In
the three years since Florida lawmakers ordered a small state agency to
begin investigating professional guardians, it has struggled to find
enough money to do the job.
Altogether,
the Office of Professional and Public Guardians says it has been
allocated $150,000 to pay for professional guardian investigations since
2016. It hasn’t been enough, and a backlog of incomplete probes has
been building.
So this year, the agency asked for a little bit more -- $97,488, to be exact.
It
was a rounding error in the context of Florida’s $91 billion budget. It
amounted to asking for less than one-one thousandth of 1 percent of the
state’s general revenue.
The Florida Legislature chose not to fund it.
The
decision has infuriated advocates for the vulnerable senior citizens
and disabled people who have been declared unable to care for themselves
and are put at the mercy of the professional guardians who are given
control over their lives -- and their money.
There
are currently 75 investigations that haven’t yet been completed because
of a lack of funding, said Sharon Bock, the elected clerk and
comptroller for Palm Beach County whose office works with the state
guardianship office on the probes.
“That
means there are 75 wards out there who are vulnerable, and could be
continually exploited, while we fight for a sliver of adequate funding,”
she said.
State
Rep. MaryLynn Magar, a Republican from Palm Beach County, chaired the
House committee in charge of health-care spending, which refused to
include the funding request in its budget. She did not respond to
repeated phone calls and emails asking her why.
A
spokesman for House Speaker Jose Oliva, a Republican from Miami, said
legislators felt they had given the state’s guardianship office enough
money already. He pointed out that the Legislature gave OPPG an extra
$2.5 million in this year’s budget -- although that money is supposed to
be used on additional public guardians to care for elderly and disabled
wards who are too poor to pay for a professional guardian. There are
more than 450 people unable to care for themselves on the waitlist for a
public guardian.
"OPPG,
it was felt by both the House and the Senate, could utilize less than 5
percent of that money to conduct the investigations,” said Fred
Piccolo, the Oliva spokesman. “To allege resources were unavailable is
simply untrue.”
When
someone believes a professional guardian is abusing or exploiting the
ward they were appointed to care for, they can file a complaint with
OPPG. The state agency then does a preliminary screening and, if the
complaint appears to have merit, it passes it on to one of a half-dozen
county clerks’ offices around the state to conduct a full investigation.
The scandal surrounding disgraced Orlando-based professional guardian
Rebecca Fierle, who is now under criminal investigation after filing Do
Not Resuscitate orders against the wishes of her wards, erupted after
one such complaint was investigated by the clerk and comptroller in
Okaloosa County.
Thorough
probes are expensive. During the state’s 2017-18 fiscal year, OPPG,
working with the alliance of clerks’ offices, says it investigated 128
cases statewide at an average cost of $1,289 per case. And the workload
is growing as more baby boomers become infirm, more are placed into
guardianship -- and more complaints are filed.
Activists
were optimistic the agency would get money for investigations this
year. Newly elected Republican Gov. Ron DeSantis included the $97,488
request in the proposed budget he recommended to the Legislature.
There
didn’t appear to be anyone lobbying against it. Representatives for the
Elder Law and Real Property, Probate and Trust Law sections of the
Florida Bar, two of the most influential interest groups when it comes
to guardianship law, said they did not oppose the request.
“We
would never want them [OPPG] to not be funded,” said Gina
Rossi-Scheiman, the executive director of the Florida State Guardianship
Association, which represents professional guardians. “We want them to
be fully able to do their job.”
The
Florida Senate included the money in its budget. But the Florida House
did not. And when the two chambers came together to work out a final
budget -- a process known as “budget conference” -- the Senate dropped
the issue early in the negotiations.
There
was never any public discussion of the decision, as most of the
Legislature’s budget conference decisions were made in private. The
public meetings were formalities in which one side read out a list of
decisions; meetings of the health-care budget conference committee --
which was responsible for more than $37 billion in spending -- lasted
about 10 minutes each.
Budget
conference is “always kind of done behind closed doors,” said Shannon
Miller, a Gainesville attorney who co-chairs the legislative committee
for the Elder Law Section of the Florida Bar. “We don’t have a lot of
access to that process.”
The
choice to not to spend an extra $97,488 on additional guardianship
investigations was just one of thousands of spending decisions the
Legislature made while building a $91 billion state budget. They also
chose to spend $250,000 to subsidize a professional golf tournament at
an Ocala development owned by a major Republican Party donor and $1
million to help build a facility for luxury corporate jet manufacturer
Learjet Inc. (DeSantis vetoed the money for the golf tournament but
approved the money for the Learjet facility.)
State
Sen. Aaron Bean, a Republican from Nassau County who oversaw
health-care spending in the Senate, said lawmakers don’t necessarily
oppose spending an extra $97,488 to investigate allegations against
professional guardians. But he said there’s an emphasis on finding
common ground quickly during the final, frenetic days of session.
“There’s
just so many things happening at once,” Bean said. “I don’t think it’s
that we didn’t want it, it’s just that we’re trying to line up with the
house and trying to get out of there.”
LONDON — For most of us, the older we get, the more
we slow down physically. But for some, growing old also means slowing
down socially — so much to the point that some home-bodied seniors go
days with little to no human interaction. A new survey of British elders
sheds light on this sad, but true effect of aging, noting that hundreds
of thousands of people often go a week without speaking to a single
person.
According to the survey of 1,896 seniors over 65 in the United
Kingdom, more than one in five (22%) will have a conversation with no
more than just three people over the span of an entire week! That translates to nearly 2.6 million elderly folks
who don’t enjoy regular human contact on a daily basis. Perhaps most
alarming though is researchers say an alarming 225,000 individuals will
go a week without talking to anyone face-to-face.
“A friendly ‘hello’ or ‘how are you?’ is something most of us take
for granted – it’s just part of every day life, but these latest figures
show that hundreds of thousands of older people in the UK will spend
today and the rest of this week alone, with no one to share even a few
simple words with,” says Caroline Abrahams, charity director at Age UK, which partnered with Cadbury Dairy Milk to commission the research, in a statement.
