Neglected to Death

Florida cracks down on troubled ALFs

After years of rampant abuse in some Florida assisted living facilities, state agents have launched a major crackdown by banning new residents from troubled homes and slashing state funds to the worst abusers — including one that forced frail residents to sleep on box springs covered with cardboard and shower with contaminated well water.

Under pressure from the governor’s office, regulators have cut the flow of Medicaid money to more than a dozen homes, forcing two facilities to shut down and threatening others that depend on the state dollars.

“We’re closed down. Today’s my last day,’’ said an employee on Friday at Sunshine Acres Loving Care, a sprawling 54-bed facility in the Panhandle with a long history of abuse and neglect. “There’s no one left here.”

The clamp down by the Agency for Health Care Administration was prompted by a Miami Herald investigation in May that showed regulators allowed some of the worst facilities to stay open, despite dangerous conditions that led to dozens of elderly residents dying at the hands of their caretakers.

Since May, more homes have been slapped with the sanctions than any other time in the past five years, records show.

“They’re finally doing what they should have been doing,’’ said Tony Willard, a former resident of the now shuttered Shalom Manor, one of Broward County’s oldest ALFs. “That should have been closed a couple of years ago.”

The actions against the homes — among the toughest in the state’s arsenal — come as lawmakers launch an inquiry into a state enforcement system that allowed dozens of shoddy operators to stay in business, leaving vulnerable residents to fend for themselves,

In addition, a statewide task force appointed by Gov. Rick Scott is undertaking its own examination of problems in the homes, now among the primary residences in Florida for the elderly and people with mental illness.

While the state slashes public dollars to punish homes, it’s also turning to other enforcement tools: Six homes were banned from taking in new residents in the last three months -- twice the rate of actions than before the crackdown. Since May, 100 homes were slapped with fines totaling $260,500.

Larry Polivka, a longtime expert on aging who is leading the governor’s ALF task force, said the state had to crack down to show it was serious about protecting vulnerable residents.,

“You are seeking a deterrent,’’ said Polivka, scholar-in-residence at Florida State University’s Claude Pepper Center.

By ordering the cuts and moratoriums on new residents, the state is sending a message to owners that “if they are not providing acceptable care, they will be identified and penalized,” Polivka said.

For Albert King, 54, who roomed at Shalom Manor for most of the year, the state's decision to stop Medicaid payments to the home and impose a ban on new residents allowed him and others to finally move to new facilities.

“It wasn’t a home. It was hell,’’ said King, who was interviewed by state regulators about the facility, which was cited 59 times in the past three years for problems ranging from filthy conditions and bedbug infestations to caretakers failing to dispense crucial medication to residents.

During an inspection in May, regulators found that caretakers at Shalom Manor discovered a blind, 46-year-old man not breathing in his room, but instead of performing CPR or calling 911, they tossed a blanket over his head and waited 37 minutes to call paramedics. By the time they arrived, James Hazel was pronounced dead.

Less than a block away, the state also took action against Briarwood Manor, cutting funding to a home where police and rescue workers have rushed to more than 1,200 emergencies in the past five years, including stabbings, fights and residents suffering psychiatric breakdowns.

Twice since 2005 the state could have shut down the home, but allowed it to stay in open while reducing $370,000 in fines by 74 percent. Owner Andy Subachan did not return phone calls seeking comment.

Since The Herald’s series, “Neglected to Death,” at least 120 other homes were hit with fines, revocations and other enforcement actions.

Several homes were targeted to lose state dollars for not safeguarding vulnerable residents, including Hillandale in Pasco County and Mily Home Care in Miami-Dade — where caretakers were cited for failing to protect mentally disabled women who were sexually assaulted in the facilities.

Experts say the loss of Medicaid funding can vary from $300 per resident a month to more than $1,000 per resident, depending on the level of disability and income. “For most homes, it’s a death knell,’’ said Doug Coffey, who operates a home in Pinellas County. “They can’t make it on that kind of margin.”

At least a dozen homes targeted in the crackdown were identified in The Herald’s investigation as troubled facilities the state allowed to stay open — including Sunshine Acres Loving Care in the Panhandle.

The past owner, Bruce Hall, was caught punishing residents by beating them, refusing to give them food and medicine and threatening them with a stick — racking up 115 violations. Yet he was able to run it continuously for 14 years until he was ordered by the state to sell it in 2009.

But the problems continued: During a state inspection on July 8, regulators found that some residents were forced to sleep on broken-down mattresses and bed springs covered with cardboard.

Though a well serving the home was found to be contaminated, residents were forced to use the dirty water to take showers. Regulators also found the same water was being mixed into lemonade for the residents.

An employee who answered the phone on Friday declined to answer any questions, saying only that the home was being shuttered and all residents were removed.

State Sen. Nan Rich said she was heartened by the state’s efforts, but is concerned that the effort will eventually wane. “Those were good laws on the books,” said the Weston Democrat, who sits on the Children, Families and Elder Affairs Committee. “But it’s a bit sad that this is what it takes to get this kind of attention.”

Miami Herald staff writers Kenny Malone and Rob Barry contributed to this report.

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