Sunday, December 31, 2017

Part 1 Abused, ignored across Minnesota

For weeks before her death, Jean Krause lay in her bed at a northern Minnesota senior home, staring mutely at the walls.

Even when her children arrived with flowers or her favorite dessert, she did not respond. Or she would suddenly sit bolt upright, asking if her door and windows were shut.

This summer, nearly a year after Krause died, the family finally solved the mystery of her strange behavior. Late one night in May 2016, Krause, who was 78 and suffered from dementia, was sexually assaulted in her bed by a male nurse’s aide who appeared to be changing her underwear.

No one — not the senior home, police or state investigators — told the family.

“It haunts me, it haunts me, it haunts me … that my mother suffered and we could do nothing to help her,” said Robert Krause, 60, of Pequot Lakes, Minn.

The tragic case tells a larger story of anguish unfolding across Minnesota.
Every year, hundreds of residents at senior care centers around the state are assaulted, raped or robbed in crimes that leave lasting trauma and pain for the victims and their families. Yet the vast majority of these crimes are never resolved, and the perpetrators never punished, because state regulators lack the staff and expertise to investigate them. And thousands of complaints are simply ignored.

State records examined by the Star Tribune show the scale of the failure.

Last year alone, the Minnesota Department of Health received 25,226 allegations of neglect, physical abuse, unexplained serious injuries, and thefts in state-licensed homes for the elderly.

Ninety-seven percent were never investigated.

That includes 2,025 allegations of physical or emotional abuse by staff, 4,100 reports of altercations between residents and 300 reported drug thefts.

When the Health Department did investigate, records show that it often neglected key steps in a criminal probe. In dozens of those cases, for instance, no one interviewed the victim and no one called the police.

Health Department documents contain dire tales of residents being choked, punched, smothered with pillows, fondled and forcibly restrained. At a nursing home in New Hope, an 85-year-old patient with dementia was repeatedly struck in the face and stomach over a span of months while other employees watched. At a care home in Crookston, an angry staff member lifted a female patient off her feet and threw her several feet to a bed, while calling her an “old hag.” In Sartell, two nursing home employees witnessed a fellow worker sexually molesting a patient; they did nothing and the worker molested two more patients. And in Isanti County, an elderly woman with dementia was placed in solitary confinement for seven hours, in a frigid room with no lighting.

“We are putting up with a level of criminality in senior facilities that would be unthinkable in any other setting,” said Amy Sweasy, an assistant Hennepin County attorney who handles elder abuse cases.

The state Health Department has broad authority to intervene in such cases. It can order corrective measures such as better training for staff, impose fines, or even revoke a facility’s license and shut it down. The department is also required under state law to notify prosecuting authorities when it finds evidence of criminal abuse.

That system routinely breaks down, records show.

Investigations drag on for months. Fines go uncollected. Resident-on-resident abuse is often ignored, if reported at all. And prosecutors say they typically don’t learn of state investigations until months after the abuse occurred, which makes criminal charges difficult, and at times impossible.

Families of victims are furious. They complain that the state will not tell them what investigators have discovered about their cases. Sometimes, they say, the state does not even notify them that an investigation is underway. Some families also have found that when they report their concerns directly to the facility’s owner or other residents, their loved ones have been threatened with immediate eviction.

The result is that many of the 85,000 Minnesotans who live in state-licensed homes for seniors are denied equal access to the criminal justice system.

“It’s painful to think about how many of these criminals are getting off the hook because we’re sending these cases down an administrative black hole,” said Nancy Fitzsimons, a professor at Minnesota State University, Mankato, who leads a state committee on abuse and neglect of vulnerable adults. “We, as a state, must recognize that these are crimes and they need to be treated as crimes.”

Even executives in the senior care industry fault the Health Department for its ineffective response. They say facilities are deprived of vital information that would enable them to make essential fixes, such as firing abusive caregivers or increasing supervision.

Senior officials with the Health Department acknowledge that the state’s inability to investigate most abuse allegations has far-reaching consequences for resident safety and care.

“The situation,” said Gil Acevedo, assistant health commissioner, “is no longer tenable.”

The volume of abuse allegations reflects rapid growth in Minnesota’s elder care industry. The state now licenses nearly 1,800 residential senior care facilities, including hundreds of homes that provide specialized care for seniors with dementia. Minnesota spends more than $1 billion annually in Medicaid funds for senior care, in addition to tens of millions of dollars paid by families. Both figures are likely to climb as Minnesota’s population ages.

The industry is also evolving in ways that are invisible to the public and difficult to regulate. More elderly Minnesotans are opting against traditional nursing homes and choosing to live their final years in less-institutional settings known as assisted-living facilities, which offer greater informality and independence.

The number of Minnesotans in assisted-living facilities has doubled over the past decade, to nearly 60,000, while the nursing home population has receded to less than 30,000.

Seniors in assisted-living centers are generally older, sicker and more volatile psychologically than in past years, making them more vulnerable to criminal abuse. But these facilities operate with much lighter state regulation than nursing homes. For instance, they are not required to maintain minimum staffing ratios, and they have fewer consumer protections, such as rules preventing arbitrary evictions.

These industry shifts have put Minnesota at risk of falling permanently behind the soaring number of abuse allegations, warned Iris Freeman, board member of the Minnesota Elder Justice Center and adjunct professor at the Mitchell Hamline School of Law.