The survey also revealed that 38% of seniors admit to feeling lonely
at times as they’ve aged, with 12%, or about one in eight, agreeing that
loneliness has kept them from leaving their home.
“Loneliness is a huge problem
because retirement, bereavement and ill health mean many older people
find they are spending a lot less time enjoying the company of others
than they’d like,” says Abrahams. “Loneliness can affect your health,
your wellbeing and the way you see yourself – it can make you feel
invisible and forgotten.”
About 40% of seniors say they’d feel more confident to head out each day if they knew their neighbors. Just the thought of someone stopping to chat
with them brightens their outlook: 54% of respondents agree that even a
short conversation with a neighbor or acquaintance would greatly
improve their day overall. And a quarter of older adults say it makes
them feel good when someone smiles or acknowledges them while waiting in
line at places like the bank or grocery store. One in five would be
thrilled if someone stopped to ask them how their day had gone.
Meanwhile, another survey of 2,000 people ages 16-45 in the UK shows
that 55% of younger folks admit to worrying about being lonely in their
elder years. With that in mind, two-thirds of this segment say they’re
willing to do something to help boost the confidence of a lonely senior,
but 37% worry that such a gesture wouldn’t be well-received. Another
30% feel too shy to spark up a conversation with seniors, 27% admit they
aren’t sure how to help, and a quarter say they’re simply too busy themselves.
To help in that area, Cadbury and Age UK have launched a new campaign called “Donate Your Words”
to help cheer up lonely seniors. The campaign encourages people to help
fight loneliness by pledging to stop and chat with elders in their
communities.
The surveys were conducted on behalf of the campaign by OnePoll.
(WXY) — Michigan’s Attorney General is officially intervening in a
controversial guardianship case first exposed by the 7 Investigators. On
behalf of Attorney General Dana Nessel, State Public Administrator
Michael Moody is officially objecting to the fees requested in the case
of Bob Mitchell and Barbara Delbridge.
“We were monitoring the
case, and watching it, but by intervening we can make arguments now in
the case itself,” Moody told 7 Investigator Heather Catallo Friday after
a court hearing in the case.
In May, 7 Action News first exposed
how Mitchell and Delbridge were kept from their family members after
Macomb County Probate Judge Kathryn George granted guardianship and
conservatorship of the couple to Cathy Kirk’s Caring Hearts Michigan
Inc. Mitchell’s daughter, Marcie Mitchell, had the family’s support to
become Bob and Barb’s guardian, but Judge George would not allow it.
Cathy
Kirk is married to prominent Macomb County lawyer Robert Kirk, and used
his law firm to bill Mitchell and Delbridge $31,624.59 while they were
under her guardianship.
Kirk also hired her own caregiver company,
Executive Care, to provide 24/7 in-home care for the couple. That bill
now for 192 days of care now totals $263,478.91.
The Attorney
General and other legal experts interviewed by the 7 Investigators argue
those charges violate Michigan law, which prevents self-dealing for
guardians.
In the Attorney General’s notice of intervention filed
with the court, Moody writes: “All of these financial transactions set
forth in Caring Hearts’ Final Account are presumed to be affected by a
conflict between personal and fiduciary interests, and therefore
voidable.”
Michigan’s Supreme Court Chief Justice Bridget
McCormack and Nessel announced in May that the case would be under
investigated. It was reassigned to Macomb County Chief Judge James
Biernat Jr.
In June, Marcie Mitchell, and Barbara Delbridge’s
sister, Anita Little, were awarded guardianship of their loved ones, and
today they were awarded conservatorship.
“This is an important
case that kind of rose to the forefront of our Elder Abuse Task Force.
The Attorney general thought this case exemplified the concerns that she
has about guardian and conservators around the state, and when we
looked at this case and the fact that it started with passing over the
family members for priority, and then we’ve gone on to this issue of
self-dealing potential, this became a case that she said hey, this is
important to the people of the state of Michigan,” Moody told Catallo
outside the courtroom Friday.
The intervention and objection to fees does not prevent the Attorney General from pursuing a criminal case in the matter.
Family
members are also objecting to the fees from Caring Hearts, Executive
Care, and Kirk’s law firm. A hearing is set for January, 10, 2020.
Edward
Nahhat the attorney for Caring Hearts Michigan released the following
statement to 7 Action News about today's developments.
The Attorney General has misapplied the statutes and
the court rules here, and is seemingly taking sides in a probate
dispute. These families have competent counsel who are giving their
clients their full day in court. Caring Hearts Michigan was appointed by
that court, then served these individuals diligently, and took good
care of them. The facts in court will ultimately prove that.
The family of a 91-year-old woman who
died following a month-long stay in a Salem memory care facility is
suing the senior assisted living company, accusing their employees of
elder abuse and neglect.
According to
the $3 million wrongful death lawsuit, Helen Banks was severely
neglected when she fell three times within four days — once being left
in a pool of blood with a broken elbow — leading to her death on April
5, 2018.
The lawsuit, filed on behalf of
Banks' personal representative, accuses East Salem Assisted Living, LLC,
a company doing business as Cedar Village Memory Care Community on 4452
Lancaster Drive NE, of elder abuse, neglect and wrongful death.
According
to Oregon Department of Human Services records, the 24-bed facility has
had 16 substantiated reports of abuse and neglect since 2010.
Banks first went into the care of Cedar Village
Assisted Living in August 2017 after suffering a fall in her home. She
was transferred to the company's memory care facility when she "began
requiring a higher degree of medical care and supervision," according to
the complaint filed by attorneys with the Gatti Law Firm on Aug. 29.
But
shortly into her stay at the Cedar Village Memory Care Community, Banks
health and well-being began to decline after her illnesses were
ignored, and she was neglected for hours at a time and denied assistance
for bathing and daily living, according to the lawsuit.
The complaint also alleges the following:
On
March 22, 2018, Banks, in need of constant supervision and struggling
from undiagnosed pneumonia, was left unattended and attempted to shower
on her own.
She fell "forcefully" to the flood and
suffered two massive lacerations to her head. Banks was taken to the
hospital and returned to the care home the next day. Despite her head
trauma, diminished cognition, pneumonia and fragile condition, she was
again left alone.
