Butler County approves funding to address backlog of cases for in-home visit program

By Larry Seward, WCPO

HAMILTON — A watchdog frozen by court backlogs got a boost in Butler County: Commissioners signed off on $500,000 worth of American Relief Plan Act funding that will allow probate and domestic violence courts to hire staff for “essential functions.”

It is personal for Probate Court Judge John Holcomb.

“They just need a little help from the court,” Holcomb said.

His mother-in-law died fighting Alzheimer’s Disease. So, as leader of the court charged with guarding the well-being of seniors and adults unable to care for themselves, Holcomb said his team’s in-home visit program needs a quick fix.

COVID-19 pandemic protocols suspended the program for six months. That led to a two-year backlog in visits. The county had just one investigator to handle the task. In January, the court had 2,648 incoming guardianships with another 140 pending, according to state records.

While the court applied for an ARPA, Holcomb’s team hired a former intern away from a nonprofit to take on investigative duties. The two investigators are working to catch up, hold caretakers accountable and make sure the vulnerable are alive and well.

“I can tell you with adding this second investigator position we are ensuring that the needs of our senior citizens are being met,” he said.

County commissioners approved a $424,068 grant award for Butler County’s Domestic Relations Court Monday. It plans to hire a magistrate/mediator to ease the rising number of custody cases. The funding will cover the position for two years.

The $183,783 grant for probate court will pay for the second investigator and a file clerk for two years.

“That is going to take the burden off our local taxpayers of funding this,” Holcomb said.

By the time the grants expire, court administrators hope to have backlogs cleared or see a county budget big enough to keep all hands on deck.

WCPO is a content partner of the Journal-News.

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Butler County approves funding to address backlog of cases for in-home visit program

5,000 nursing home investigations delayed, thanks to Covid-19

by Lou Michel

Leona Post at Absolut Center for Nursing & Rehabilitation at Aurora Park on April 20, 2020. Family members says she is missing her dentures and eyeglasses.
Photo courtesy of Michele Vaillancourt

The New York State Health Department has a backlog of nearly 5,000 unresolved complaints filed against nursing homes during the Covid-19 pandemic.

Citing privacy laws, the Health Department refuses to shed any further light on those complaints other than to say they are pending and under review. 

While fighting the virus that killed more than 6,300 nursing home residents, the Health Department gave top priority to investigating complaints of infection control and immediate jeopardy. Other complaints – including at least one about a local fatality – have not received the same attention.

“Amidst one of the worst pandemics in history, the federal Centers for Medicare and Medicaid Services mandate all state agencies nationwide only conduct focused infection control and immediate jeopardy surveys,” said Jeffrey Hammond, a spokesman for the Health Department.

Since March 1, 4,927 complaints were filed against nursing homes and 965 of them involve facilities in the 17 most western counties of the state, including Erie and Niagara.

The U.S. Centers for Medicare and Medicaid Services on March 23 suspended all other types of inspections to allow states to concentrate on halting the spread of the new coronavirus amid the country’s frail nursing home population. On June 1, the agency issued a memo providing guidance to resume enforcement of other regulations governing nursing homes.

"Due to the risk the Covid-19 poses to the health and safety of nursing home residents, our primary focus remains on ensuring facilities are prepared to prevent its spread. However, we are also concerned about nursing homes’ compliance with other federal requirements. Therefore, we are prompting states to begin to survey for compliance with these requirements," the Centers for Medicare and Medicaid Services said in a statement to The Buffalo News.

Among those who have had to wait months for a complaint to be addressed are the daughters of 83-year-old Leona Post, who died May 1. Her children complained Post did not receive enough assistance in eating while in an East Aurora nursing home. They say Post’s eyeglasses and dentures were also lost at the facility, making it all the more difficult for their mother to eat, according to the complaint.

An official at Absolut Center for Nursing & Rehabilitation at Aurora Park said Post died May 1 because of ailments that made her vulnerable to Covid-19.

