbreak.

Cooper drafted the bill to help prevent the types of neglect and abuse in senior care homes that were exposed last year by a series in The Atlanta Journal-Constitution.
 
Advocates applauded the Senate’s move to add the COVID-19 requirements.

Most of the bill relates to assisted living and personal care homes with 25 beds or more. But the additional COVID-19 requirements would also apply to the state’s nursing homes.

“Georgia’s seniors gain new protections in this landmark legislation,” said Kathy Floyd, executive director of the Georgia Council on Aging.

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Legislature adopts sweeping reforms for senior care homes

More seniors are suffering from 'self-neglect.' Here's why.

State and federal data suggests there's a growing threat to the nation's senior population that experts warn can lead to poor health outcomes or death—and that threat is self-neglect, Yuka Hayashi reports for the Wall Street Journal. 

The problem of self-neglect

Self-neglect occurs when someone loses the ability to perform essential self-care, such as keeping up with personal hygiene, taking proper medications, or providing him- or herself with food and shelter. 

When left unaddressed self-neglect can lead to poor physical and mental health outcomes, Hayashi reports. XinQi Dong, director of the Institute for Health, Health Care Policy and Aging Research at Rutgers University, said the risk of premature death is 15 times higher for people experiencing self-neglect than for other adults.

And the issue is particularly prevalent among seniors, as they are more likely to suffer from illness, dementia, poverty, depression, or the loss of a caregiver.

In 2018, more than half of reported cases of alleged elder abuse or neglect investigated by adult protective services actually involved self-neglect, according to a new HHS report. Overall, those 144,296 cases accounted for more elder abuse cases than neglect, financial exploitation, physical abuse, emotional abuse, and sexual abuse combined.

And a look at state-level data suggests the problem has gotten worse in recent years, Hayashi reports. Virginia's local service providers investigated 18% more self-neglect cases in 2019 when compared with 2015, while Iowa reported a 55% increase in self-neglect cases between fiscal years 2017 and 2019.

Self-neglect, particularly in seniors, can stem from various situations, Hayashi reports. For instance, a senior who falls and fractures a hip could become bedridden and become unable to care for themselves. On the other hand, seniors who struggle to pay bills might have their utilities cut off or, in extreme cases, could lose their homes.

Lori Delagrammatikas, executive director of the National Adult Protective Services Association, said the increase in self-neglect cases can also be partly attributed to an increase in the number of seniors who live alone.

According to government data, about 25% of seniors ages 65 and older, or 14.3 million, lived alone in 2017, up 31% from 10.9 million in 2007. As a result, on average, seniors age 60 and over spend more than 10 hours of their daily measured time alone, according to the Pew Research Center.

"A lot of people end up getting very isolated in their homes," Delagrammatikas said. "That can cause a downward spiral."

How state governments are addressing self-neglect

Some experts say the key to curbing self-neglect cases is to make it easier for seniors to live in their homes. For instance, services like medical transportation services, grocery delivery, and home help with chores could make living alone safer for seniors and reduce cases of neglect.

Paige McCleary, director of Virginia's Adult Protective Services Division, said agencies in Virginia work with seniors to arrange house cleanups or Medicaid-covered home care. In other states, agencies try to move seniors into assisted-living facilities.

In extreme cases, when self-neglect is apparent but the individual refuses help, agencies turn to the courts and law enforcement to relocate individuals or place them in short-term guardianship.

But, according to Hayashi, such extreme measures are needed on rare occasions. The ultimate goal, according to McCleary, is to help people live safe and healthy lives.

"It's not uncommon that our workers face individuals who clearly can't manage themselves in their own homes but absolutely refuse to go to assisted living facilities or nursing homes," McCleary said. "We try to support them in making their own decisions about how they choose to live their lives" (Hayashi, Wall Street Journal, 2/11).

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More seniors are suffering from 'self-neglect.' Here's why.