"Defendants failed to provide any supervision, assistance, medical
treatment, physical assessment, or intervention of any kind that Ms.
Banks so desperately needed," the complaint said.
Barely seven hours after her return from the hospital,
Banks was found on the floor in a pool of blood, writhing in pain from a
broken elbow and cuts to her arm.
After
another hospital stay, she was discharged back to the care facility on
March 24, 2018 and staff was given specific instruction that she
required line-of-sight supervision.
Two days later,
Banks suffered a "third and fatal fall" at the facility after being
provided inadequate assistance while moving. She broke her clavicle and
was taken to the hospital.
She died from her injuries on April 5, 2018.
Suit claims records were falsified
Banks'
estate's attorneys accuse facility staff of negligently and wrongfully
causing her death by failing to supervise her, failing to document her
conditions and giving unlicensed and untrained individuals access to
Banks "where they abused and neglected her."
They
also accused management of falsifying chart notes and falsifying
licensure and qualifications of employees, leading her family to believe
staff underwent training and held licenses that they did not, in fact,
possess.
Staff was also accused of depriving Banks of adequate nutrition and allowing her to become malnourished.
The lawsuit requests $1 million in medical economic
damages, no more than $50,000 in funeral costs and $2 million for loss
of companionship.
"(The family) will seek punitive
damages as a result of defendants' malice or reckless and outrageous
indifference to a highly unreasonable risk of harm and conscious
indifference to the health, safety, and welfare of others, including
Helen Banks," their attorney stated in the complaint.
The
facility's parent company, Frontier Management, and Frontier's
President and CEO Greg Roderick were also named as defendants in the
complaint.
Roderick did not respond to request for comment.
A
representative with Frontier Management responded instead, saying they
were not aware of any lawsuit. Cedar Village management did not respond
to requests for comment.
Frontier Management
is listed as the 19th largest senior living provider, according to
Argentum, the leading national trade association serving senior living
companies. The Portland-based company owns more than 6,300 senior living
units and more than 2,100 memory care units, according to Argentum's
report.
One substantiated violation alleging neglect matches the details of Banks case and resulted in a $900 fine.
Investigators
determined the facility failed to assess and intervene, resulting in
the patient falling three times and sustaining injuries.
"The
facility's failure is a violation of resident rights, is considered
neglect of care and constitutes abuse," the investigative report
stated.
Two other reports involved falls were found to be substantiated in 2018.
Other reports include sexual abuse, neglect, verbal abuse, physical abuse and mental abuse.
DHS
also reported that the facility had 18 substantiated licensing
violations since 2010. The violations included not properly
administering five different residents' medications and failing to
report suspected abuse.
More information on inspections and violations at care homes can be found at oregon.gov.
Per
AARP, an estimated 1.3 million American adults are under guardianship,
with approximately 85% being over age 65. In the wake of revelations
that professional guardian, Rebecca Fierle, signed Do Not Resuscitate
orders for a plethora of elderly wards in her care without knowledge or
approval by family members, you may be wondering how to protect your
family in the event that guardianship is necessary or appropriate.
The first tip is that FAMILY IS BEST.
Rebecca Fierle aside, there are dedicated and wonderful professional
guardians who serve an important function in the guardianship system.
However, wherever possible, select a family member to serve as guardian.
Two family members can also be appointed as co-guardians to ease the
burden on any one family member. Family members have intimate knowledge
of the ward’s likes, dislikes, preferences, and medical history that can
be critically important in the long-run.
The second tip is to BE REPRESENTED.
The Court will appoint a lawyer for the ward. However, you can (and
should) hire your own lawyer to participate in the process and to keep
the family involved in making decisions that are truly in the best
interest of the ward. Court appointed lawyers are not compensated unless
a guardianship is established. This is not always in the best interest
of the ward but you need a lawyer to participate and seek less
restrictive means where appropriate. This leads me to my third and most
important tip:
BE AN ADVOCATE.
Whether through your lawyer or individually, effective communication
and active participation is necessary to protect your loved one. Do not
sit on the sidelines and assume that the professional guardian or family
guardian has everything handled properly. Seek out copies of relevant
records and ask questions. As we’ve learned from the Rebecca Fierle
scandal, your active participation could be a matter of life or death
for your loved one. While the investigation is ongoing in the Fierle
matter, the media has reported that the Attorney General is
investigating Medicare fraud and financial exploitation. The cremated
remains of 9 wards were found in Ms. Fierle’s office by local law
enforcement and conflicts of interest between a local hospital and an
examining committee member charged with determining whether a person
lacks capacity and requires guardianship in the first place abound. Stay
vigilant and part of the process to ensure the safety of your elderly
family member.
South Lake Tahoe resident Tracy Sellers recounts her mother's drug overdose while she was under home hospice care. Sellers filed a complaint claiming the hospice nurse brought painkillers that weren’t properly labeled and lacked written directions.
By Elaine Chen
One day after her 80-year-old mother started hospice care at home
last August, Tracy Sellers found herself racing into an emergency room,
pushing a wheelchair carrying her mother.
“The moment we got to the ER, she passed out, her
eyes rolled back, her face was white as a sheet,” Sellers said about
her mother.
“And her head rolled back, her face was rolled to the ceiling.”
“I grabbed her, and I said, ‘Mom, wake up. Wake up. Mom!’ ”
The nurse rushed over to look at her mother’s eyes, Sellers said. “Pinholes. They’re the size of pinholes.”
Hours later, with IVs pumping fluids in and out
of her, Sellers’ mother woke up. Sellers discharged her, signing papers
listing the reason her mother was admitted: “narcotic overdose.”
Two weeks later, Sellers filed a complaint with
the California Department of Public Health, claiming the hospice nurse
had brought to their home a bag of opioid painkillers that weren’t
properly labeled and weren’t accompanied with written instructions. She
said the nurse gave her verbal instructions that resulted in her
mother’s overdose.
Then she waited.
The department took 201 days to finish its
investigation. By the time it was done, concluding that the hospice did
not violate any regulations, her mother had died. Sellers said that no
one in the Department of Public Health formally interviewed her or
looked at the bag of painkillers she said was brought to the house by
the visiting hospice nurse.