“We should all be appalled by this picture,” Freeman said. “Minnesota used to be at the top of the heap when it came to elder abuse enforcement, and now we’re becoming known for being nonresponsive.”

‘It haunts me, it haunts me, it haunts me’  Robert Krause, surrounded by family, sobbed outside the courthouse in July as he heard that his mother's attacker had pleaded guilty to sexual assault. The family didn't know about the attack until nearly a year after she died.  
Robert Krause wakes up every morning to the memory of his dead mother.

Portraits of Jean Krause adorn nearly every wall and cabinet of his living room on the outskirts of Pequot Lakes in north central Minnesota. In many of the photos, Jean’s long blonde hair is tucked beneath the nurse’s cap that was part of her working uniform for most of her adult life.

One morning last summer, he received an unexpected phone call from a Crow Wing County assistant attorney, Janine LePage, who calmly informed Krause about “an important situation” involving his mother. Nearly a year had passed since her death. Krause suspected that LePage was calling about some minor dispute involving her estate.

He never expected to hear the words “sexual assault.”

About 9 p.m. on May 8, 2016, Jean Krause was found curled up in a fetal position, naked below her waist, in her bed at the Heritage House assisted-living complex in Pequot Lakes, court records show. Just a few feet away, a male caregiver, David DeLong, who was 59, stood sweating and breathing heavily, with his jeans and underwear at his knees, according to an eyewitness account described in a criminal complaint. When a female aide spotted DeLong, he began awkwardly trying to pull up his pants and underwear, the witness recalled.

Supervisors at Heritage House waited nearly two hours after the assault before calling police, and only did so after sending DeLong home for the night, according to the police and a criminal complaint. Later, investigators discovered that two crucial pieces of evidence — Krause’s red nightgown and mattress pad — had been placed in the facility’s washing machine, possibly by DeLong, police and prosecutors say.

“It’s infuriating,” Pequot Lakes Police Chief Eric Klang said of the facility’s handling of the case. “We had an eyewitness to a sexual assault of a frail woman with dementia, and the perpetrator was kept there and sent home without calling us. That’s not proper protocol.”

DeLong was never taken into custody by local police, and insisted on his innocence until detectives found DNA on the victim’s body that matched his. Months later, even DeLong wondered why he was sent home on the night of the assault and not treated more like a criminal.

“Why didn’t the people who saw me do it arrest me on the spot that night?” he asked, speaking from his home in Pine River, Minn.

After the police arrived, Jean Krause was sent to the hospital for a sexual assault exam. When she returned, Heritage House staff sent her back to the same room where just hours earlier she had been attacked, police and family members said.

In an interview with the Star Tribune, the owner of Heritage House said staff “acted properly” in sending DeLong home and then contacting police that night. She declined to discuss the family’s complaint that no one contacted them about the sexual assault.

“We are just very thankful that it was caught and reported and is going through the judicial system, and people can feel that some justice is done,” said Kathy Birchem, the facility owner.

LePage, the Crow Wing County prosecutor, said the facility’s “blatant tampering” with the crime scene the night of the attack made it harder to prosecute DeLong. By cleaning up the victim and her bed, the facility compromised crucial physical evidence, making a serious charge difficult to prove, she said.

The failure to inform family of the assault was another setback, because relatives often play a major role in pressing for tougher sentences, she said.

“Why didn’t the people who saw me do it arrest me on the spot that night?” asked David DeLong, at his home in Pine River, Minn., months after he sexually assaulted Jean Krause in her room at a senior facility.

DeLong eventually pleaded guilty to one count of fourth-degree criminal sexual conduct, which involves force or coercion, in a negotiated deal that is common when prosecutors lack strong physical evidence. He agreed to a sentence of one year in jail and 10 years’ probation.

In September, following Star Tribune inquiries into its regulatory history, Heritage House surrendered licenses for three of its properties under pressure from the state Health Department. It was just the second time in four years that a senior facility has surrendered its state license.

LePage said she sometimes wonders whether the outcome would have been different had the victim been a young girl instead of a 78-year-old woman who was unable to speak.

“If it was an 8-year-old girl, maybe someone would have rushed in and grabbed the girl, tried to protect her in some way,” she said. “A protective instinct might kick in that didn’t occur here.”

Robert Krause said he never would have let his mother stay at the facility had he known about the assault.

“How do you live with yourself knowing that your mother suffered but you did nothing to help?” said Krause, sobbing.
The Health Department took four months to investigate the incident and then cleared Heritage House of any wrongdoing. State investigators reached that conclusion without interviewing Jean Krause or any of her family. The department’s final report made no mention of the fact that Heritage House staff waited to report the crime, even though state and federal law requires the immediate reporting of maltreatment in state-licensed senior care facilities.

The state’s failure to issue discipline in such incidents is the rule rather than the exception, according to records reviewed by the Star Tribune. Even when the state substantiates abuse, it frequently blames an individual employee, not a breakdown in the facility’s management. The state has revoked the licenses of only two senior care homes in the past five years.

“Our current staff is really cracking under the pressure of our current caseload,” said Deputy Health Commissioner Daniel Pollock, in testimony this spring before lawmakers, who approved a small increase in the agency’s investigative budget.

Given the high volume of allegations filed each year, the department uses a triage system to sift through complaints and investigate the most serious cases first. Yet for two consecutive years, federal auditors from the Centers for Medicare and Medicaid Services (CMS) have cited Minnesota for incorrectly categorizing complaints as non-urgent, even when they involved severe abuse. The agency also failed to notify victims of their findings, the auditors said.