Nursing Home and Assisted Living Activities

By Anthony Cirillo

At the heart of any nursing or assisted living home is the activity program it has for residents. It is an integral part of the cultural change movement and central to person-centered care. It is essential for resident quality of life. Nursing Home activities are governed by federal regulations called F-Tags. While Assisted Living activities are not as highly regulated, many facilities emulate the standards set for nursing homes. Here is a primer on nursing home and assisted living activities that can help both professionals and family caregivers understand the expectations and responsibilities associated with a quality activity program.

 

F-Tag and Implication

F-Tag 248 states that ”the facility must provide for an ongoing program of activities designed to meet, in accordance with the comprehensive assessment, the interests and the physical, mental, and psycho-social well-being of each resident.”

The intent is that:

• The facility identifies each resident's interests and needs.
• The facility involves the resident in an ongoing program of activities that is designed to appeal to his or her interests and to enhance the resident's well-being.

 

More Than Just the Initial Assessment

The resident assessment begins to crack the surface of understanding what activities they could be interested in participating. But really knowing the resident goes beyond that.

• Involve the family to understand the resident’s interests.
• Do a "social history" of the person's life soon after intake. Build activities around them.
• See other staff as a resource. Aides are with residents in their rooms and have a chance to talk to them at different times. Find out what they know about the resident’s interests. And remember an activity does not just mean a group activity. It can take place in a room and be administered by any staff member.
• Visit the residents in their rooms and look at their photos and other display objects, and use those things as a starting point for a conversation about interests.
• Ask them the things they have done in their life; what they are still hoping to do; something they would like to try again.

 

Beyond Bingo

The stereotype of activities in elder care homes is playing bingo and watching television. Of course, some progress has been made on the PR front as Wii games in nursing homes have become big media stories.

"F-Tag 248 stipulates that activities should be relevant to the specific needs, interests, culture, background, etc. of the individual for whom they are developed."

In research by the Centers for Medicare and Medicaid Services (CMS), residents reported that independence and a positive self-image were central to their well-being. They want a choice of activities and “activities that amount to something."

• Many female residents were homemakers. Folding laundry, doing dishes, sweeping, setting the table, and ironing. These are tasks that many residents can still do with assistance.
• Elderly male residents kept everything working around the house. Let them help. Give them something to take apart and fix. They want to feel like they are contributing.
• Meals become central for many residents. Let them help plan your menu. Ask them to share recipes.
• Gardening and doing yard work may have been important. Let them plant a small garden.
• Let them tell you stories about the people in the pictures they have brought with them.

 

Other Considerations

Even severely limited residents can have one-to-one activities such as talking to the resident, reading to the resident about prior interests, or applying lotion while stroking the resident’s hands or feet.

Activities can occur at any time, are not limited to formal activities being provided only by activities staff, and can include activities provided by other facility staff, volunteers, visitors, residents, and family members.

CMS also considers these items when evaluating the activity program.

• Medication administration, to the extent possible, should not interfere with the resident’s ability to participate in an activity.
• Residents should be notified of preferred activities.
• Transport should be provided for residents to and from activities.
• Functional assistance (such as toileting and eating assistance) needs to be provided.
• Needed supplies or adaptations, such as setting up adaptive equipment need to be considered.

 

Stretching and Reaching

Encouraging and supporting the development of new interests, hobbies, and skills is encouraged and well as connecting with the community through places of worship, veterans’ groups, volunteer groups, support groups, and wellness groups.

 

F-249, The Activity Professional

F-Tag 249 states that ”the activities program must be directed by a qualified professional wh (i) Is a qualified therapeutic recreation specialist or an activities professional who--(A) Is licensed or registered, if applicable, by the State in which practicing; and

(B) Is eligible for certification as a therapeutic recreation specialist or as an activities professional by a recognized accrediting body; or

(ii) Has 2 years of experience in a social or recreational program within the last 5 years, 1 of which was full-time in a patient activities program in a health care setting; or (iii) Is a qualified occupational therapist or occupational therapy assistant; or (iv) Has completed a training course approved by the State.