In California, where the population is rapidly aging
and end-of-life care is on the rise, patient advocates and researchers
say the state’s oversight of hospice facilities and hospice care has not
caught up. Largely subsidized by federal money through Medicare,
hospice care consists of nurses entering hospitals, nursing homes or
patients’ homes to ease patients’ pain in their last months of living.
Interviews and documents reviewed by The
Sacramento Bee show a system marred by lax oversight and an inability of
regulators to take meaningful action against hospices that may have
violated rules and jeopardized the health of patients.
Many elderly patients are being transferred to
hospice care too quickly, advocates say, taking them away from remedial
treatment and costing Medicare more money.
The Department of Public Health has taken months,
and in some cases years, to investigate complaints filed for patients
who are meant to have six months or less to live.
When the department has investigated complaints
and found deficiencies, hospices are not fined, as the state has no
penalty system for hospices as it does for nursing homes.
Further, the majority of regular surveys of
California hospices are now conducted by private accreditation agencies.
Unlike nursing homes, hospices can pay the agencies to inspect them in
place of the state, posing what advocates claim is a conflict of
interest as the agencies have incentives to approve the hospices that
are paying them.
Tracy Sellers, a resident of Tahoe, holds a
picture of her mother in her home, Monday, August 5, 2019. Her mother,
Dolores Sellers was on hospice care and was allegedly given an overdose
of drugs administered by a hospice nurse in August of 2018. Later
Sellers died of natural causes in October of last year.
Daniel Kim
dkim@sacbee.com
The problems in California mirror what the federal Office of the Inspector General found last month in a report
outlining the ways hospices have not complied with federal guidelines.
The report found that nationwide, 87 percent of hospices surveyed
violated at least one federal guideline. Among the hospices surveyed in
California, the number was 94 percent.
The federal report found that hospice workers had left one patient’s pressure ulcers untreated, resulting in gangrene and a lower leg amputation,
while another patient in Missouri was discovered with a “maggot
infestation” where a feeding tube was inserted into his abdomen.
Patient advocates and researchers say they
recognize that the Department of Public Health has a wide mandate that
covers a state with 40 million people, but they believe hospice care
should not be overlooked. David Stevenson, a health policy professor at
Vanderbilt University, said that the people placed in hospice care are
exactly the ones that needs the most attention.
“Hospice agencies have escaped close scrutiny and
it’s hard to know why,” he said, “given the vulnerable population being
cared for.”
Sellers learned of that vulnerability when she
discharged her mother from the emergency room. She said the doctor told
her to stop giving her mother opioid painkillers, and instead switched
her to steroids.
“The doctor said, ‘Don’t give her morphine, it’s too strong for her. If you do that every single day, she’ll die.’ ”
A booming industry
California is on the cusp of a “silver wave.”
The California Department of Finance predicts that in 2033, there will
be twice as many Californians who are 80 or older as there are today,
and in 2043, there will be three times as many. This growth rate is
higher than that of any other age group in the state.
As the population ages, the number of people in
hospice care has increased. According to Centers for Medicare and
Medicaid Services, the number of hospice patients in California covered
by Medicare has increased 55 percent in 10 years, to about 71,000 people
in 2017.
With that, Medicare spending on hospice care in
California has skyrocketed, growing 99 percent in 10 years to reach $1.1
billion in 2017, adjusted for inflation.
Some advocates believe that the growing number of
hospice patients could also be attributed to elderly people being
transferred to hospice too quickly. Hospice care is meant for people
expected to live six months or less, as hospices provide comfort care to
ease patients’ pain and not remedial care intended to cure patients of
illnesses.
Tony Chicotel, a staff attorney with California
Advocates for Nursing Home Reform, said that people could be pushed into
hospices by hospitals and nursing homes, which may want to transfer
patients to hospice to lighten their workload, and in some cases, to
replace patients covered by public insurance with higher-paying
patients.
On the receiving end, hospices — particularly ones seeking profit — may be incentivized to admit patients who will stay longer.
A federal Inspector General report published last year
noted concerns about the current system of subsidizing hospices, in
which Medicare pays hospices for each day a patient is in their care.
The report showed that in an analysis of 2013 data, the median length of
stay for Medicare patients in for-profit hospices was nearly one month
longer than that for Medicare patients in nonprofit hospices.
Among the 1,413 hospices in California, 9 percent are nonprofit.
People working for hospices counter these
concerns. Sheila Clark, president of the California Hospice and
Palliative Care Association, a trade association representing hospice
workers, believes that patients are being transferred into hospice too
late.
She said that families of hospice patients tell
her they wished they had made the transfer to hospice sooner and that
patients are largely in hospice care for less than six months, noting
that in 2017, the median length of stay for Medicare patients in
California hospices was 31 days. Hospice doctors are also required to
regularly check in with patients to determine if end-of-life care would
continue to be appropriate for them.
Even for people with family members who are
certain to be terminal, though, the process of transferring family
members to hospice can still feel rushed.
Last December, Alexander Sheldon transferred his
mother, who was being treated for leukemia at O’Connor Hospital in San
Jose, to the care of Bridge Hospice, which is run by a limited liability
company.
He felt pressure transfer his mother, Sheldon said. “The hospital was pushing me as if my mother was being evicted.”
He also felt that the hospice misinformed him. A
representative from Bridge told him that his mother would be able to
continue taking her leukemia medication once she went on hospice, he
said. However, hospice nurses began giving her the medication only
several weeks after she got on hospice care, a few days before she died.
Tere Johnson, executive director of Bridge
Hospice’s Bay Area office, said that due to patient privacy laws, Bridge
cannot comment about Sheldon’s experience.
Sheldon said he is still frustrated when he
thinks back to the hospice representative’s early assurances, and how
they did not reflect that staff’s actual treatment of his mother: “There
was a disconnect.”
Long investigations
As the population of hospice patients has grown, oversight and regulations have lagged, advocates and researchers say.
One of the main ways the Department of Public
Health keeps track of hospice conditions is through investigating
complaints filed by patients, their family members or hospice staff —
which, in several people’s experiences, has not been done quickly or
thoroughly.
