For the residents of Hillandale, punishment was swift and painful: violent takedowns, powerful tranquilizers that made them stumble and drool, and staffers who would scream and tackle them when they misbehaved.
The worst was the closet a cramped room at the end of a hallway where the residents who were deemed unruly were locked, sometimes for hours.
Its like youre in jail, said Karen Westfall, who lived at Hillandale for five years.
And like a jail, the Pasco County assisted-living facility sometimes prevented residents from leaving, records show.
Last April, the staff protested the removal of a 47-year-old man frail and mentally retarded who said he wanted to move, while residents shouted and blocked the path of state workers trying to safely escort him from the home.
In the end, regulators were forced to bring in sheriffs deputies to clear a path and break up the crowd gathered behind the gates of the facility.
The dramatic rescue highlights the problems that have turned a special subset of assisted-living facilities into Floridas most dangerous.
While most ALFs are designed to care for the elderly providing help with everyday tasks Florida licenses facilities like Hillandale to also care for people with severe mental illness.
Created a generation ago, the special homes were the states answer to providing housing for thousands left in the streets after the historic closings of Floridas psychiatric institutions.
But The Miami Herald found dozens of the homes are so poorly run that residents are forced to languish without crucial needs including medication and psychiatric help leaving their care to police and rescue workers.
Ranging from small cottages in suburban neighborhoods to 350-bed complexes, the homes represent a third of ALFs in the state, but account for some of the most egregious cases of abuse.
Its a cheap, easy, unregulated system of care, said Miami-Dade Mental Health Court Judge Steve Leifman, who refuses to send people in his program to some of the homes because of dangerous and decrepit conditions.
While The Herald found sweeping breakdowns in the states oversight of standard ALFs, the lack of controls in ALFs for mentally ill residents have created even more problems for some of the states most vulnerable residents.
Complaints to the Agency for Health Care Administration the state entity entrusted with overseeing the facilities are routinely ignored, leaving residents at the mercy of shoddy operators.
Even when the agency found enough violations to close facilities, which frequently mix elderly and mentally ill residents, regulators rarely act under state law.
The Heralds examination of Floridas 1,083 homes for people with mental illness, including a review of state inspection reports, police investigations, court records and interviews with mental health experts, found:
• Regulators find nearly twice the rate of abuse and neglect at the special homes, including caretakers beating and sexually molesting residents.
• State agents have caught nearly 100 homes using illegal restraints since 2002 including doping residents with tranquilizers without doctors approval, tying them with ropes and locking them in isolation rooms only to catch them doing it again.