The intent of this regulation is to ensure that the activities program is directed by a qualified professional. An activity director is responsible for directing the development, implementation, supervision and ongoing evaluation of the activities program. Directing the activity program includes scheduling of activities, implementing and/or delegating the implementation, monitoring the response to determine if the activities meet the assessed needs of the resident, and making revisions as necessary.

Activity professionals are the unsung heroes of the profession. They are called to do much and what they do positively affects lives and ultimately affects the image of the home. So while activities, in theory, are everyone’s responsibility, help yourself by hiring an experienced and certified activity professional.

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Nursing Home and Assisted Living Activities

She’s 91 and Is Being Kicked Out of Her Apartment

Dozens of residents of an independent living community in Manhattan — some as old as 99 — are being forced out of the homes they thought they’d die in.

Residents of the Riverview Senior Residence in Manhattan.Credit...Photographs by Karsten Moran for The New York Times

By Sharon Otterman

Gabrielle Wagner, 91, moved into the Riverview Senior Independent Living facility last April after her identical twin, whom she had lived with, died in 2018. She had been lonely and the modern apartment tower in Hell’s Kitchen felt less like assisted living and more like a comfortable community for active seniors where she could live out her days.

“I thought I’d go out feet first,” she said just before Christmas. “I thought I’d finally found a place I can stay in until I die.”

Muriel Fisher, 86, left her $811-a-month, rent-controlled, two-bedroom apartment in Jackson Heights, Queens, to move in to a studio at the Riverview in 2018. Her grandson, who lives on the same Manhattan block as the center, insisted it was no longer safe for her to be alone.

Milton Gluck, also 86, moved in three months ago to be closer to his son, after his partner of 30 years entered a nursing home. He hasn’t yet fully unpacked.

Then, on Dec. 3, the building’s management distributed a surprise letter to all the residents. Riverview was being sold, it said, “sometime in the first few months of 2020.” Everyone would have to leave.

The nonprofit that owns the building said the center, which opened less than two years ago, had been losing money and it could no longer afford to run it. The group was seeking a market-rate buyer.

The news sent the 31 residents of Riverview — who are nearly all in their 70s, 80s and 90s — into a panic, unsure of where they would go.

New York City is in the grips of an affordable housing crunch for seniors — the latest data shows an estimated 200,000 low-income seniors were on waiting lists for federally subsidized housing in 2016 citywide — and middle-income seniors are also struggling to find homes that fit their needs.

A banner reading “Now Available Senior Residence” can be seen at the top of the facade of the Riverview Senior Residence.

At the high end, there are luxury independent living options in Manhattan like the Atria on West 86th Street, where fees soar to over $11,000 a month for a one-bedroom, and the Inspir, an even more expensive option opening on the Upper East Side.

For older New Yorkers in the middle — even those who can afford Riverview’s rates of about $4,000 a month for a small apartment, three meals a day, housekeeping and some social events — the options are limited. And when you’re a nonagenarian looking for what may be your last home, it’s not just about finding an open spot.

The EastView, a new independent living facility that the Salvation Army just opened in Harlem, has space, but many residents felt it was too far from their families. The West 74th Street Residence, which has interviewed several Riverview residents, was less expensive, but had less charm, some said.

Nothing felt like the Riverview, a 14-story building at 49th Street and 10th Avenue in the heart of Midtown. Several residents described falling in love with its hotel-like hallways, modern finishes and Hudson River views. So its residents, many using pensions from careers as educators, engineers or public servants, sold homes, left friends and moved in.

For Stuart Dunn, 90, it was the second time that his senior living landlord was asking him to move in order to sell the property. Until 2018, he lived in the Williams on the Upper West Side, a Salvation Army-owned independent living residence that was closed to make way for luxury housing.