In recent audits obtained by the Star Tribune through public-records requests, CMS uncovered nearly two dozen allegations of serious harm and criminal abuse that were received but never investigated by the Health Department.

In one case, the state failed to respond to four separate reports of sexual abuse from a nursing home patient in Duluth. In another case, a nursing home resident had an unexplained black eye, a fractured foot and gangrene, but health officials categorized the complaint as nonserious. In another, a perpetrator confessed taking medications from patients in a nursing home, yet the state still categorized the complaint as not requiring an immediate investigation.
Minnesota’s Department of Health has won accolades over the years for promoting public health and investigating disease outbreaks. But the agency has never put a high priority on fighting crime, advocacy groups for seniors say.

Of the 27 Health Department staff who investigate abuse and neglect at state-licensed senior facilities, only one has a forensic background as a criminal investigator, agency officials said. The others are registered nurses with backgrounds as caregivers. The agency said it plans to hire three more investigators with forensic experience by year’s end.

“We are overburdening a state agency that was never designed to investigate criminal behavior,” said Suzanne Scheller, a Champlin attorney and founder of Elder Voice Family Advocates, a group of Minnesota families advocating for better care for seniors.

To assess the state’s handling of serious allegations of abuse, the Star Tribune reviewed a sample of 300 investigations completed by the Health Department since 2014. They show that its inspectors failed to interview victims in roughly half the cases and failed to notify police in nearly 40 percent. Only a fraction of the cases ever reached a prosecutor’s desk, according to county prosecutors interviewed by the Star Tribune.

In addition, completed investigations are removed from the agency’s website every three years, making it difficult for families to assess a facility’s safety record.

In 2011, concern over a surge in elder abuse allegations led Minnesota lawmakers to pass new criminal penalties, including prison time, for caregivers who intentionally neglect seniors under their care. Yet on average, fewer than 70 people are convicted each year under Minnesota’s vulnerable adult statute — most of them for financial crimes, not physical abuse.

At the Star Tribune’s request, a group of public prosecutors reviewed the 300 completed investigation reports. These attorneys, including prosecutors from Hennepin, Ramsey and Anoka counties, estimated that about one-third of the incidents had enough evidence of criminal wrongdoing to warrant charges or a formal criminal investigation.

“It’s a huge area of concern that we’re not seeing these [elder abuse] cases reach our desk, because the vulnerability of this population is huge,” said Tara Patet, senior prosecutor in the St. Paul city attorney’s office. “We have to treat elder abuse as the crime that it is, or otherwise it will keep happening.”

Prosecutors also said the investigations included dozens of suspicious deaths that warranted forensic investigations but had not been treated as crimes.

In early 2015, for instance, nurses at a facility in Bloomington watched and did nothing as an elderly woman with neurological problems fell four times over three days, and eventually died of a catastrophic brain injury. Multiple nurses were aware of the patient’s injuries, yet they never called her doctor, inspectors found.

In another case, in northern St. Louis County, a woman with Alzheimer’s disease was found lying face down in a pool of blood outside her nursing home. The woman had unexplained facial fractures and died two days later in May 2016, state records show.

And early this year, a resident at an assisted-living facility in Maple Grove died from blunt force injuries five days after being found at the bottom of a stairwell, bleeding.

Prosecutors said that such suspicious incidents would probably be investigated as crimes if they occurred in a person’s home or other community setting. But because they occurred in a state-licensed senior facility, they are routed through the Health Department, where nurses with little or no training in law enforcement review them as cases of medical neglect.

“Some of these cases would be a prosecutor’s layup, but they never get to our desk,” said Sweasy, the assistant Hennepin County district attorney.
She added, “If there was a 3-year-old child left standing in the middle of a busy intersection, we would all rush to hold someone accountable. But if an 80-year-old is physically or emotionally abused in a nursing home, then no one even knows what to do.”

Officials with the Health Department say they are taking steps to respond more quickly to allegations of harm.

Over the past year, the agency has streamlined its system for receiving and processing complaints, eliminating unnecessary paperwork. As a result, it can now launch a formal investigation within days after receiving a report of abuse. Previously, it took the agency weeks or months just to assign a case to investigators. In the coming year, the department will begin discussions with city and county prosecutors on improving the flow of cases and evidence. Currently, the agency shares details of its investigations only when they are completed, which can be too late for prosecutors to file charges.

“We feel very strongly that every citizen out there deserves at least an acknowledgment that we’re doing something, that we’re on the case,” said Acevedo, the deputy health commissioner. “When someone files a complaint with us … we owe it to the families to let them know that we take these allegations seriously.”

Representatives of the senior care industry are urging the state to be more transparent about its investigations. Currently, the state collects data on categories of abuse, such as drug thefts and resident-to-resident altercations, but not on the types of facilities where they occur and who is targeted.

Industry representatives are also seeking more consistency in the handling of abuse allegations. Nursing homes, for instance, must submit written action plans to correct violations, while assisted-living and home care providers do not.

“Frankly, we have a great opportunity to address problems that have built up for decades,” said Patti Cullen, president and chief executive of Care Providers of Minnesota, an association that represents the senior care industry. “If you keep throwing money at an agency that has systemic issues, then you’re not getting at the root cause of why there are so many delays and problems that are not getting fixed.”
 Delores Holz, reflected in the framed print “Grace,” was among the residents at a senior facility in Fairmont, Minn., who faced crippling pain because a staff member was stealing prescription pain medication.