After Sellers’ mother experienced an overdose,
Sellers sought help from Carole Herman, an advocate at Foundation Aiding
the Elderly who helps families file complaints with the Department of
Public Health. Herman repeatedly called department officials to get them
to investigate Sellers’ claims that Barton Hospice’s nurse left opioid
painkillers in Sellers’ home that were not labeled properly or
accompanied with written instructions, and then gave verbal instructions
that resulted in an overdose.
Drugs given to Tracy Sellers sits on a table in
her home in Tahoe, Calif. Monday, August 5, 2019. Sellers claims the
drugs were given to her without proper labeling and without written
instructions.
Daniel Kim
dkim@sacbee.com
According to notes taken by Herman during her
calls, department officials offered the possibility that Sellers could
have been at fault by retrieving the drugs herself and throwing out
labels and instructions — a proposition that Sellers and Herman both
found perplexing. Herman kept calling, telling department officials to
go look at the drugs themselves and talk to Sellers, and they told her
they would.
Sellers said they never visited.
201 days after the complaint was filed, Herman
received a notice that the investigation was closed and the department
did not find a violation of any regulations.
When asked to comment, the department reiterated
the notice, saying “all the allegations were investigated through
observations, interviews, and record review. There were no regulatory
violations cited.”
Mindi Befu, director of public relations at
Barton, echoed the department’s statement, saying that “Barton Health
fully cooperated with the investigation.” Citing patient privacy laws,
Befu said Barton would not be able to share information about Sellers’
mother’s care.
The Department of Public Health appears to not
have the resources to investigate complaints quickly and thoroughly,
said Joyce McKee, whose mother was under hospice care with the Milpitas
office of VITAS healthcare in January 2017.
McKee attempted to file a complaint because, she
said, hospice staff arrived to care for her mother days after her
mother’s doctor requested them to come, and just several hours before
her mother died. Claudia Quintana, public relations director of VITAS,
said VITAS could not comment due to patient privacy laws.
McKee said that when she called the Department of
Public Health describing her mother’s situation and asking them to
investigate promptly, the department official “would tell me, ‘I want to
do all that, I just don’t have the humans to do all that.’”
“She doesn’t have the wherewithal,” McKee said. “They do the best they can but they are completely backlogged.”
The long period of time officials take to
investigate could affect the results of the investigation, said Charlene
Harrington, a UC San Francisco professor who researches elderly care
and used to work in the Department of Public Health.
Investigators with the department “often don’t
visit to investigate a complaint in a timely way, and then too often
it’s too late to verify things,” she said.
According to data from the department obtained by
The Bee, in the past ten years, the department has received 2,209
complaints and has investigated 89 percent number of them. Of the
complaints it has investigated, it has taken an average of 62 days, more
than two months, to begin investigations once complaints have been
filed.
Harrington noted that the amount of time the
department takes to begin investigations is not always an accurate
measure of the department’s promptness, because investigators may record
an early start date but not properly investigate until later.
Data from the department shows that to finish
investigations, the department has taken an average of 129 days, more
than four months. Seven percent of complaint investigations took one
year or longer to finish.
While the department has grown quicker with
investigating complaints — for example, for complaints filed in 2018,
the department took an average of 31 days to begin investigations and an
average of 86 days to finish them — the process is still slow compared
to existing policy for nursing homes, which requires the department to close nursing home investigations within 60 days.
Currently, the department is not required to finish hospice investigations within a certain number of days.
The department said it “has continued to improve
its timeliness for health facility investigations and is currently
implementing new systems to be able to investigate complaints more
efficiently.”
No fines, no reforms
When the state does investigate promptly and find
deficiencies, the hospice must submit to the state a plan it will
follow to correct its faults; however, it does not receive any fines.
Researchers and advocates say this means hospices don’t face an
effective form of punishment that would prevent them from continuing to
mistreat patients.
On the federal level, the only punishment that
hospices can receive is the extreme measure of being removed from the
Medicare program. Stevenson, a professor at Vanderbilt University, said
he believes that federal authorities should institute a penalty system
they can use to punish hospices while the hospices are still in business
and receiving Medicare subsidies.
In 2014, the daughter of a woman who died in the
care of Bristol Hospice in Roseville filed a complaint with the
Department of Public Health, claiming that under Bristol’s care,
pressure sores in her mother’s right leg were left unattended, and the
sores developed into sepsis and gangrene that ultimately caused her to
die.
While the department found that the hospice did violate regulations through its investigation, it did not issue any penalties.
Records from the Department of Public Health
obtained by The Bee show that Bristol Hospice continued to violate
regulations even after the department released results of its
investigation to Bristol. Eight subsequent complaints were filed by
patients’ family members and hospice staff. The department ruled in five
of them that Bristol had failed to properly train its staff as well as
update or follow treatment plans for patients — the same deficiencies
the department found in the daughter’s complaint.
As this was occurring,the daughter continued to pursue a lawsuit she had filed against Bristol soon after her mother died.
“Without a penalty system, Bristol had no fear
that its egregious failures in care would result in any interruptions of
the operations of this facility,” Dudensing said.
Bristol finally settled. Dudensing said that
during negotiations, the daughter demanded Bristol change ownership and
Bristol eventually agreed, selling its operations to a different company
before the final settlement was reached.
Bristol did not respond to multiple requests for comment.
In the hands of private agencies
Complaints are one way for the state to keep
track of hospice conditions, but complaints often do not fully reflect
issues in hospices.
“Some people don’t know that you can file
complaints at all,” Stevenson from Vanderbilt University said. “Most
likely people aren’t thinking about [filing a complaint] after their
loved one dies.”
The other key way the state keeps track of
hospice conditions is through regular surveys of hospices. To qualify
for Medicare subsidies, hospices must undergo surveys every three years.
States are tasked with conducting these surveys, but hospices have the
option of getting “accredited”: paying private accrediting agencies to
survey them in place of the state.
Data from the Department of Public Health
obtained by The Bee show that 63 percent of hospices in California are
accredited. Nationally, approximately 40 percent of hospices are
accredited.