“It is a societal issue that we really are at the cutting edge of,” he said, of the difficulty of finding a quality place to live with other independent seniors. “What is society going to do about the elderly?”

He said he most feared losing contact with his fellow residents, particularly Ms. Fisher, with whom he had become very close.

Muriel Fisher sitting in her apartment at the Riverview Senior Residence on Dec. 19, 2019.Credit...Karsten Moran for The New York Times

Some residents are meeting with lawyers to see what else can be done. About five have already moved out.

One has died, and another, who has been in the hospital, has not been able to deal with the news completely. “They are fearful of what is going to happen, and overwhelmed,” Joel Riff, 68, who is among the younger residents. “The mood is pretty depressed.”

They were particularly surprised, they said, because Riverview is owned by a nonprofit corporation that largely operates homeless shelters, Homes for the Homeless. After losing its city contract to run the building as a family homeless shelter in 2015, the organization decided to renovate and reopen the facility as an independent living building in early 2018, said Ralph da Costa Nunez, the chief executive officer of Homes for the Homeless.

The organization had succeeded with a similar conversion in Staten Island, and thought it could do the same in Manhattan. But Riverview never filled more than 35 or so of its 82 apartments, he said.

The residents felt that Riverview had not adequately marketed itself. Some said that they knew seniors who had reached out to explore moving in, but that the management had not followed up with them. Mr. da Costa Nunez disputed that account. He said there were likely not enough interested residents because Riverview did not offer assisted living services, and some families wanted the option of more comprehensive care as their family members aged.

Assisted living centers are regulated by the New York Department of Health, which provides additional protections to residents. But the Riverview, though it marketed itself as a place where seniors could bring private aides, had no such designation. As a result, the seniors, who had only month-to-month contracts, were vulnerable to eviction.

Mr. da Costa Nunez said that his organization could no longer afford to run the facility at a loss. “We are getting killed” with the costs of food, staffing and utilities, he said, adding that part of the issue was that the seniors were keeping the heat too high.

The losses, which he said amounted to “several million dollars already,” had started to threaten the operation of the senior facility in Staten Island, he said.

“No one wants to shut this down,” he said, “but Economics 101 is Economics 101.” He added that the closure “won’t happen before April for sure,” though the management had not stated the same in writing to the residents.

As the losses spiraled, residents said, the nonprofit repeatedly reassured its tenants not to worry and kept signing new contracts. Among the most fragile residents are a 99-year-old Holocaust survivor, who has no family and is looked after by an organization, Selfhelp Community Services, and Mildred Burt, 95, who arrived in March at the urging of a niece.

Ms. Burt had come from a public-housing project where she had lived for 60 years. Her niece, Pat Jackson, said: “Where does that leave me? With an aunt who is 95 years old who is basically homeless, and not much time to look. This is just heartless.”

Determined to fight back, the seniors formed a committee and contacted their elected officials. Five local elected officials signed a joint letter to Mr. da Costa Nunez demanding more time and support to the displaced seniors. 

“They are slipping through the regulatory framework,” said State Senator Brad Hoylman, who represents the area, vowing to look into the matter further. “That seems to be duplicitous.”

Mr. Nunez himself earned over $620,000 in 2018 as the director of Homes for the Homeless and its nonprofit affiliates, according to tax documents. At a heated meeting with elected officials on Dec. 19, he claimed to be surprised by the angry reaction to the closure and “questioned why these seniors can’t fend for themselves,” Mr. Hoylman recalled.

As the issue gained attention, Riverview sent residents a follow-up letter on Dec. 20, saying that the building would “likely” not be sold until April.

“No one is being thrown out,” the letter said.

Gabriel Wagner, 91, reads in her apartment at the Riverview Senior Residence.Credit...Karsten Moran for The New York Times

“We are going to run the place until we can transition every person out of there appropriately,” Mr. Nunez said in the interview.

