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| Andrew Simmons, right, blows bubbles with his father Bo last spring.
Andrew, who's profoundly autistic and mostly non-verbal, lives in a
supported living home in Snohomish County operated by Aacres WA, a
troubled state contractor. Bo Simmons says conditions in the home over
the past year have deteriorated to the point of being dangerous for
Andrew and his housemates. |
By Austin Jenkins
In February of this year, Leigh Anne Francisco’s severely
autistic 21-year-old son Angus moved into a home for people with
developmental disabilities operated by Aacres WA, LLC in Snohomish
County.
Almost immediately, Francisco grew concerned about conditions in the home.
First, she noticed mysterious bruises on her son, including a large dark purple one on his inner thigh.
Then Angus and his housemate were left unsupervised one night because the overnight staff member never showed up.
There were other issues too.
Francisco said Angus was overfed and rarely taken out for a walk
or to kick a soccer ball into the net she had set up for him in the
backyard. He quickly gained 30 pounds.
When she visited, Francisco
said she often found Angus’ hygiene had been neglected. The condition
of the house also dismayed her — food and garbage on the floor, shampoo
and toothpaste spilled in the bathroom. To make matters worse, Francisco
said the staff was often “lounging around and on their phones.”
There
were also medication errors. By September of this year, Francisco was
frantic and trying to get Angus moved out of Aacres’ care.
“This is not what I had imagined for my son!” Francisco wrote in an email summarizing her concerns.
Francisco
is one of two parents who, independently of each other, contacted the
public radio Northwest News Network in September regarding concerns
about Aacres in Snohomish County. The second was Bo Simmons whose
23-year-old son Andrew is also profoundly autistic and lives with three
other Aacres clients in a home in Lynnwood.
In his message to the Northwest News Network, Simmons said Aacres
was “very much not living up to expectations as a residential care
provider for the state.”
“We’re talking about a serious burn which
was never communicated to us, repeated times where there is a single
staff member for four residents, never taking our son out into the
community,” Simmons wrote.
In recent weeks, the parents’ pleas for
oversight and accountability have reached state regulators who say
they’re now investigating the company’s Snohomish County operations.
The
complaints are just the latest against Aacres, a long-troubled care
provider that currently has contracts with Washington’s Developmental
Disabilities Administration (DDA) to provide in-home support to
developmentally disabled clients in Clark, Pierce, Thurston, as well as
Snohomish Counties.
Canceled contracts
In 2019, DSHS cancelled three
contracts it had with Aacres WA to provide care for vulnerable clients
in Spokane County. DDA said it took the action “based on serious
non-compliance with the law and regulations.”
One of the contracts was terminated following the death of a client who was given household cleaning vinegar in lieu of colonoscopy prep medication. A former Aacres caregiver was subsequently charged with third-degree assault, and reckless endangerment in connection with the death. Her trial is scheduled for January.
In
a statement at the time, the then-assistant secretary of DDA, Evelyn
Perez, said: “We have lost confidence in Aacres Spokane. Not being in
compliance with regulations and ensuring the health and safety of our
clients is unacceptable.”
Previously, Aacres had also operated in King County. But in November 2018, Aacres announced it was pulling out of King County
because of a lack of affordable housing and challenges related to
recruiting and retaining staff. The move came after the state had put
the company’s King County operation on 90-day provisional status for
failing to correct serious deficiencies that "jeopardized clients'
health, safety and welfare."
Nevertheless, DDA allowed Aacres to
continue serving vulnerable clients elsewhere in Washington under
separate contracts with the state.
Records show that during the 2019 to 2021 biennial budget,
Washington’s Department of Social and Health Services (DSHS) paid Aacres
more than $92 million making it the agency’s seventh largest
contractor. So far this budget cycle, which started July 1, state
payments to Aacres total $16.3 million.
As of the end of 2020, Aacres served approximately 220 clients across the four counties, according to DDA.
Founded in 1974, Aacres is one of several human services companies operated by Spokane-based Embassy Management, LLC. According to the website for Bregal Partners, a New York private equity fund, Embassy is one of its portfolio companies.
Aacres and Embassy Management did not respond to multiple requests for comment.
In
previous statements, the company has said that shortcomings in care “in
no way reflects our passion, commitment and resolve to our mission to
safely serve individuals in their homes and communities.”
