Florida curtails effort to police ALFs
Under fire from some lawmakers and healthcare industry leaders, Florida’s struggling elder ombudsman program now has turned on itself.
10/22/2011 5:00 AM
09/08/2014 5:51 PM
When elder advocate Diane Carpenter entered Our Golden Home in 2008, she found an elderly woman languishing in a recliner, soaked in her own urine.
After ordering an aide to put clean clothes on the woman, Carpenter, a supervisor with the state’s volunteer ombudsman program, heard muffled cries from the rear of the Hialeah assisted-living facility. “Help me, help me,” a man pleaded.
Curled in a fetal position, the man was burning with fever.
Carpenter ordered caregivers to call an ambulance. They refused. She then threatened to call the state’s elder abuse hotline. When paramedics finally rushed the man to a nearby hospital, they had little time to spare: He had already lapsed into life-threatening renal failure.
Three years later, the program that Carpenter represents also is in grave condition.
Under attack by powerful industry groups, the once celebrated program launched during the Great Society legislation of the 1960s has been hit by a wave of resignations and firings that have left it reeling over the past year. Amid the turmoil, federal regulators blasted the state last month for allowing political meddling to cripple the advocacy group.
Just six months ago, key lawmakers wanted to do away with the group’s ability to perform yearly inspections of nursing homes and assisted-living facilities — the program’s key mission — even as its corps of trained volunteers was turning up a record number of abuse and neglect cases in ALFs across the state.
Created as an advocacy group for frail residents in long-term care homes, the program now finds many of its veterans at odds with their new leader, Jim Crochet — a longtime state administrator recommended by industry leaders. They say he is trying to diminish their roles as protectors of vulnerable adults to appease the industry.
“People just don’t understand how important these people are,” said David Gillespie, former manager of the Broward ombudsman office. “The volunteers are responsible for saving countless lives, and for improving the lives of countless others.”
Internally, nearly a dozen employees and volunteers have resigned or been fired as Crochet launched an overhaul of the agency after his appointment in April.
“We are going through a paradigm shift and it is difficult for some who have been ingrained in the old way,” Crochet said in an August email to a top administrator of the Agency for Health Care Administration, the state’s nursing home and ALF regulator. “Unfortunately, that shift may require that some folks will leave the program.”
The new approach, Crochet acknowledged, has infuriated both volunteers and paid administrators, many of whom are fleeing. When an AHCA administrator wished him “good luck’’ in a May 17 email following his appointment, he replied: “I’ll surely need it with the reception I received by the council,” a reference to the group that meets regularly to set policy and discuss issues.
Crochet’s shift in philosophy comes as ALF industry heads, several lawmakers and even AHCA leaders have mounted their own campaigns to weaken the program.
Earlier this year, state Rep. Matt Hudson, a Naples Republican, pushed legislation that would have eliminated the program’s ability to perform annual “assessments,” or inspections, of facilities — retaining authority only to evaluate complaints. Lawmakers and industry leaders had complained bitterly that ombudsmen were duplicating the role of AHCA, and AHCA inspectors had complained repeatedly of “interference” from the volunteers.
The legislation failed. But no matter; Crochet introduced a new tool that will have a similar result. A new inspection form, and the guide that explains it, allows volunteers only to interview residents, not to observe ALF conditions as a whole.
“Jim Crochet met with Representative Hudson, who supports the program’s resident advocacy, but not regulatory involvement,” the minutes of a July 5 statewide ombudsman meeting state.
At a meeting of the South Miami-Dade Ombudsman Council last week, Don Hering, the program’s director of field operations, called the new form a “capitulation” that was necessary for the program to survive: “Some legislators were trying to shut the program down,” Hering said. “They were going to reduce our budget.”
Program administrators, Hering said, were getting “pressure” from lawmakers to stop behaving as regulators.
Hering encouraged the Miami volunteers to fight the new inspection form. “Please don’t take this lying down,” he said, “because it’s not going to go away.” But he also encouraged the Miami group to accept some of the changes, “instead of worrying about whether the legislators are going to take pot shots at us.”
The changes come as the lead regulator of long-term care homes, AHCA, is under intense pressure for failing to shut down dozens of troubled assisted-living facilities, allowing the worst offenders to stay open over the years, according to a Miami Herald investigation.
While the ombudsman program found that abuse and neglect cases had doubled in ALFs over the past five years, AHCA was cutting back on its own inspections by 33 percent, records show.
And while AHCA has been forced to make fewer visits to homes, veteran ombudsmen say the new assessment form will hamstring their ability to inspect a host of conditions that for decades have been within their power, especially in turning up decrepit conditions: rodents, ants, roaches, the stench of urine and feces in rooms, leaking roofs, piles of dirty laundry that molder for days; filthy floors and bathrooms; rotten produce, and expired milk and canned goods.
The new form has prompted a backlash among volunteers, who say the approach is fundamentally flawed because at many ALFs, residents — particularly those with mental illness or disabilities — are fearful of retaliation or too impaired to communicate. In fact, The Herald found 292 cases in the past decade in which an ALF resident told an ombudsman that they were too afraid of reprisal to talk.