Amid the uncertainty, the seniors have begun to plan their next steps. Both Mr. Dunn and Ms. Fisher have put deposits down at the Carnegie East House on East 96th Street, where assisted-living studios with meals start at $6,400 a month, a stretch for them. Ms. Wagner is moving March 1 to the EastView in Harlem, selling some of her furniture to do so.

“Luckily for me, I was a Navy wife, so I know what moving is all about,” she said. “Not that I am looking forward to it.”

Kitty Bennett contributed research.

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She’s 91 and Is Being Kicked Out of Her Apartment

California Assisted Living Residents Are Vulnerable to Financial Elder Abuse

As our population ages, more of our seniors are moving into assisted living facilities.  The number of such facilities has nearly tripled over the past two decades, with construction of memory care units the fastest-growing segment of senior care.  Half of assisted living residents are age 85 and older, and over 40 percent have some form of dementia.

In “How Not to Grow Old in America,” an article by Geeta Anand in the New York Times last year, the author discusses caring for her parents, notes the above trends, and argues that if assisted living “is to be a long-term solution for seniors who need substantial care, then it needs serious reform, including requirements for higher staffing levels and substantial training.”  She cites examples of deaths and injuries that have befallen seniors at assisted living facilities in California and elsewhere.

While Ms. Anand’s focus is on the physical care of seniors in assisted living, the transition from a home environment to an assisted living environment also can lead to serious financial elder abuse.

Seniors moving into assisted living often relocate many miles to be closer to a particular family member.  Such relocation may uproot seniors from existing relationships with local family, friends, neighbors, professional advisors and social groups, leaving seniors more vulnerable to financial exploitation.

For example, Mom’s longtime estate planning attorney and/or accountant may become too distant to work with her.  An abuser may connect Mom with a new professional who will find it harder to detect undue influence.  If Mom told her estate planner in confidence five years ago that she wanted to treat all her kids equally and did not want Susie to be her successor trustee, a new attorney may not be wary when Susie brings Mom in to sign documents so that Susie can take over as trustee.

Staff members at assisted living facilities develop close relationships with residents that are generally very positive.  However, such relationships can result in exploitation as when a staff member may share a financial tale of woe with a resident or connect a scam artist with a resident.  Such staff/resident interactions are difficult to monitor, and even more so with staff turnover when supervision is thin.

Staff also may have broad access to the units of residents such that theft of cash and other valuables can be a risk.  Consider that seniors may have a lifetime habit of paying in cash and may have difficulty tracking how much cash they have on hand and when it has gone missing.  Senior also may leave the doors to their units unlocked.

Of course, the risks of financial exploitation associated with in-home caregivers may be higher than those with caregivers at assisted living facilities.  In-home caregivers typically have sweeping access to seniors and may have no significant oversight.  Such caregivers may have criminal backgrounds that are not detected as they are hired without a background check.  And, as we have noted previously, families who directly hire in-home caregivers risk tax and employment claims, such that an accusation of financial abuse by a caregiver may be met with an expensive wage and hour claim.

While assisted living facilities no doubt can do more to protect their residents from financial elder abuse, family members should not be lulled into a false sense of security.  Spa-like facilities, myriad activities and extensive menus, as Ms. Anand notes, are wonderful attributes that attract seniors and help family members feel that Mom or Dad are better off in the facility than they would be remaining at home.

The move into a facility also has an upside of economic simplification.  Seniors who struggle to pay bills on time (and may feel uncomfortable with autopay arrangements) generally will receive one all-inclusive bill from the facility that family members can help review.

Instead of tuning out of the financial details of a parent who has moved into a facility, children should remain tuned in to help protect their parent’s financial security.  The same vigilance that Ms. Anand encourages with respect to the physical care of assisted living residents should be applied to their economic well-being so that they retain the resources they will need to support themselves as their needs and expenses increase.

See our prior post for general suggestions on what to do when an elder has been the victim of financial elder abuse.

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California Assisted Living Residents Are Vulnerable to Financial Elder Abuse