Lawmakers hear assisted-living concerns
This article originally appeared in the U-T San Diego
State regulators are fundamentally failing residents of assisted living homes for the elderly, leading to abuse, neglect and death, according to testimony on Tuesday at two legislative hearings.
Complaints to the departments of Public Health and Social Services are closed without thorough investigation, witnesses told lawmakers, or they are never responded to at all.
Penalties against violators are so weak, and take so long to be imposed, there is little incentive for licensees to comply with the rules, advocates testified.
And when crimes against the elderly are reported to state inspectors, they are processed as administrative violations and rarely sent to police or prosecutors, the legislators were told.
“It’s a sorry situation when seniors in need have little trust in the department we have relied upon to care for us,” said Margaret Griffin, president of the California Continuing Care Residents Association. “They should be able to rely on the department to make sure their communities are safe.”
The hearings were called in Sacramento after U-T San Diego published “Deadly Neglect,” a series of reports in September and December resulting from a ten-month partnership with the CHCF Center for Health Reporting.
The investigation revealed that 27 deaths in San Diego County assisted living homes in recent years were the direct result of neglect and abuse.
The series exposed bribery allegations against state inspectors that were never prosecuted and criminal acts that were never reported to police. The Department of Social Services’ internal police force has not made an arrest since 2004, the U-T reported.
The news organizations Frontline, ProPublica and The Center for Investigative Reporting also published or broadcast lengthy investigations into abuse and neglect inside board-and-care homes, hospitals and skilled nursing centers last year.
The publicity prompted the chairmen of the Senate and Assembly Human Services committees to convene a joint hearing to get answers from state bureaucrats who license and regulate about 7,500 assisted living homes.
“We’ve got to find better ways of taking care of our seniors,” Sen. Leland Yee, D-San Francisco, said at the conclusion of the morning hearing. “We can only go so far with regulation. I just implore the department to understand there are intangibles that cannot be taken care of with legislation.”
Throughout the day, advocates told lawmakers that regulators failed to respond to complaints in a professional or timely manner.
Too often, regulators looked the other way when confronted with potential abuses or waited too long to respond to problems reported by family members or others, witnesses said.
Markie Parker testified that she spent 21 years as a regulator before resigning in frustration because top Public Health administrators would not allow her to do her job effectively.
She told a joint session of the Senate’s Health and Business, Professions and Economic Development committees that senior managers discouraged employees from conducting thorough investigations and acting on their findings.
“The pressure to close cases and get them done is relentless,” said Parker, who now works as a family advocate. “People are not doing their jobs.”
Advocates complained that consumers had no access to information about assisted living homes because the computer system the department relies on is from the 1990s. They criticized regulators for going easy on violators.
“The enforcement system creates no accountability,” said Pat McGinnis of California Advocates for Nursing Home Reform, which has been lobbying for stricter regulations and tougher penalties for years.
McGinnis cited the case of Iris Ramirez, a facility operator who was featured in the U-T San Diego report about operators accused of paying bribes to avoid negative inspections.
According to court records, Ramirez admitted to paying inspectors and purchasing plane tickets for them but continues to run — and profit from — four assisted-living homes. She has not responded to the U-T’s attempts to discuss the allegations with her.
“Iris Ramirez is still open,” McGinnis said. “We ask, ‘Why is that?’ How is that she is still allowed to operate her facilities?”
Social Services Director Will Lightbourne acknowledged deep problems in his agency, including a notorious case from October when 19 elderly residents were abandoned at a Castro Valley home.
“Lessons have been learned,” he told the lawmakers. “Immediate operations changes have been made.”
Lightbourne said his office is working on a plan to alert consumers to problem homes.
The only way family members can check out potential residences for their loved ones now is to make an appointment at a regional office and read a redacted file in person some days later.
The director said he hopes to develop a system that allows consumers to access investigative records online. In the meantime, the plan is to add references to violations to the existing website so people at least know to read the file in person.
“We expect this to be operational in the spring,” Lightbourne said.
State long-term care ombudsman Joseph Rodrigues testified that licensing inspectors too often accept an operator’s version of events over that of his staff or complainants.
In one case, Rodrigues said, action was never taken against a home where an employee was accused of registering a client’s sport-utility vehicle in the employee’s name.
He criticized investigators for dragging their feet in investigations, citing one case in which a pawnshop reported seeing a Rolex watch that was stolen from a client and the case was still under investigation years later.
Rodrigues also singled out a home where reports of medication errors persisted for months without action by regulators.
“This is ongoing, and to this day (licensing) has not cited this facility,” Rodrigues told the panel.
Many of the problems identified in the “Deadly Neglect” series and other media investigations are addressed in the RCFE Reform Act of 2014, a package of bills introduced last month. RCFE is short for residential care facility for the elderly, the state term for assisted-living homes.
Among other things, the bills would require more frequent inspections, which now are required once every five years. They also would raise the penalty for violations, now set at $150 even if a death occurs.
State officials did not respond to specific concerns addressed by witnesses. Nor did they explain why so many cases are not referred to police or prosecutors for possible criminal charges.
The licensing office “treats crimes inside RCFEs as regulatory deficiencies,” said Chrisy Selder of San Diego-based Consumer Advocates for RCFE Reform. “Rather than refer these cases to outside law enforcement, they are handled internally.”
Ed Howard of the Center for Public Interest Law urged legislators to do more than pass laws. He said senators should summon department heads to the Capitol every month for an in-person update.
“Don’t let this hearing be your last one,” Howard said. “Keep those agencies on a relatively short leash … The news cycle is going to move on to another scandal.”