Jason Newman, an Absolut spokesman, said an on-site state Health Department inspection Wednesday "found no wrongdoing whatsover" in the treatment of Post. He said the Health Department has not provided the nursing home with that determination in writing.

Hammond said there was no information publicly available Thursday when asked by The Buffalo News if the Health Department had determined the complaint was unfounded.

Post’s daughters filed their complaint May 6 with the Health Department seeking an investigation into the care given to their mother at the nursing home. Michele Vaillancourt, her mother's health proxy, said Thursday they still had not heard back from the Health Department on any findings.

Since March 1, state Health Department inspectors have conducted more than 1,300 on-site “infection control Covid-19 focus inspections,” at the state’s 613 nursing homes and 544 adult care facilities, according to Hammond. Those inspections included 143 at Western New York nursing homes.

When pressed on the status of the 965 complaints, Hammond said the ones involving infection control and immediate jeopardy were investigated. As to the overall status of the complaints and whether any were resolved, Hammond said, "The 965 complaints remain under review. All complaints are kept confidential and privacy laws prohibit the department from discussing an individual’s medical history."

In further explaining the Health Department's position, he said, "It’s important to note annually DOH receives more than 15,000 nursing home complaints statewide."

Advocates: State should investigate complaints

Advocates for nursing home residents believe the state has a backlog of complaints that are not directly related to the pandemic. Delays in investigating those complaints, now that the deadly wave of deaths in New York nursing homes has subsided, is doing a disservice to residents, according to the advocates.

“Nursing home residents have suffered for months under an inhumane, untenable lockdown that has separated them from their families and friends and any chance of monitoring or enforcement of even the most basic, essential care standards,” said Richard Mollot, director of the Long Term Care Community Coalition in New York City.

On March 13, Gov. Andrew M. Cuomo ordered a ban on visits to nursing homes in response to the highly contagious coronavirus. But Wednesday, limited visiting resumed at some long-term care facilities that filed visitation plans with the Health Department.

An official at the Empire Center, an independent nonpartisan think tank and watchdog group in Albany, said it is understandable that the government focused on the most serious complaints when the pandemic struck, but that other complaints should not be put aside.

“In a crisis, you would focus on the most urgent complaints as a kind of triage. At the same time, because there are no visitors and the access of ombudsmen have been restricted, the role of inspections becomes that much more important,” said Bill Hammond, health policy director at the Empire Center.

The limited visiting also allows for ombudsman visits.

“So as soon as possible, after the crisis has passed, you would want to redouble inspections and look at all kinds of complaints,” said Bill Hammond, who is not related to Jeffrey Hammond.

Lisa Newman, local program director of the state’s Long Term Care Ombudsman Program, said the ban made it “challenging” to follow up on concerns expressed by nursing home residents and their family members.

“We’re not able to have eyes on the situation and verify what is happening in the nursing home,” Newman said. “We have reached out to our volunteers at specific nursing homes to make sure they have contact with a staff social worker or administrator in order to resolve concerns.”

Even before the pandemic, the Health Department was already backlogged with complaints against nursing homes and questions regarding the department’s ability to enforce corrections for cited violations, according to Lindsay Heckler, supervising attorney at the Center for Elder Law & Justice in Buffalo.

“The State Legislature had concerns about the DOH’s ability to enforce the regulations which is why they passed legislation that established an independent quality monitor of the written corrective action plans,” Heckler said.

The bill was signed into law by the governor last December.

Heckler said she realizes the state Health Department is “overwhelmed at the moment and likely under-resourced and short staffed,” but that steps need to be taken to resume investigations into all complaints.

Complaint against Absolut 

Vaillancourt, one of Post's daughters, said a Health Department investigator promised Tuesday to get back to her within 10 days about the complaint against Absolut at Aurora Park.

Newman, the Absolut spokesman, said Post’s eyeglasses were found and returned to the family, but her dentures remain missing. Nursing home documents on Post’s care, he said, prove she continued to receive “food and nourishment leading up to her Covid diagnosis.”

