Neglected to Death

Lawmakers: Regulators need to crack down on ALFS

With Florida’s elderly population expected to boom in the next two decades, state regulators must crack down on rogue assisted living facilities by shutting down homes where residents die from abuse, slapping harsher fines on places that repeatedly break the law, and boosting the qualifications of people who run ALFs, a legislative study says

A report released by the state Senate calls for sweeping changes in oversight of ALFs, asking lawmakers to improve a state system that’s woefully underfunded, allows caregivers to work with “inadequate training” and relies on “deficient’’ enforcement to protect thousands of frail residents.

“The rotten apples need to be shut down, and [regulators] were not doing it,’’ said Sen. Eleanor Sobel, a Hollywood Democrat and vice chair of the Health Regulation Committee, which headed the investigation. “The Agency for Health Care Administration needs to step up to the plate and do the job they’re supposed to do.”

The release of the interim project report is the latest effort by elected leaders to overhaul Florida’s oversight of ALFs, which has been severely criticized for allowing some of the worst homes to stay open, despite decrepit and dangerous conditions.

The study, carried out by Senate staffers over the past two months, was prompted by a Miami Herald investigation in May that found that dozens of vulnerable residents died of abuse and neglect in homes — nearly one a month since 2002 — and that the worst facilities were still in business.

Among the study’s key recommendations: strip AHCA’s discretion to bargain down punishment when inspectors find the most serious abuse — such as death or serious injuries from neglect — and compel the agency to take tougher action to close homes.

“ALF residents may be better protected if the AHCA’s discretion to deny, revoke, or suspend a license were removed when a facility has committed the most egregious acts, such as when a death occurs due to an intention or negligent act for which the facility was complicit,” the report said.

The report also recommended that AHCA be forced to impose severe fines, ban new admissions and suspend licenses when a home’s negligence “presents a threat to the health, safety or welfare of a client.”

Among the report’s findings:

•  The healthcare agency is failing to keep up with inspections of the state’s 2,956 ALFs — as required by state law — nor is it collecting enough fees from homes to cover the costs of its visits.

•  At least 23 other states require greater qualifications for people to operate an ALF — including college degrees and gerontology coursework — while Florida requires only a high school diploma and 24 hours of training.

•  Regulators must ramp up inspections of Florida’s most troubled homes, including those that care for residents with chronic mental illness, where many of the neglect and abuse deaths occur.

•  Sixty percent of residents with severe dementia, such as Alzheimer’s disease, wander from homes, and caregivers are ill-equipped and inadequately trained to handle such residents.

The problems of the state’s enforcement come as the number of elders in Florida continues to increase — from 3.3 million today to 4.5 million a decade from now — with many of those seniors choosing to move to assisted living facilities, the report says.

To meet those challenges, the report urges lawmakers look for ways to improve enforcement, including raising fines on homes that repeat the same violations — a widespread problem The Herald’s series found.

The Herald found at least 100 homes that care for people with mental illness were caught by regulators illegal restraints, including doping residents with tranquilizers, tying them with ropes and locking them in isolation closets — and there were caught doing it again.

The 35-page report described a dozen deaths detailed in The Herald series, including the case of a 74-year-old woman bound to her bed, the restraints pulled so tightly that they ripped into her skin and killed her, and a 71-year-old man with schizophrenia who died from burns after he was left in a tub of scalding water.

AHCA Secretary Elizabeth Dudek said her agency is studying the report, though she agrees with the proposal that regulators take harsher actions, including suspensions and revocations, when inspectors turn up egregious abuses.

“A hard and fast line sometimes might be a good thing,” Dudek said.

She also favored the report’s recommendation that regulators ratchet up inspections of the worst facilities, while conducting abbreviated exams of the less troubled homes. “I think it helps us to focus on the problem facilities,” she said.

The Herald found that as the number of facilities grew across Florida — 550 new ones in the past five years — AHCA failed to keep up with the growth, cutting inspections by 33 percent during the same period.

Another problem area targeted in the report: the qualifications for people running ALFs, which are less than the requirements for barbers, cosmetologists and auctioneers in Florida.

Senate staffers strongly urged lawmakers to consider enhancing the core training for ALF managers by looking to other states, like North Carolina, which requires on-the-job 120-hour training, and even those states that require studies in health care and gerontology. One way to raise the standards might be to return the responsibilities of training to the Department of Elder Affairs, which provided it until 2003, the report states.

In addition to boosting qualifications, the report recommends that AHCA create a five-star rating system for ALFs — similar to the one used for nursing homes — to help consumers make choices on where to place loved ones.

Dudek said she expects the report to be reviewed lawmakers as well as by Gov. Rick Scott’s task force, which was formed in June to also probe the problems outlined in The Herald’s series, Neglected to Death.

Since the series, AHCA has slapped admission bans on troubled facilities and cut state funding to homes at three times the rate of prior years. In an interview Monday, Dudek soft-pedaled her agency’s aggressive stance, saying little has changed in enforcement — though her own agency wrote a press release in June announcing a “crack down’’ on ALFs in order to “monitor these facilities closer than ever.”

Brian Lee, who headed the state’s Long-term Care Ombudsman Program until last winter, praised the report for urging lawmakers to push AHCA to punish facilities with a history of abuse and neglect. “No more arbitrary decision making,” Lee said. “You found these things, now you have to do something.”

But Lee said the plan for regulators to do shorter inspections of homes with better track records made him “extremely nervous.” Among his concerns: Regulators have little way of identifying the “good’’ homes deserving of less scrutiny, because the state’s oversight has been so poor for so long, he said. “I would say this is a dangerous move by the agency, and it will put residents in jeopardy,” he said.

Sen. Mike Fasano, a member of the health committee, said he will push for a change in law requiring AHCA to take immediate action when turning up abuse deaths.

“You don’t have the option” to leave them open anymore, the New Port Richey Republican said. “You must shut them down.”