Of all the hospices nationally that are accredited, more than one-third are in California.
Michael Connors, an elderly care advocate with
California Advocates for Nursing Home Reform, said that the Department
of Public Health has incentives to push hospices toward accreditation ,
as that “reduces [Department officials’] workload and saves them money
if they don’t have to go out and inspect facilities.”
That raises issues, Connors said, because
accreditation agencies, which are not required to release their survey
results publicly, can pose a conflict of interest.
“Accreditation agencies get their business from
these hospices and if they were to make findings and release the
findings to the public, the likelihood that hospices to do business with
them is very low,” he said. The agencies “rely on a friendly
relationship with the hospice entities, not the general public.”
Barton Hospice, whose care Sellers’ mother was under, is currently accredited with The Joint Commission, which has given Barton a “gold seal of approval.” Out of all the accreditation agencies, The Joint Commission surveys the greatest number of hospices in California.
Tracy Sellers, a resident of Tahoe, holds a picture of her mother in her home, Monday, August 5, 2019.
Daniel Kim
dkim@sacbee.com
Maureen Lyons, a spokeswoman for The Joint
Commission, said, “Our goal is to protect the public by identifying
deficiencies in care and having organizations correct those deficiencies
as quickly and sustainably as possible.”
Addressing the concern that accreditation
agencies’ inspections are not transparent to the public, Lyons said,
“While accredited organizations may choose to release their reports, The
Joint Commission provides them as confidential reports of our
surveyors’ standards deficiency findings for organizations to implement
corrections within a specific time frame.”
Lyons added, “Of all health care accrediting
organizations, The Joint Commission shares the most information with the
public,” noting that The Joint Commission uploads reports on survey outcomes online.
The Joint Commission’s reports rate hospices’
general care in comparison to hospices nationwide and statewide, but do
not show what regulations the hospices have violated, if any.
Hospice care is difficult
Hospice care can be one of the most taxing types
of care to provide and one of the most anxiety-inducing to see family
members experience.
“Due to the short length of stays, hospice
workers and the patients and families they serve are stressed with
decision-making in an already difficult time,” said Clark, president of
the California and Palliative Care Association.
Many advocates and researchers feel that especially because hospice is such a sensitive area of care, reforms need to be made.
“Hospices are rarely inspected,” Connors said.
“Most hospice inspections are conducted by private agencies that have
strong incentives to ignore poor care.”
“Nothing is done when serious violations are detected,” he continued, “and findings of neglect are covered up.”
People who have come to the difficult realization
that their family members are close to dying can often only find peace
of mind when they know that their family members will be able to enjoy
ease and comfort in their last periods of living.
“If somebody has eight weeks, or nine weeks, or
six months, I feel like [hospice staff] should be treating you with pain
until you pass away, they shouldn’t be overdosing you,” Sellers said
about her mother’s time in hospice.
“I feel like they don’t care if someone dies in hospice before their time,” she continued. “So I feel hurt that they did that.”
Former New Mexico Supreme Court Chief
Justice Daniels died Sunday at age 76.
It was classic Charlie Daniels.
In the aftermath of a Journal
series detailing abuses in the state’s guardianship/conservatorship
system for the elderly, many in the industry and the judiciary defended
the status quo. The alleged problems, they said, were overblown and the
system worked just fine, thank you very much.
It would have been
easy, and popular in some quarters, for then-Chief Justice Charles
Daniels of the state Supreme Court to toe the party line.
Instead, he went to a town hall hosted by the Journal in the spring
of 2017, where he sat in the audience – without fanfare – and took
copious notes as people told their stories of being barred from seeing
loved ones, family wishes being disregarded and estates wasted by
court-appointed conservators.
Rather than defending the status
quo, Daniels became a driving force in the court’s efforts to reform the
guardianship/conservatorship system that now provides for greater
transparency and mechanisms for families to challenge what they believe
are injustices in the system.
A renaissance man who drove race
cars and was an accomplished musician, Daniels approached issues with a
brilliant legal mind and incredible work ethic. (Meet for coffee? He
would say he was available anytime after 5 a.m.) The son of
sharecroppers who farmed an Arkansas plot with a borrowed mule before
moving to Albuquerque when he was 6, he was someone who wasn’t afraid to
sit in the audience with regular folk and take notes.
Daniels
died in his home Sunday at age 76. He had been diagnosed with Lou
Gehrig’s disease, or amyotrophic lateral sclerosis, seven weeks earlier,
and it progressed rapidly, his wife, Randi McGinn, said.
A former law professor, criminal defense and civil rights lawyer, Daniels leaves a lasting legacy with his work.
On
bail reform, he first wrote an opinion in 2014 that correctly pointed
out that the bail bond system – or as he described it, “the
money-for-freedom system” – that had been in place for decades violated
the state Constitution, which required makeable bail in all but a
handful of the most serious cases. Then, acknowledging something needed
to be done for community safety, he became the driving force behind a
constitutional amendment overhauling the bail bond system. He worked the
halls of the Legislature, which sent it on to voters, who approved it
overwhelmingly in 2018. The result: Hundreds of poor people who can’t
afford to post a minor bail are no longer languishing in jail pending
trial, while judges now have the authority – under the law – to order
defendants who pose a serious danger to the community to be held without
bail pending trial.
The National Association of Pretrial Services
Agencies singled him out for special recognition last week as “a
driving force behind changes to promote pretrial justice and public
safety through evidence-based practices in New Mexico courts.”
Daniels,
an Air Force veteran whose life changed when he read “Clarence Darrow
for the Defense” while stationed 700 miles north of the Arctic Circle –
or as he called it, the “northernmost outpost of humanity” – served on
the Supreme Court from 2007 until his retirement Dec. 31. He was known
for his collegiality and worked hard to keep politics out of the
judiciary – once noting he had seen no difference in “judging” by
colleagues who had been appointed by governors of different political
parties. He wrote more than 100 opinions, but never a full dissent.
The current chief justice, Judith Nakamura, a Republican, recalled
one of their final conversations: “One of the last things he said to me
sitting in my office was, Judy, we’ll always be friends. The issues
don’t define that.”