A beleaguered industry
Historically, people with
developmental disabilities in Washington were served in state
institutions known as Residential Habilitation Centers. But over the
decades those facilities have downsized as part of a state and national
shift to serving individuals in the community.
DDA’s largest community residential program for people with developmental disabilities and significant support needs is called Supported Living Services.
Today, roughly 140 supported living agencies, including Aacres, serve about 4,600 clients who qualify for DDA services.
Under
the program, clients live in their own home with up to three other
housemates while being supported, often around-the-clock, by agency
staff.
The clients pay for rent, food and other expenses while the
state’s Medicaid program covers the cost of the support staff. In 2020,
Washington’s supported living expenditures were $768 million, according
to DDA. That included a temporary COVID-19 rate increase for contracted
agencies paid for with federal relief dollars.
But Scott Livengood, the legislative chair for the state’s Community Residential Services Association, said the industry has not caught back up since rates were cut during the Great Recession.
“Due
to funding increases not keeping pace with the cost of living and the
steady increase in our statewide minimum wage, the average starting wage
for a [direct support professional] is now around $15 per hour, which
is only 5% above the statewide minimum wage [that takes effect] next
month and 25% below a self-sufficient wage,” Livengood said in a
statement.
As a result, he said, most frontline support staff work
two to three jobs and average turnover in the industry is about 50
percent. Livengood estimated the current vacancy rate is approaching 20
percent as agencies lose workers faster than they can hire them.
“The
pandemic has made the situation even worse, as we are competing with
fast food and retail jobs offering $18 to $20, along with attractive
benefit packages and hiring bonuses,” said Livengood who is also CEO of
Alpha Supported Living Services, a nonprofit serving clients in King,
Snohomish and Spokane counties.
To try to slow the attrition,
supported living agencies have offered signing bonuses and “hazard pay”
during the pandemic. But the federal stimulus dollars that funded those
enhancements are scheduled to expire at the end of the year making it
even harder to recruit new employees, Livengood said.
It’s not
just the pay, but the nature of the work that makes finding and keeping
employees difficult. Staff are often required to work nights and
weekends. And the clients can exhibit challenging and even violent
behaviors.
In the past, Aacres has pointed to the challenge of
recruiting and retaining front-line staff as a factor in its quality of
care lapses.
State records show that since 2018 Aacres in
Snohomish County has been subject to four inspections, two
investigations and one enforcement action.
In January 2019, Aacres was fined $1,000 after the subflooring in one of its Snohomish County homes failed and a client fell into the space below and was injured.
Then in August of this year, an unannounced inspection of Aacres homes in Snohomish County found a number of deficiencies
— especially around COVID-19 protocols. Among the findings was that
visitors, staff and clients weren’t properly screened for COVID
symptoms.
The concerns of family members have also reached state
regulators. The state’s Residential Care Services (RCS), a division of
DSHS, confirmed to the Northwest News Network that it has active
investigations underway into multiple complaints about substandard care
at Aacres homes in Snohomish County.
However, Aacres in Snohomish
County has not been put on “stop placement” status, where an agency is
barred from accepting new clients, or put on provisional certification
status which is the last step before decertification.
“If the
complaints are found to be substantiated, Aacres, like any other
provider, will be held accountable for its deficiencies,” said RCS
director Mike Anbesse in a statement.
Aacres isn’t the only
supported living agency to draw scrutiny this year. Over the past 11
months, the state has issued 171 citations and 48 statements of
deficiency against supported living providers for violations, according
to data provided by DDA.
An unreported burn
For months, Bo
Simmons and his former wife Louise had been uneasy about the care their
son Andrew was receiving from Aacres. They noticed staff turnover was
high and sometimes there was only one caregiver on duty in the home,
despite there being four clients to care for.
Often Andrew would
spend much of the day in bed. Occasionally, the staff failed to get him
to dental and doctor appointments. He even missed virtual meetings with a
job coach.
But concern turned to alarm earlier this year when
Louise went to visit Andrew and discovered the palm of his hand had been
burned, possibly from touching the stove.
Adding to their
distress was the fact no one told them about the injury. Andrew had also
not been taken to the doctor for treatment of the burn.