Post, who had a number of medical conditions, including dementia and diabetes, died May 1 at Buffalo General Medical Center, five days after she was transferred there from Absolut at Aurora Park.
 

Leona Post at the Eden Heights
assisted living facility the day
before she was moved to
Absolut Center for Nursing
& Rehabilitation at Aurora
Park on March 11, 2020.
Photo courtesy of
Michele Vaillancourt

Absolut records indicate Post weighed 155 pounds when she became a resident on March 11, according to documents provided by Post’s relatives and the nursing home. She was moved to Buffalo General on April 26, three days after she tested positive for Covid-19. Her weight upon admission to the hospital was 110 pounds, according to hospital records.

That would mean she lost 45 pounds in 46 days at the nursing home.

But Newman said another record indicates Post lost less weight.

Post weighed 138 pounds on Feb. 27, according to a record the family obtained this week from Eden Heights, the assisted living facility where Post resided at the time, Vaillancourt said.The daughter added that she remains concerned about her mother's weight loss.

The main purpose of the complaint, Vaillancourt said, is for the state to determine if her mother received adequate assistance in eating her meals.

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5,000 nursing home investigations delayed, thanks to Covid-19

State employees say elder-abuse reports tossed in trash due to backlog of cases

Minnesota Health Commissioner Dr. Ed Ehlinger

The abrupt firing of a senior regulator at the Minnesota Department of Health is unleashing a torrent of complaints by employees who describe dysfunction and disarray at the state agency responsible for protecting vulnerable adults at senior care facilities.

In interviews with the Star Tribune, employees described an office so overwhelmed by backlogged cases that workers dumped dozens of maltreatment complaints into recycling bins without reading them. Others said unread complaint forms piled up into stacks 2 feet high and went unexamined for months.

At one point, employees said, they were ordered to stop making phone calls to elderly victims and other individuals who reported nursing home abuse because it was too time-consuming. But that only angered families, hindered investigations and subverted office morale, they said.

“Day after day, people here are put in an impossible situation,” said Jessie Saavedra, who has worked at the Health Department for 23 years, including the past three years at its Office of Health Facility Complaints (OHFC).

Workers contacted the Star Tribune after learning that Nancy A. Omondi was terminated last month as director of the agency’s health regulation division. Her firing came just weeks after the Star Tribune published a five-part series documenting that ­hundreds of residents at senior care centers across Minnesota are beaten, sexually assaulted or robbed each year.

The employees’ accounts help explain why the Health Department suffered chronic breakdowns in investigating maltreatment complaints, holding facilities accountable and addressing the alarm and anxiety of worried families.

In an interview, Health Commissioner Dr. Ed Ehlinger said he was “really disturbed” by reports that employees may have destroyed complaint records and said he has already launched an investigation into those claims. He and other agency officials also emphasized that OHFC staff are expected to call individuals who report complaints, and that such calls are vital to families and the investigative process. An agency spokesman said any contrary guidance by a supervisor “would be unacceptable.”

“I admit that we have some dysfunction in OHFC,” Ehlinger said. “We acknowledge that we are not doing as good a job as we should. If we are going to be a resource that people can trust and come to, then we need to do a better job.”

More investigators

Agency officials acknowledge they were caught off guard by a massive surge in abuse complaints in recent years, and they are now taking steps to reduce the backlog and streamline investigations. This includes a plan to double the OHFC’s investigative staff over the next four years by adding 27 investigators. The surge in complaints partly stemmed from the July 2015 launch and promotion of a new, centralized hot line for maltreatment reporting, which made it easier for seniors to report abuse.

The agency is also modernizing its computers so it can collect and share more information about abuse investigations electronically. Starting in January, agency staff will begin scanning maltreatment complaints into its computer system, an important step toward reducing the agency’s reliance on paper.

The number of maltreatment allegations received by the OHFC has swelled from about 4,000 in 2010 to more than 25,000 in 2016. Yet the unit has failed to keep pace with this surge, and last year it only investigated 3 percent of these cases on site, state records show.