McGinn, a powerhouse trial lawyer who
practiced law with her husband of 30 years, said he didn’t feel sorry
for himself with his diagnosis. In fact, he felt lucky because “people
realize you’re running out of time to say the things you want to.”
Described
by former partner John Boyd as a man of “absolutely scrupulous honesty
and ethics” who never cut a corner, Daniels leaves the law and his state
better than he found it.
Nakamura is not exaggerating when she says, “Our state has lost a titan of the law.”
This
editorial first appeared in the Albuquerque Journal. It was written by
members of the editorial board and is unsigned as it represents the
opinion of the newspaper rather than the writers.
Caring for the elderly is a fulfilling but sensitive duty. Nursing
homes have to constantly devise new means to keep the elderly
comfortable and happy. It’s not always easy to get them to follow a
daily routine that’s suitable for their current state of health. A lot
of elderly people who are admitted into care facilities suffer from
dementia, with Alzheimer’s accounting for about 60 to 80 percent of all
cases [1].
They suffer a decline in memory and the inability to perform daily
functions efficiently. They are sensitive to certain sights, sounds, and
environmental conditions. Dementia can’t be cured but can be managed by
therapy and changes to lifestyle.
Care
providers are trained to be more cautious and gentle with dementia
patients. They require a lot of assistance in performing their daily
activities and most times, they don’t know when it’s time for certain
things such as bathing, eating, or sleeping. Alzheimer’s, especially, is
associated with a disruption of the normal sleep-wake cycle and is
believed to be caused by brain cell deterioration [2].
Administering sedatives every day can be potentially harmful to the
patients, and it’s much safer to come up with natural means to get them
to sleep at the right time.
Everyone gets in their jammies
The Old Vicarage Nursing Home
in the United Kingdom came up with a very simple idea to help their
beloved patients sleep easier, and it’s been working effectively so far.
The care home works on with the Butterfly Model of Care,
a system that’s focused on empathy and where the emotions and feelings
of the aged residents are considered before everything else. The staff
is required to dress in warm clothes to avoid provoking, terrifying or
upsetting the elderly.
“The uniform requirements are that I give staff 30 (pounds) to buy a
range of casual clothing which may not be abusive or have scary images
on them,” said Kamal Siddiqi, owner of the care home to Hello Care [3]. “Night
staff buy dressing gowns and pajamas. The idea came from staff
attending training by David Sheard’s Dementia Care Matters model of care.”
It’s easier for the residents to get ready for sleep when the staff
is doing the same. They don’t have to be cajoled or persuaded so much.
The pajama strategy serves as a reminder that it’s time for everyone to
get in their warm, comfy sleepwear. Psychological therapy is part of the
care routine for dementia patients, and visual cues are great for
helping patients perform daily activities more easily.
A cardboard statue of a man brushing his teeth in the morning, a
wallpaper of a lady at the sink washing her hands after using the
bathroom, and playing a short clip of people getting into soft, comfy
beds when movie night is nearly over – visual cues are a powerful way to
help patients suffering from memory decline to live a more normal
life.
Happy in their new home
According
to Kamal, the no-uniform policy downplays the unhappy feeling of being
in an institution on the elderly, enabling them to relate better with
the staff.
“Wearing casual clothing is part of a method of de-institutionalizing the environment in which the residents live,” said Kamal. “It
means that the care home doesn’t feel like an institution for both
staff and residents, which helps to reduce the kind of behavior that can
occur in an institutional environment. We found it was easier to
encourage residents to go back to bed in the evening when staff were
wearing dressing gowns and pajamas.”
Everyone at the care home, both staff and residents took to the idea
immediately and fell into place with it. The families of the elderly
were happy with the administration for constantly working out ideas to
keep their loved ones happy and healthy.
Care homes don’t necessarily have to go for high-end technology to
help the elderly get around better. If the funds are available, there’s
nothing wrong with bringing in soft, human-like robots to cradle the
residents when it’s time to sleep (the care facility would then become
ridiculously expensive). However, the simplest and most cost-effective
changes can go a long way to make life better for everyone. Something as
minor as wearing a pair of pajamas during the night shift is cue enough
for the residents to go get ready and turn in for the night.
“I would say the resident’s
favorite thing about the old vicarage is the range of activities we do
and the fact it doesn’t feel like a care home,” said Kamal. “The staff enjoy trying new ways of making the residents feel better and happier.”
The assisted living industry is booming, by tapping into the fantasy that we can all be self-sufficient until we die.
By Geeta Anand
Ms.
Anand, formerly a reporter for The New York Times, is a professor at
the University of California, Berkeley, Graduate School of Journalism.
Assisted living seems like the solution to everyone’s worries about old age.
It’s built on the dream that we can grow old while being self-reliant
and live that way until we die. That all you need is a tiny bit of help.
That you would never want to be warehoused in a nursing home with
round-the-clock caregivers. This is a powerful concept in a country
built on independence and self-reliance.
The problem is that for most of us, it’s a lie. And we are all complicit in keeping it alive.
The
assisted living industry, for one, has a financial interest in
sustaining a belief in this old-age nirvana. Originally designed for
people who were mostly independent, assisted living facilities have nearly tripled in number in the past 20 years to about 30,000 today. It’s a lucrative business: Investors in these facilities
have enjoyed annual returns of nearly 15 percent over the past five
years — higher than for hotels, office, retail and apartments, according
to the National Investment Center for Seniors Housing and Care.
The
children of seniors need to believe it, too. Many are working full time
while also raising a family. Adding the care of elderly parents would
be a crushing burden.
I know this
fantasy well. When my parents, who were then in their 70s, were unable
to take care of themselves, I bought an apartment in Brooklyn that was
big enough to fit them, in addition to my husband and our two young
children. But then my husband lost his job in the Great Recession, and
we could no longer afford the mortgage.
The only solution
I could think of was to move. I took a job in India, where the dollar
goes farther, so I could rent an apartment big enough to fit us all and
hire helpers to care for my parents and children while my husband and I
worked.Back then, I, too, dreamed
about those assisted living facilities. My parents seemed so bored and
lonely in my house. And it was hard for us to keep up with their
ballooning needs. They grew so enormous that I eventually had to quit my
job.