Earlier this year, a painful and mysterious affliction spread through Goldfinch Estates, a spacious seniors’ complex that overlooks cornfields near Fairmont, Minn.

Longtime residents complained of nonstop pain, fatigue and loss of appetite. Normally outgoing men and women suddenly were bedridden, too weak to participate in the facility’s many group activities, from bake sales to games of gin rummy. At least two residents were hospitalized.

Months passed before a pharmacist discovered the cause. A nurse’s aide had been stealing full containers of painkillers from medication carts, then hiding the thefts by swapping them out with caffeine pills and other over-the-counter drugs. In the days following the discovery, more than a half-dozen residents came forward and complained of near-debilitating pain. They demanded an investigation.

The employee accused of taking the painkillers, Jennifer Ann Kiewiet, 28, was eventually charged with theft, drug possession and mistreatment of residents. She died of an apparent drug overdose just weeks before a scheduled court hearing, and the Martin County attorney’s office closed the criminal investigation.

To the frustration of residents of Goldfinch Estates, that seemed to end the matter. At least three residents told the Star Tribune that they filed formal complaints with the Health Department. They hoped the state would uncover how Kiewiet was able to steal the medications for so long, and order Goldfinch to take steps to ensure it would not happen again.

While the agency launched a formal investigation, residents said they have not been interviewed since the thefts were uncovered nine months ago.

Meanwhile, Goldfinch Estates sent every resident a short form letter asserting that, to the facility’s knowledge, “no resident” was “negatively harmed” by the incident.

“All I could do, night after night, was pray to God to let me die, and they try to claim that no one was even harmed?” said Delores Holz, 83, who estimates that she went three months without painkillers for her chronic arthritis. “It’s like we’re invisible.”

Elaine Cottew, 90, and other residents of a senior home said their questions about stolen meds were brushed off. “I was lying around like a zombie for weeks ... Of course I was harmed. We all were.”

Elaine Cottew, 90, said she found the letter “insulting.” She waved it with anger as she described the agony of going without her pain medications.

“What do you mean, I wasn’t harmed?” she said, her voice rising. “I was lying around like a zombie for weeks … Of course I was harmed. We all were.”

Finally, last spring, about a dozen residents and family members gathered in the ornate lobby of Goldfinch Estates and demanded to speak with facility management about the drug thefts. An administrator declined to meet with the group, saying the issue was already handled, residents said.

“Residents just wanted some assurance that it wouldn’t happen again, and they were just brushed aside like little children,” said Gary Ricard, whose 91-year-old mother lives at the facility. “The arrogance really upset people.”

Calvin Diekmann, executive director of Goldfinch Estates, said in an interview that the facility has taken steps to prevent another incident of residents receiving the wrong medications. Before pills are administered, he said, staff are now provided with a physical description of each drug to prevent mistakes.

Diekmann said he is still not aware of anyone who had been harmed by the drug thefts. “I’ve never gotten a doctor’s report saying that” a resident was hurt, he said.
Even as the population of elderly Americans receiving long-term care has risen to more than 8 million nationally, state and federal budgets for combating elder abuse have declined slightly over the past five years.

Funding isn’t the only challenge: A study by the National Institute of Justice found that the older the victim of sexual abuse, the less likely it is that the offender will actually be convicted. Investigators are also less likely to believe older people if there is no physical evidence of abuse, researchers found.

The surge in incidents of unchecked abuse has profound consequences for public health. A study published early this year by two University of Chicago sociologists found that elder maltreatment leads to significant declines in health, including greater anxiety, feelings of loneliness and increased susceptibility to disease.

Lori Smetanka, executive director of the Washington-based National Consumer Voice for Quality Long-Term Care, said awareness of elder abuse is still decades behind movements to stamp out domestic violence and child abuse. “We hear regularly from families across the country, that any complaint they file involving a [senior] facility goes down a black hole,” she said. “Across the country, investigations are not happening in anywhere near the numbers that they should.”
It’s been nearly a year since Marjory Aldrich, 80, reported being hit by a nurse at a nursing home in New Hope. “I laid there for 20 minutes, too petrified to move,” she said. The state recently wrote her a letter saying that the investigation was delayed.

Nearly a year has passed since Marjory Aldrich’s encounter with an abusive nurse.

Aldrich, 80, was recovering from pneumonia at a nursing home in New Hope and says she became frightened when the facility stopped giving her antibiotics.

She said she could feel fluid building up again in her lungs, and asked an aide about resuming her medications. When she got no response, she asked that a nurse call a doctor to renew her prescription. She said the nurse reacted by slamming a phone against her chest so hard that she nearly passed out.

“I laid there for 20 minutes, too petrified to move,” she said.

A day later, Aldrich reported the incident to the Health Department, thinking someone would come to interview her.

No investigator came.

She called the agency three times to check on the status of her report.

No investigator returned her calls.

Last month, Aldrich received a letter from the Health Department informing her that the state’s investigation into her case had been delayed until later this year.

From her mobile home west of the Twin Cities, Aldrich now wonders why she bothered to call the state agency instead of 911 or local police.

“This is why no one knows about these crimes,” she said, holding up a copy of the state’s last letter. “It’s not because we don’t have a voice. It’s because people in power deliberately choose not to listen.”

