Neglected to Death

Fred Grimm: Assisted living facility horrors have gone unpunished

The maddening thing is that the horrors — and they were gut wrenching — have gone unpunished.

A Miami Herald investigation found grotesque neglect and outright abuse and awful deaths suffered by elderly and mentally disturbed residents consigned to assisted living facilities.

The Herald’s Carol Marbin Miller, Mike Sallah and Rob Barry chronicled a pervasive use of illegal restraints. Some as crude as tying residents to their beds with ropes or shoving them into closets. Some using powerful tranquilizers, as if ALFs had a business plan for warehousing zombies.

They reported ALFs that subjected their residents to filthy conditions. They found awful instances of physical neglect. Of residents denied crucial medications and critical medical care. They found wounds left untreated.

The Herald reporters found ALFs where residents had been beaten and terrorized and raped by other inmates. They found cruelty by ALF staffers. They found negligence – often utter obliviousness – that resulted in deaths. And they found deaths from negligence or cruelty reported as natural causes.

But the most disturbing findings, the stuff that made a reader’s teeth clinch, was that so much of the negligence and abuse and shoddy treatment and outright cruelty and cover-ups went unpunished.

The Herald found a trove of reports from state regulators and law enforcement agencies noting negligence, awful conditions, abuse and illegal practices that came to nothing. For example, The Herald series cited the All America ALF, in Miami-Dade, where caretakers didn’t notice that a 71-year-old man had been scalded in his bathtub, suffering burns so severe he later died. But ever after his death, and at least 100 state citations – including one for the staff standing by while two residents walloped each other with two-by-fours — All America remains a state-licensed ALF.

We can assume that the actual number of deaths due to negligence in these places considerably exceeds those reported. After Alva Trout died in a Wilton Manors nursing home in 2007, doctors associated with the ALF signed a death certificate that listed the cause of death as “failure to thrive.” But the funeral home that received her body found that rather suspicious, given her sores and injuries, and sent the remains to the medical examiner. She had died of a pneumonia brought on by traumatic injuries, including a fractured neck.

But she was 93. If the morticians at the Barbara Falowski Funeral Home had been less conscientious, or if the injuries less conspicuous, no one would have questioned the original diagnosis. AFLs cater to frail, elderly folks, expected to eventually die in those facilities. The Herald discovered doctors who had authorized putting innocuous causes on the death certificates by phone, without ever examining those inconvenient bodies.

Ten years ago, the Florida Legislature voted to limit the legal liability of nursing home and ALFs. Maybe tort reform was a good idea at the time. But the problem since then has been that the state’s Agency for Health Care Administration, which oversees ALFs, has been underfunded and understaffed and uninspired, even as the number of AFLs has increased to 2,850, with some 80,000 residents. The state can only manage to inspect each ALF once every two years. Violations, more often than not, bring only warnings. The rare fines that are levied are often reduced, and often go uncollected. For all the scandals in its purview, the Agency for Health Care Administration has closed only 26 ALFs.

The results of such tepid oversight of these low-margin businesses should have been predictable. The only requirement for an ALF administrator is a high school diploma and a 26-hour training course. Staffers are low paid. Social Security reimbursements are inadequate. And regulators don’t have the resources to do much regulating. It’s a sure formula for all the horrors The Herald uncovered.

Florida just can’t do both. We can’t shrug off (and underfund) regulation of institutions charged with the care of the frail and vulnerable elderly. And you can’t overlook gross violations of state law. Not while simultaneously keeping the civil courts from punishing the bad actors.

“Private plaintiffs lawyers are doing the work that assistant state attorneys or AHCA would otherwise being doing,” said Jeffrey Gale, a lawyer who practices in Miami Shores who was blogging this week about Miami Herald series. Except, under this system, nobody is doing the work.

One or the other: Provide serious, properly funded state oversight of ALFs or let the civil lawyers go after the worst offenders.

Or we can just live with the shame.