Then,
about a month ago, there was another upsetting incident. Andrew, who has
migraines and often bangs his head on surfaces because of the pain,
slammed his head into a plaster wall in the bathroom. Shortly after that
he knocked a staff member to the floor and in the tussle hit his head a
second time.
Medics were called to the house. They evaluated
Andrew, but did not take him to the hospital. Simmons said the staff was
supposed to monitor Andrew for signs of a concussion. Instead, he said,
they gave Andrew a sedative and let him go to sleep. When Louise came
to visit Andrew that afternoon, she found him in bed soaked in urine.
For Andrew’s parents, that was the last straw.
“He’s a very amazing young man, and he deserves better,” Simmons said tearfully during an interview.
In
his desperation, Simmons launched what he described as a “full court
press” to bring attention to the plight of his son and other Aacres
clients in Snohomish County.
Working closely with Louise, he's
urged the state to conduct a “complete review” of Aacres and its parent
company, Embassy Management. He's also lobbied DDA to move Andrew to a
different supported living provider. And, recently, he retained an
attorney who specializes in representing the interests of people with
special needs.
In September, Simmons summarized his concerns about Aacres in an email to a top DDA official.
“Andrew
has languished in their care,” Simmons wrote. “We suspect that there
are many other clients who are not well represented who are in a similar
state and we want to advocate for them as well.”
Last month, Simmons followed up with an even more desperate message to DDA’s regional administrator in Snohomish County.
“The
situation is dangerous. Seriously dangerous,” Simmons wrote. “The
residents and the caregivers are being placed in an extremely unsafe and
dangerous environment. It is Aacres management who are to blame for
this situation, not the caregivers.”
In response, DDA officials said they’re aware of the concerns.
“I
do understand that we are experiencing some challenges right now up in
Snohomish County with Aacres,” said Shaw Seaman, DDA’s quality assurance
chief.
Seaman said the state is committed to quality improvement and interested in supporting Aacres so that it can get back on track.
Getting results
Lately, Bo Simmons said he’s seen some signs of progress.
First,
DDA dispatched an inspector to visit all of the Aacres homes in
Snohomish County to document immediate health and safety hazards. Aacres
is now required to submit weekly reports on progress in correcting any
deficiencies, according to email communications Simmons shared with the
Northwest News Network.
Simmons also met with Aacres management
and received assurances that the company would address his concerns.
Soon after, Aacres held a retraining session for the staff who work with
Andrew.
Aacres management also sent a behavioral clinician and
its clinical director to visit Andrew and observe him in his
environment. The behavioral clinician plans to continue twice weekly
visits with the goal of modeling “for staff how to work with him,”
according to an email Aacres’ area director sent Simmons.
Then, on
the evening before Thanksgiving, both parents attended a virtual
meeting with DDA officials. In a post-meeting email, Simmons said the
DDA staff showed “empathy and compassion for our situation.”
The
state has also agreed to make a referral for Andrew to a state-operated
home for people with developmental disabilities, although there’s no
guarantee of a bed being available for him.
Simmons is hopeful
Andrew’s care will improve. But he also continues to question whether
Aacres is deserving of the $726.28 a day that the state pays the company
to care for his son.
“Andrew is most definitely not receiving what the state is paying for,” Simmons wrote in his September email to DDA.
Leigh
Anne Francisco, Angus’ mother, also reported her concerns to DDA and
RCS, but said months went by before she heard back from anyone.
Separately, she was contacted by Adult Protective Services (APS) and
provided the investigator with a statement. APS would neither confirm
nor deny if it's currently investigating Aacres.
Like Simmons,
Francisco also decided that she needed to get Angus moved out of the
Aacres home. Her final straw came when her son and his housemate were
left unattended overnight earlier this year.
“He’s not safe there, the other roommate is not safe,” Francisco said.
But in the months since, she’s had no luck finding another provider to take him.
“I feel as if I’ve failed as a mother because I haven’t gotten him out of there,” Francisco said.
Francisco
recently had a conference call with the new area administrator for
Aacres who apologized and told her they want to do better.
Even
before that call there were some hopeful signs. The waist-high lawn in
front of Angus’ house was finally mowed and damage the residents had
done to the walls, which had previously been covered by cardboard, was
repaired.
“I’m always cautiously optimistic,” Francisco said: “But
the story that I’ve been given so many times is ‘we’re going to make
this better, we’re so sorry, we’re retraining everybody.'"
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