“We were not ready for that kind of onslaught,” Ehlinger said.

However, former and current employees at OHFC say the problems in the unit are deep-rooted and unlikely to be solved through more funding or additional staff.

“The system is broken and it’s been broken so long that the people in charge can no longer see it,” Omondi said in an interview shortly after her termination.

OHFC employees said many of the unit’s problems stem from an archaic, paper-based reporting system. Even when complaints are sent electronically by other state and county agencies, staff must still create a special paper file. At times, the complaints are written out by hand and stuffed in the complaint files, workers said.

“You could fill up a whole baseball diamond with the tons of paper files waiting to be processed,” Saavedra said. “With that volume of paper, the chances of things getting lost and important things going missing is really, really high.”

Employees said files would sometimes go missing for months at a time or get permanently lost. The delays frustrated relatives who reported abuse because they couldn’t learn why their cases were not being investigated, workers said.

Enforcement breakdown

The result, as documented by the Star Tribune investigation, is that the vast majority of abuse allegations from senior care homes in Minnesota are never resolved and perpetrators are never punished.

Two former OHFC employees, who spoke on the condition of anonymity, said they recall written complaints being tossed in recycling bins, without being reviewed, because of pressure to reduce the backlog of unresolved cases. The practice, they said, contradicted the agency’s claim that it reviews every complaint.

Diane Konecny, a former complaint intake specialist, said she left the unit in 2013 after 16 years, partly because of guilt over not being able to respond to abuse complaints in a timely manner.

“People were in tears because we felt so bad for these families and these vulnerable adults,” said Konecny, who is retired. “We wanted to get these cases resolved. But obstacles were being thrown our way that made it impossible to do quality work.”

Mixed messages

One of these obstacles, say former and current employees, was conflicting messages on whether to communicate with abuse victims and others who report abuse.

These interviews were often vital to determining exactly what happened in an incident and whether the allegation warranted a deeper investigation. The regular calls also put victims and their relatives at ease, indicating that the state took their allegations seriously, employees said.

But OHFC staff said they were told by administrators — at various points since 2013 — to stop calling individuals reporting abuse, as a way of speeding up investigations and reducing the backlog of unresolved cases. At other times, employees said they were encouraged to make such calls.

“I remember thinking, ‘Why are they putting a roadblock in front of us?’ ” Saavedra said. “People file these complaints because they have a serious concern, and we should be responding to [them] in a timely fashion.”

Crying in their cubicles

Omondi said she became concerned about a “dysfunctional work environment” at the OHFC soon after joining the agency in September 2016. She said she was told that some staff were “crying in their cubicles” because of the backlog of unresolved cases. The unit also suffered from high turnover, with more than a third of the staff leaving each year, she said.

“I walked into a lot of chaos,” she said. “People desperately wanted to do a good job, but their plate was overflowing. So how could they catch up?”

A number of OHFC staff said they have shared their concerns with top department administrators and the Minnesota Office of the Legislative Auditor. The auditor’s office is conducting an evaluation, expected for release in February.

Responding to the Star Tribune series, Gov. Mark Dayton has appointed a special work group led by a handful of consumer groups, which will make recommendations to the 2018 Legislature.

State legislators also have expressed concern. Last week Sen. Karin Housley, chairwoman of the Senate Aging and Long-Term Care Policy Committee, and two other lawmakers called for an investigation into management practices at the Health Department after receiving reports of bullying at the agency. Housley, a Republican from St. Marys Point near Afton, is also working with advocacy groups to craft legislation that would improve the speed and transparency of senior home investigations.

“We need to remember that elder abuse is a life-or-death issue,” said Sen. Jim Abeler, R-Anoka, chairman of the Senate Human Services Finance and Reform Committee. “If I ran the [Health] Department, I would be working overtime … to solve this problem.”

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State employees say elder-abuse reports tossed in trash due to backlog of cases