South Miami-Dade volunteer Bill Hearne, who represents the area on a statewide council, said he frequently uncovers physical and emotional abuse of residents, medication errors and poor living conditions during facility inspections — and fears such violations will go undetected under the new system.
During one ALF inspection, for example, Hearne watched in horror as a caregiver screamed at an elderly man with Parkinson’s disease who spilled his soup on the table because the neurological disorder made it difficult for the man to use his spoon. “How would you like it if somebody spoke to your granddad like that?” Hearne asked. “It hurt the man, and he began to cry. I went over and I touched him; I held his hand. I came this close to crying.”
During an inspection of Bilmar Gardens by the Broward County ombudsman last year, volunteers turned up a host of violations, including filthy and decrepit conditions that prompted the immediate removal of 14 residents. “Willful neglect,” wrote David Gillespie, manager of the Broward office. “Living environment is detrimental to their dignity, health and well being.”
Though AHCA had turned up enough violations in prior years to shut down the home, it didn’t do so — even allowing the facility to operate without a valid license until reaching a settlement in 2006. Since then, it turned up 44 more violations, but it wasn’t until the ombudsman program called fire inspectors last year that AHCA took action to close the home.
“Bilmar Gardens would still be open today if not for the ombudsman program,” said Gillespie, who resigned his job recently to work for the city of Orlando.
Differences between AHCA and local ombudsmen also erupted two years ago when AHCA refused to shut down the troubled Munne Center, a Miami-Dade facility where a 71-year-old woman suffering from Alzheimer’s disease was raped and other residents were found languishing with life-threatening conditions.
At one point, Hering threatened to hold a news conference to expose the state’s failure to act, but AHCA arranged a settlement with the home in 2009. In the ensuing years, however, conditions grew worse. Munne was finally shut down last month, following a scathing, 63-page report that uncovered a litany of violations: poor training of key employees, a failure to hospitalize residents with life-threatening pressure sores, scorching temperatures inside the building, foul odors, filthy bathrooms, stained floors and broken furniture, and the home’s habitual inability to keep track of its residents.
During another inspection in Miami-Dade, Hearne said he found an elder had just been beaten up by another resident. No caregiver was in sight, and the ALF owner was at work elsewhere, unable to return to the facility.
“We find these things out,” Hearne said. “AHCA does not see it, and we will not find it under the new policies and procedures going into effect.”
Volunteer Joel Beyer drew applause from other South Miami-Dade council members last week when he attacked the new form: Residents, he said, “need us.”
In an interview with The Herald, Crochet dismissed the criticism, saying the overwhelming majority of volunteers throughout the state had “embraced” the new assessment process, and the Miami area represented but a small pocket of resistance.
“That may be what you’re hearing in Miami,” Crochet said in the interview, “but I can tell you that is not going on across the board.”
But other councils have complained, as well.
In his comments to the Miami group last week, Hering acknowledged that the new assessment had become a bone of contention everywhere as he criss-crossed the state visiting local councils. “The argument I hear across the board is ‘we don’t need to capitulate to the guys or gals who are after us,’ ” he said.
And in September, the Broward County Ombudsman Council drafted its own recommended assessment guide, which included a laundry list of items to inspect, including the safety of cleaning supplies, swollen or dented canned goods, evidence of roaches and rodents, medication carts, and the cleanliness of bathrooms and kitchens. The outline also encourages inspectors to look for signs of life-threatening pressure sores, bruises or other injuries, insect bits and rashes among residents.
“Members were appreciative that the assessment is resident-centered,” the council wrote, “however, it was felt that there were areas of resident health and safety that the residents themselves would not be in position to be aware of unless or until tragedy strikes. These areas have been included in past assessments and have frequently uncovered egregious conditions that could impact resident health and/or safety.”
Crochet insists the program has as many, if not more, volunteers than when he took office in May, and takes issue with the suggestion made by Miami council members that the program’s new direction has led to a spate of firings and resignations. The firings, in particular, sparked criticism from members of the state Senate’s Children, Families and Elder Affairs Committee, who grilled the Department of Elder Affairs secretary at a meeting earlier this month.
One South Miami-Dade volunteer, Teresita Mestre, resigned in the middle of last week’s council meeting, eliciting an audible gasp. Mestre said she became an elder advocate after seeing her father treated poorly at an ALF — at one point, she discovered caregivers had simply put a second diaper on her dad rather than clean him up. But changes in the ombudsman program, she said, will leave it crippled.
“Some people are afraid to speak up to you because of retaliation,” she said of the requirement that volunteers only investigate what residents tell them. “Even caregivers are afraid to speak to you.”
“We are not respected anymore,” Mestre added.
State Sen. Eleanor Sobel, a Hollywood Democrat who as vice chair of the Health Regulation Committee is helping draft a brill overhauling ALF oversight, said the program’s woes go far deeper than a lack of respect.
Sobel said she is infuriated by the criticism of a volunteer corps “that should be recognized as heroes, and instead, they are being attacked.
“There’s a gag order on them,” she said. “This is not a totalitarian state.”
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