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The Top 37 Things You'll Regret When You're Old

1. Not traveling when you had the chance.
Traveling becomes infinitely harder the older you get, especially if you have a family and need to pay the way for three-plus people instead of just yourself.

2. Not learning another language.
You’ll kick yourself when you realize you took three years of language in high school and remember none of it.

3. Staying in a bad relationship.
No one who ever gets out of a bad relationship looks back without wishing they made the move sooner.

4. Forgoing sunscreen.
Wrinkles, moles, and skin cancer can largely be avoided if you protect yourself. You can use Coconut oil!

5. Missing the chance to see your favorite musicians.

“Nah, dude, I’ll catch Nirvana next time they come through town.” Facepalm.

6. Being scared to do things.
Looking back you’ll think, What was I so afraid of, comfort zone?

7. Failing to make physical fitness a priority.
Too many of us spend the physical peak of our lives on the couch. When you hit 40, 50, 60, and beyond, you’ll dream of what you could have done.

8. Letting yourself be defined by gender roles.
Few things are as sad as an old person saying, “Well, it just wasn’t done back then.”

9. Not quitting a terrible job.
Look, you gotta pay the bills. But if you don’t make a plan to improve your situation, you might wake up one day having spent 40 years in hell.

10. Not trying harder in school.
It’s not just that your grades play a role in determining where you end up in life. Eventually you’ll realize how neat it was to get to spend all day learning, and wish you’d paid more attention.

Home for elders accused of losing a resident (twice), dumping another who couldn’t

Miami Gardens
A Miami-Dade care home that allegedly deprived frail elders of their medication, twice lost track of one resident and dumped another in a hotel over lack of payment has had its license suspended by the state.

In all, six residents were neglected at the Miami Gardens-area home — three of them so severely they had to be hospitalized.

The home, at 1415 NE 200th St. in unincorporated Miami-Dade, was licensed by the state Agency for Health Care Administration to care for five disabled adults or frail elders within a private residence.

On Nov. 9, AHCA’s deputy secretary, Molly McKinstry, filed an emergency order suspending the home’s license — effectively shutting down the home, at least temporarily. The care home is owned by 54-year-old Claudene Barthelus.

Under Barthelus’ license, she was to provide room, board and personal care around the clock, including monitoring the health of residents and ensuring they receive medications and wound care.

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But the 14-page suspension order offers a litany of alleged failures, some of them life threatening.

One resident, identified only as Resident 1, moved into the home on Oct. 6 with a range of diagnoses, including bouts of disorientation, and diabetes. Resident 1 also was at risk of falling. The day after Resident 1 was admitted, the resident was hospitalized with high blood sugar, and was discharged five days later with a two-month supply of insulin.

Three days after returning to the home, Resident 1 was right back in the hospital. “There is no indication that [Barthelus] obtained the services of skilled nursing care, and there is no indication the resident’s insulin was administered,” the order says. Resident 1 returned to Barthelus’ home on Oct. 18, but was hospitalized yet again the next day. In all, the order said, Barthelus accepted the resident into her home three times despite the fact that she could not care for him or her.

Resident 2 was hospitalized after a fall — despite being admitted to the home on Oct. 30 with weakness in his or her right side, and under fall precautions. “The resident was unable to obtain assistance from [caregivers] and called an adult sibling to obtain emergency medical services,” the order said.

Resident 3 moved into Barthelus’ home on Oct. 14. The resident required help administering medication, the order says, but there’s “no indication [Barthelus] notified the resident’s healthcare provider or responsible party that the resident was not receiving prescribed medication.” Nine days later, Resident 3 was hospitalized as well. “The resident’s medications remained in a bag at [Barthelus’] facility as of Nov. 1,” the order said.

Another resident, who is diagnosed with dementia, told authorities there wasn’t enough food in the home, and had lost 10 pounds before regulators moved to suspend the home. The order said Barthelus had failed to record residents’ weights, and was unaware Resident 4 was deteriorating.

Resident 5, who could not leave his or her bed, was left in a hotel room on Oct. 23 after running out of money. And Resident 6’s pressure sore worsened from Stage I to Stage II while in Barthelus’ care. “There is no indication that [Barthelus] obtained the services of a licensed professional to assess or treat the resident’s pressure ulcer,” the order said.

The home “failed to honor the residents’ rights to live in a safe and decent living environment free from abuse and neglect, and to have access to adequate and appropriate healthcare,” the order said. Barthelus, the order said, “exhibited a willing and negligent disregard for the rights and needs of [her] residents.”

But Barthelus said she cares for her patients.

“I like them. They like me,” she said.

She said she didn’t want to say anything else because she didn’t know what AHCA had released.

“I say something, they say something else,” Barthelus said.

AHCA records show Barthelus’ home had violated state regulations before.

In August, the home was cited for not having proof of an up-to-date county health inspection. It also had no proof of passing recent fire inspections. The last one noted violations.

A month prior to this, the sister of a resident complained that Barthelus tried to charge her $171.60 for her brother’s ironing. The owner also tried to charge a 15 percent late fee despite never having set a monthly due date for payments.

In April of this year, AHCA noted that one resident had gone missing from the home twice before, but this was never documented. And Barthelus never called police. On another occasion documented in the same report, Barthelus took a resident to an unnamed office to find out about the resident’s benefits. Barthelus told AHCA officials that she left the resident with a case manager and went home. The case manager called it abandonment, noting Barthelus had been frustrated with the resident.