As I struggled to support my parents, assisted living became a private dream for my own old age.
Now
that I am back in the United States, I have been thinking about
assisted living again. My dad died in 2017, after living with us for
nine years, and my 83-year-old mother now lives in New York City with my
sister. Would assisted living offer our mother better care and relieve
the pressure on my sister, who works full time while raising a young
daughter?
Sadly, I’ve discovered the answer is no.
The
irony of assisted living is, it’s great if you don’t need too much
assistance. If you don’t, the social life, the spalike facilities, the
myriad activities and the extensive menus might make assisted living the
right choice. But if you have trouble walking or using the bathroom, or
have dementia and sometimes wander off, assisting living facilities
aren’t the answer, no matter how desperately we wish they were.
“They
put their money into the physical plant. It’s gorgeous,” said Cristina
Flores, a former home health care nurse who has a Ph.D. in nursing
health policy, lectures in the gerontology program at San Francisco
State University and runs three small group homes for the elderly.
But when it comes
to direct care, the facilities are often lacking. “The way they market
everything is, it’s all about autonomy and independence, which are
important concepts,” she said. Families and residents don’t realize that
these facilities are not designed to provide more than minimal help and
monitoring. Even those that advertise “24-hour” monitoring may have
someone present round-the-clock on the premises, but may not have
sufficient staff to actually monitor and assist the large number of
residents.
“People’s defense against
something horrible happening is, ‘Well, they have a right to be
independent,” she said. “‘Yes, he did walk up the stairs with his walker
and fall down and die, but he had a right to do that.’ That’s a
horrible defense. You don’t just allow people to do unsafe things.”
Most residents of assisted living need substantially more care than they are getting. Half of those residing in assisted living facilities
in the United States are over the age of 85, the Centers for Disease
Control reports. And this trend is accelerating. The number of people 85 years of age and older in the United States will nearly triple to about 18 million by 2050, according to the Census Bureau.
“When
you say nursing home, people say, ‘Yuk,’” said Eric Carlson, the
directing attorney for Justice in Aging, a national advocacy group for
low-income older Americans. “When you say assisted living, a lot of
people say, ‘That sounds good.’ Nobody realizes the system is broken.”
When something bad happens to a resident of an assisted living facility,
“They just think it was that facility that was horrible,” he says.
Part
of the problem is a lack of regulation. Nursing homes are regulated and
inspected and graded for quality to ensure that residents receive
adequate care. The federal government does not license or oversee assisted living facilities, and states set minimal rules. Nursing homes are
required to have medical directors on staff who review patient
medications regularly, while there is usually no such requirement in
assisted living.
Not surprisingly, complaints against assisted living facilities are mounting in courts around the country.
In
June of last year, Claude Eugene Rogers, an 83-year-old retired Marine,
suffered from heatstroke at an assisted living facility in Roseville,
near Sacramento. He died a few days later. A state investigation said
that he had been left on an outside patio in his wheelchair for one hour
and 45 minutes or longer that morning, when local temperatures reached
93 degrees Fahrenheit. The state in July moved to revoke the facility’s
license to operate, which it is fighting to retain, while denying any
wrongdoing.
His
family was devastated. They had chosen assisted living when his
dementia grew more severe and his wife was no longer able to care for
him at home. “We thought it was a nice place and the people there could
provide great care and the other residents there would be friends for my
dad,” his son, Jeffrey Rogers, told me.
Bonnie
Walker, 90, who also suffered from dementia, wandered undetected out of
an assisted living facility in South Carolina sometime after midnight
in July 2016. According to a lawsuit, her remains were found eight hours
later in a pond nearby, and her pacemaker was recovered from inside an
alligator that lived on the property.
Her family, after
struggling to care for her at home, had taken her to assisted living
believing she would be safer. They visited her daily and took her home
on Sundays. “My grandma deserved to have us there” when she died, her
granddaughter, Stephanie Weaver, told me, “not to go the way she did.”
Ruth
Gamba, 96, fell three times during her first month in a memory care
unit of an assisted living facility in Fremont, Calif., her family said
in a lawsuit against the facility. Memory care units are supposed to
provide closer monitoring and care of patients with dementia. But in
Mrs. Gamba’s most recent fall, she broke her hip and fractured her toes,
her family said in the lawsuit.
Her
son, Peter Gamba, a television editor in Los Angeles, told me that he
and his sister moved their mother into the facility because it promised
round-the-clock monitoring. More than 40 percent of people
in assisted living have some form of dementia. Construction of memory
care units in assisted living facilities is the fastest-growing segment
of senior care. But assisted living, even memory care units, often
aren’t the right place for people with dementia. In most states, there’s no requirement that these units be staffed with enough people or that they be properly trained.
Assisted
living has a role to play for the fittest among the elderly, as was its
original intent. But if it 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.
That will raise prices, and assisted
living already costs between about $4,800, on average, each month, and
nearly $6,500 if dementia care is needed, according to the National
Investment Center, a group that analyzes senior housing reports.
Perhaps
the United States can learn from Japan, which is a few decades ahead of
us in grappling with how to care for its rapidly aging population.
Japan created a national long-term-care insurance system that is
mandatory. It is partly funded by the government but also by payroll
taxes and additional insurance premiums charged to people age 40 and
older. It is a family-based, community-based system, where the most
popular services are heavily subsidized home help and adult day care.
Japanese families still use nursing homes and assisted living
facilities, but the emphasis is on supporting the elder population at
home.
We need to let go of the ideal
of being self-sufficient until death. Just as we don’t demand that our
toddlers be self-reliant, Americans need to allow the reality of
ourselves as dependent in our old age to percolate into our psyches and
our nation’s social policies. Unless we face up to the reality of the
needs of our aging population, the longevity we as a society have gained
is going to be lived out miserably.
As Mr. Gamba told me, “There’s going to be lots and lots of old people dying left and right with nobody attending to them.”
And there’s a pretty good chance, I believe, that among those languishing there will be you and me.
