Neglected to Death

Senate panel demands answers to crisis in ALF care

Sitting before U.S. Sen. Bill Nelson and his colleagues, Alfredo Navas carefully recounted the day his sister told him by telephone the horrific news: that their 85-year-old mother drowned in a shallow lake behind the Miami-Dade assisted living facility where she was supposed to be protected.

“I I couldn’t believe it. I said it can’t be. So I rushed over there and as I got there ... reality sets in,’’ Navas told the hushed hearing room of the U.S. Senate’s Special Committee on Aging on Wednesday afternoon.

He said all the safeguards his family had assumed were in place to monitor the frail woman with dementia — cameras, door locks and vigilant caretakers — failed on that cold January morning in 2008. In the end, there was no investigation by Florida’s top regulator — nor any punishment for the home.

The 60-year-old man’s story was among the dozens of deaths from abuse and neglect chronicled in a Miami Herald series that reached the Senate panel that is now looking into the major problems of what are expected to be the homes of the future for America’s seniors: ALFs.

“This is America in the year 2011, and these kind of things shouldn’t be happening,’’ said Sen. Bill Nelson, D-Fla., who recounted aloud to the panel chilling examples of abuse and neglect revealed by The Herald.

They include a 75-year-old Alzheimer’s patient in Clearwater torn apart by an alligator after he wandered away from his ALF for the fourth time, a 71-year-old mentally ill Hialeah man who died from burns after he was left in a bathtub filled with scalding water, and a 74-year-old Kendall woman who was restrained for six hours until the bindings cut into her skin and killed her.

Federal regulators and lawmakers said during the testimony they don’t want the federal government overseeing ALFs, but they want more of a role in making sure that states, like Florida, do their jobs in protecting the most vulnerable adults, said Barbara Edwards, lead director at the Centers for Medicare and Medicaid Services at the U.S. Department of Health and Human Service.

“We’d like to have additional sanctions when states are not aggressively pursuing corrective action,’’ Edwards said, adding it’s not practical to hold up state Medicaid funding when there are problems at ALFs.

Shortly after The Miami Herald series appeared last May, the agency fired off a letter to Florida’s lead regulator, the Agency for Health Care Administration, demanding answers, she said.

“We talked with high-level state officials within a couple of days of those articles to ask for more detail about what the state was doing to respond to those situation,’’ Edwards said. “The state did report back to us on their activities to respond. We actually view this as a still an open issue with the state and are continuing to gather information.’’

The Herald found that AHCA launched a crackdown on troubled facilities after the series, imposing the state’s harshest sanctions on more than 40 homes and forcing the shut down of at least 10 facilities.

Edwards said she believes the state is taking “responsive action’’ to investigate and review its own policies.

“We continue to monitor what the state is doing and continue to offer assistance, but also to encourage the state to be assertive and aggressive in its efforts to ensure that its systems are adequate.’’

Other witnesses testified before the committee on Wednesday, covering everything from regulation to the role of assisted living facilities in housing aging Americans who are living longer.

Larry Polivka, a scholar-in-residence at the Claude Pepper Foundation at Florida State University, said there are concerns as the state considers reforming Medicaid, it could shift more people into community residential programs.

They worry ALFs could become “sloppy, less expensive nursing homes’’ with less-restrictive regulations, said Polivka, head of a governor’s task force formed after The Herald’s series to examine the troubled industry.

Among those with concerns about who will be monitoring assisted-living facilities is the corps of volunteer ombudsmen. Earlier this year, state lawmakers wanted to do away with the key mission of the volunteers: performing yearly inspections of nursing homes and assisted living facilities.

That move came even as the trained volunteers were turning up a record number of abuse and neglect cases in ALFs across the state.

The debate over ALFs come as baby boomers are living longer and are too frail to live on their own, but who don’t require the intense care provided by more heavily regulated — and more expensive — nursing homes.

“All Americans — no matter which state they live in — should have the tools that they need to make the right choice,’’ Nelson said.

Problems aren’t limited to Florida, which only inspects ALFs once every two years: California requires inspections once every five years, Nelson noted. In Texas, there is no schedule — only when inspections are deemed necessary.

“When something goes wrong, folks need to know that their complaints will be heard, and that someone will be held accountable,’’ he said.

For Alfredo Navas, the death of his mother, Aurora, still haunts him on several fronts: Her caretakers never told the state what happened when the protections broke down — nor did AHCA ever investigate.

“If the laws are not strong enough, then we are dependent on our legislatures to pass stronger laws, which are enforceable so that our seniors are protected from these careless operators,” said Navas in his prepared statement. “If these operators continue to go unpunished, it will only get worse as these unscrupulous people get rich on the backs of our senior and taxpayers.”