And in May 2016, Barthelus was cited for not having documentation to prove her completion of a required 12-hour training program. She also lacked proof of first-aid training.

Health administrators declined to discuss Barthelus’ home with a Herald reporter.

AHCA did release a short statement: “The Agency takes resident health and safety very seriously for the facilities that we regulate, and we will hold those facilities that fail to protect residents accountable. The emergency suspension prohibits this facility from operating an adult family care home, and we have taken action to revoke the facility license, which is pending litigation.”

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Home for elders accused of losing a resident (twice), dumping another who couldn’t pay

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Saturday, December 30, 2017

96-year-old faces Christmas Eve eviction for recording alleged caregiver neglect

LOS ANGELES -- Sally Kelly is unable go to the bathroom without help. In fact, she needs help with all of her daily needs because she previously had two strokes and two broken hips.

CBS Los Angeles reports a video shows the 96-year-old waiting for help for 58 minutes while needing to go to the bathroom. The video camera stopped recording after about an hour.

Her daughter, Audrey Kelly, says it took more than two hours for a paid caregiver to respond. She says this isn't the only time this has happened.

"Cameras are catching them not coming and performing services," Audrey said.
Another recording, a couple of months later, shows Kelly waiting 38 minutes before the recording stops.

Audrey says her mother mounted visible security cameras in her apartment at City View Villa, which is a senior living facility, for her own safety. She says the video shows her mother is not receiving the desperately needed services that she's paying for.

"Everything from her calling for help and no one coming for hours, prompting me to call several times and they still don't come after I call," Audrey said. "They don't show up for showers 95 percent of the time so I have to do it, they don't show up to dress her in the morning, provide her grooming in the morning."

Audrey says the facility's executive director accused her and her mother of committing a criminal offense by using the cameras and ordered her to take them down. But the LAPD says it's not illegal to use cameras in the privacy of your own home.

What's ironic is that Kelly was a detective for the Los Angeles County Sheriff's Department years ago.

Audrey is demanding for her mother's account to be credited for all of the services she has not received. The facility, however, responded by serving her with an eviction notice.

Kelly says she's not backing down.

"We won't get rid of the cameras," she said.

"She's scared, she's upset, rightfully so, she doesn't understand why they wont credit her account when they know she has these cameras that have caught them red-handed and she doesn't understand why on the eve of the holidays would they be so cruel," Audrey said.

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96-year-old faces Christmas Eve eviction for recording alleged caregiver neglect

Assisted suicide laws are creating a 'duty-to-die' medical culture

Despite not hearing about it often, assisted suicide is a major issue in the U.S. right now. In more than 20 states this year alone lawmakers have introduced bills to legalize assisted suicide, and almost every single one of them has been struck down — with bi-partisan support. A recent bi-partisan Sense of Congress bill introduced in Washington, D.C., has opened up the discussion at a national level, and paved the way for upcoming bills and debates in 2018. If 2017 was a busy year for assisted suicide legislation, 2018 will be even more so.

Though assisted suicide is promoted as freedom of choice, the economic forces that drive insurance companies, and subsequently patients’ coverage options, greatly restrict self-determination for already vulnerable populations, including people with disabilities. There is evidence that economic considerations limit choice when it comes to health insurance coverage. And the deadly combination of assisted suicide and our profit-driven health care system does in fact steer some patients toward lethal drugs, the cheapest form of “treatment.”

Dr. Brian Callister, a physician from Reno, Nev., was told by two separate insurance medical directors that assisted suicide would be covered for his California patients, but the curative therapies Dr. Callister had prescribed to save their lives would not.

Callister confirms the concerns of health care advocates, saying that “since assisted suicide became legal in California and Oregon, the practice of medicine across the West has been irreparably harmed for patients who still want their diseases treated but are now simply offered the cheaper option of a quick death.” Patients Barbara Wagner and Randy Stroup in Oregon had similar experiences.

Multiple studies show that people with disabilities, senior citizens, poor people, and people of color are more likely to be mistreated by medical professionals, and the likelihood of being mistreated increases if family members view them as an emotional or financial burden. 

When it comes to assisted suicide, we see in states like Oregon, where assisted suicide has been legal for two decades, the percentage of Oregon deaths attributed to a patient’s reluctance to “burden” their families rose from 13 percent in 1998 to 40 percent in 2014

This reveals that the right to die “option” for some vulnerable populations has quickly become more like a duty to die.

The legalization of assisted suicide also devalues the lives of people with disabilities because it creates a double standard — insurance companies and state agencies readily offer to pay for life-ending drugs for individuals with disabilities and serious health conditions when they ask for death, but provide suicide prevention services to non-disabled individuals who make the same request.

But there is more cause for alarm. In states where assisted suicide is legal, nothing prevents a relative who stands to benefit from the patient’s death from steering that person towards suicide, witnessing the request, picking up the lethal dose, or even administering the drug. The same goes for abusive caregivers. No witnesses are required when the lethal drugs are administered, and despite assurances by assisted suicide proponents, there are no checks or balances that would prevent abuses. 

On top of that, oversight and data reporting are difficult or impossible to enforce. At present, states that have legalized assisted suicide do not even require doctors to record the lethal medication they prescribed as the direct cause of death on the death certificate. Instead, they list the cause of death as, for example, the patient’s terminal illness thereby leaving behind a trail of misleading documentation.

When it comes to assisted suicide, mistakes by health care professionals, widespread misinformation, coercion, and abuse all limit the ability of people with disabilities to make informed and independent decisions. And in this profit-driven economic climate, is it realistic to expect that insurers are going to do the right thing, or the cheap thing? If insurers deny, or even delay, approval of costlier life-saving alternatives, then money saving but fatal measures become the deadly default. 

The truth is that assisted suicide as public policy is rife with dangerous loopholes and consequences, especially for the vulnerable in our society. We should reject laws that legalize the practice.

Helena Berger is president and CEO of the American Association of People with Disabilities.

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Assisted suicide laws are creating a 'duty-to-die' medical culture

Retirement home shut down months after attack on 86-year-old

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(CNN)A newly uncovered video of a resident at an assisted living facility in Florida mercilessly beating another resident raises new questions about the safety of the elderly in places meant to protect and care for them.

In the video, obtained last week, a 52-year-old resident is seen punching an 86-year-old resident with dementia more than 50 times as the older man lay curled up on the floor.

The younger resident accused the older resident of eating his cupcake, according to law enforcement.

The video was taken by the facility's closed circuit surveillance system in October and later turned over to the police, who shared it with CNN.

The facility -- the Good Samaritan Retirement Home in Williston -- had a history of violations, and more sanctions in the past five years than any other assisted living facility in Florida. In December, two administrators were arrested in connection with separate incidents on charges of neglect of the elderly.

The beating, which was first reported by the Gainesville Sun, lasted on and off for nearly 2 minutes. It occurred in a common area of a secured unit within the facility while other residents ate and watched television mere feet away.

At the time the beating took place, there was no staff member attending to residents in the unit, and no one had been assigned to monitor the unit's video surveillance, according to official reports.

By the time staff arrived, the beating was over. The elderly resident was hospitalized with bruising and swelling to his face, as well as hip pain, according to the police report.

A month after the beating, another resident hit her head at the facility and was not immediately taken to the hospital. She later died.

One of the facility's administrators, Nenita Alfonso Sudeall, later broke down and cried as she told police she was "overwhelmed" at the facility, which she said was short-staffed and had poorly trained employees, according to a police report.

A number of other recent reports and incidents have called into question the safety of residents of nursing homes and assisted living facilities across the country.

Sometimes, as in the case in Florida, the threats come from fellow residents. Other times, it's from staff.

According to a 2016 study of 10 New York nursing homes, in a given month, one out of five residents suffers mistreatment at the hands of another resident. In September, residents of a Florida nursing home died after Hurricane Irma knocked out the facility's air conditioning. According to the Hollywood Police Department, Broward County Chief Medical Examiner Dr. Craig Mallak classified 12 deaths as homicides from heat exposure, as staff at the Rehabilitation Center at Hollywood Hills failed to evacuate residents amid sweltering temperatures in the days following the storm.

Also earlier this year, a CNN report found that the federal government has cited more than 1,000 nursing homes for mishandling or failing to prevent alleged cases of rape, sexual assault and sexual abuse at their facilities between 2013 and 2016.

"There are far too many cases of abuse and neglect happening in nursing homes and assisted living facilities," said Brian Lee, executive director of Families for Better Care, a national advocacy organization for residents and their families. "We've been seeing cases for decades. This one incident in Florida shows how bad the problem can be."

A spokeswoman for the association that represents many of Florida's long-term care providers said the October beating at Good Samaritan and the national report about nursing home rapes are "disturbing." The association does not represent Good Samaritan.

"We extend our heartfelt thoughts and sympathies to all residents and families involved," Kristen Knapp, the spokeswoman for the Florida Health Care Association, wrote in an email to CNN.

"Cases of abuse are appalling and deeply troubling, and actions that jeopardize the privacy, dignity and safety of the elderly should be condemned and prosecuted to the fullest degree possible," she added.

Fifty-six punches in two minutes

The beating occurred October 3 in a secure unit of Good Samaritan, a 45-bed assisted living facility.

The 86-year-old man was punched 56 times, according to law enforcement reports. Two other residents futilely attempted to help. Staff members arrived at the scene roughly 30 seconds after the beating ended.

The resident seen doing the beating had previously suffered a traumatic brain injury, according to police.

Clay Connolly, Williston's deputy police chief, said the man, whose name was not released, has been arrested several times in the past for assault and battery. Connolly said the man was never prosecuted because he was declared mentally incapacitated. According to a police report, he wasn't arrested for the October beating because of his "limited capacity."

Staff at Good Samaritan told police the man had shown no signs of aggression since coming to the facility in 2015, according to police reports. After beating the other resident, he was removed from the facility temporarily for evaluation, but was later allowed to return to Good Samaritan.

After his return, he was supervised one-on-one by facility staff, according to a report by the state's Agency for Health Care Administration. The report goes on to say that "there was no evidence that the staff had been trained on the scope of such responsibilities."

According to the Florida Health Care Association, which represents some of the state's long-term care providers, nursing homes and assisted living facilities have mandatory staff training programs that address prevention and recognition of abuse, including abuse committed by residents.

CNN attempted to contact the owners and administrators of Good Samaritan by phone and email, and attempted to reach the owners on Facebook, as well. Court records do not yet indicate the names of the administrators' lawyers.

A long history of violations

Over the past five years, the state Agency for Health Care Administration has sanctioned Good Samaritan 17 times -- more than any other assisted living facility in Florida. The agency has also hit Good Samaritan with $73,750 in fines over the same time period -- again, more than any other facility in Florida.

CNN obtained these numbers from the agency's website last week, before the facility was listed as closed.

Over the last five years, there were changes in ownership at the facility. The most recent owners, Helen Romero and Jhoana Paz, appear on ownership documents dating back to August 2015, according to the agency. CNN was unable to determine if their roles at the facility go back further.

In the year before the beating, the state agency reported that the facility had problems with documentation for medications given to residents, failing "to provide a decent living environment," and failing "to provide appropriate supervision for a resident in need of medical services."

State Sen. Lauren Book became involved after receiving a phone call from Lee, the advocate who is also Florida's former long-term care ombudsman. She questioned why Good Samaritan wasn't closed down after the beating in early October, especially given the facility's long track record of infractions.

"Why are residents being left in these facilities that clearly aren't safe?" Book asked.

A resident death

The Florida Department of Children and Families was informed of the October beating the day it happened, police records show.

One month later, on November 1, a 72-year-old female resident fell and hit her head. Staff did not take her to the hospital or inform her daughter or health care provider about the fall.

According to the police report, Sudeall, the facility administrator who complained of being overwhelmed, told police that the elderly woman had fallen in the parking lot and did not wish to be transported to the hospital for treatment. Sudeall told the police she had followed established protocol since "the wound was not actively bleeding and she was conscious and responsive, she was permitted to make the decision as to medical treatment."

Sudeall told the police she placed the elderly woman in the "memory ward," a special unit within the facility, to better monitor her condition and keep her from wandering outside. The woman was reportedly monitored on an hourly basis by staff, according to the police report.

About six hours after she fell, the resident was found unresponsive in bed and 911 was called, according to the police report. Police found the woman, her face turned toward the pillow, occasionally gasping for air and with dried blood on her head and hands.

Sudeall, the facility administrator, told police she delivered first aid to the woman. When police asked what that entailed, Sudeall said she cleaned the blood off her face and hands, according to a law enforcement report. In an incident report, staff also recorded they had given her an ice compress and that she "refused to go to the hospital," according to an agency survey.

The woman was taken to the hospital, where she later died.

The fatal injury was first reported in the Gainesville Sun.

Connolly, the police deputy chief, said he and his colleagues became frustrated that the Agency for Health Care Administration wasn't doing enough to protect the residents.

"The whole thing was atrocious. We have people being killed and injured. We were anxious. We were beside ourselves," Connolly said. "There was a huge amount of frustration in my office because regulatory agencies weren't regulating."

On November 22, nearly three weeks after the woman's death, the Agency for Health Care Administration put a moratorium on new admissions to Good Samaritan.

Connolly says that wasn't enough.

"That just meant they could only kill the people they had left," he said. "We asked, 'What are you planning to do with the people who are there?' We never got a good answer."

According to a statement from a spokeswoman, the state agency took "swift action to hold this facility accountable. ... The health and safety of residents is our top priority, which is why (the agency) has and will hold any facility who fails to protect residents fully accountable."

Two weeks later, there was another incident -- one that resulted in the arrest of a facility administrator.

On Thursday, December 7, a resident underwent a medical procedure. A nurse instructed Rhaimley Yap Romero, an administrator who police said was the co-owner's son, to closely monitor the resident over the weekend and alert her immediately if there were any changes in the resident's condition, according to a press release by the Williston police.

Over the weekend, the patient's condition did deteriorate, and the facility staff contacted Romero twice, but Romero did not contact the nurse and gave no care instructions to the staff, according to police.

On December 11, police arrested Romero, 31, on charges of neglect of the elderly. Sudeall was taken into custody days later on the same charge involving the death of the resident who had hit her head.

Neither has entered a plea.

Still, the facility was not immediately shut down.

'Why did it take seven weeks to shut this facility?'

On December 19, the Agency for Health Care Administration filed a report about the facility. It noted many problems, including that some patients had been given the wrong dosages of medications, and other patients were given medications even though there was no documentation of a physician's order. In another case, the medication record reflected that a medication wasn't given to a resident until 11 days after it was prescribed.

The agency also reported that the facility's administrator "lacks requisite qualifications" and that the "current administrator and shareholder both candidly admit a lack of knowledge of Facility operations."

The report continues to say that most of the staff were not English speakers, while most of the residents spoke only English.

"The majority of (Good Samaritan's) staff is unable to communicate with the resident population due to language barriers," according to the report.

"No resident need be subject to the rudderless management and operations which exist" at Good Samaritan, the report continued.

On December 19, Deputy Chief Connolly and others expressed their frustration during a conference call with officials from the state agency. Book, the state senator, said she contacted the agency the same day.

The state filed an emergency suspension order of the facility's license that day.

"We have taken aggressive action to ensure the Good Samaritan facility will no longer be responsible for any residents, and this facility will be shut down by this Saturday, December 23," Mallory McManus, a spokeswoman for the agency, said in a statement on December 21. "We will continue to work with our partners, and with families to quickly and safely relocate all residents."

Book says that while she's glad the facility will no longer operate, she looks back and wonders why it wasn't closed back in October when the beating occurred, or nearly two months ago, after the other resident died.

"There are some questions the secretary (of the Agency for Health Care Administration) and I are going to have to go over," she said. "Why did it take seven weeks to shut this facility?"

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Retirement home shut down months after attack on 86-year-old