Aug 10, 2011

Lawmakers pushed to slash state oversight of Assisted Living Facilities

Lawmakers pushed to slash state oversight of Assisted Living Facilities

While vulnerable residents were dying of abuse and neglect in ALFs, Florida lawmakers waged a campaign to slash state oversight of the state’s troubled homes.

When Sedrek Singleton, a career criminal with a violent past, checked into Nueva Vida assisted living facility, caretakers at the cluster of cottages in Miami-Dade never took steps to protect other residents.

They never had to.

Months after moving in, the 30-year-old man flew into a rampage, beating his roommate to death with a brick — nearly tearing off the disabled man’s ear — before bolting from his new home.

The brutal assault came just weeks after Florida lawmakers rejected a bill that would have put the burden squarely on ALF owners to safeguard people in their homes when accepting residents with criminal histories.

But the defeat in 2008 to bring more protections to vulnerable residents was just the beginning.

Over the next three years, lawmakers rejected sweeping plans to toughen Florida’s ALF law — often at the urging of industry leaders — while stripping away enforcement powers that left hundreds of residents to fend for themselves in dangerous conditions.

While frail residents were dying of abuse and neglect in ALFs across the state — nearly one a month — lawmakers pushed three dozen pieces of legislation since 2007 to cut crucial protections that had been in place for a generation.

The changes in Florida’s ALF law created even more gaps in a state enforcement system that was already failing to investigate dangerous practices and shut down the worst offenders.

For example:

• Lawmakers said state regulators no longer have to report abuses and deaths to the Legislature, instead allowing them to keep the cases secret.

• Even as homes were caught breaking the law — including caregivers beating residents, doping them with powerful tranquilizers and locking them in closets — lawmakers rejected a plan to crack down on rogue operators.

• Though abuse cases have risen over the past five years, lawmakers blocked efforts to heighten checks on bad homes — including inspections every 15 months — saying they were too expensive.

• As the state was finding hundreds of people languishing without proper care, lawmakers stripped the authority of inspectors to call doctors and get them removed — leaving the decision to ALF operators.

The moves to change the state’s historic ALF law — one of the oldest in the country — came as abuse and neglect cases were rising in ALFs.

Led by Florida’s largest industry group, a dozen lawmakers stepped forward in the past five years to create 36 pieces of legislation to remove regulations — including parts of the Residents’ Bill of Rights that guarantees safety and protection to vulnerable adults.

The effort peaked this year, with legislators pressing 23 bills, including a plan by Sen. Rene Garcia — a powerful Hialeah Republican who chairs the Senate’s health committee — to overhaul ALF law.

The 37-year-old lawmaker, whose district includes more than 100 ALFs — including some of the most heavily fined homes in Miami-Dade — pushed to cut back penalties against caretakers and reduce the state’s power to close troubled homes.

Garcia said he was simply pressing for changes raised by industry leaders who were working with the state’s chief regulator — Agency for Health Care Administration. “This was just the beginning of a long process,” he told The Miami Herald. “You file a bill. Some things stay, some things don’t. ”

But a Herald investigation found Garcia’s proposal would have stripped critical enforcement tools from a state system that has allowed dozens of the worst facilities to stay open.

Ironically, the push to slash regulations started with an effort to bring about reforms.

The gruesome discovery of Ron Larsen, 85, who was ignored by caregivers in Manatee County as a cancerous tumor engulfed his face prompted GOP Sen. Ronda Storms of Valrico to push for the most sweeping changes in the ALF law in three decades.

But her effort to increase inspections, criminal background checks and penalties on bad homes in 2008 was not only defeated, it backfired, triggering the most intense effort in state history to cut back on oversight.

Over the next three years, key lawmakers, with the support of the Florida Assisted Living Association, introduced major legislation to strip regulations in place since the 1980s.

Just months after the Storms bill was rejected, FALA named Hugh Gibson — the House sponsor who ended up killing the measure — its legislator of the year before a packed audience at an industry convention in St. Augustine.

“It was like a snowball,” said Don Hering, former chair of the state ombudsman council, which opposed many of the industry’s proposals. “There was no way we could compete with these people. It’s the money and the staying power.”

While industry leaders were pouring hundreds of thousands into the coffers of key lawmakers — more than $215,000 since 2007 — the number of new bills affecting ALFs rose every year, records show.

In one of the first significant acts, the Legislature gave up its right in 2009 to see what was taking place in the homes. No longer were regulators required to provide lawmakers the number of adverse incidents like deaths and injuries — information that can show dangerous trends.

Co-sponsored by Sen. Don Gaetz, the law also ended the state’s power to bring in medical teams to decide whether sick residents should be removed from homes failing to provide enough care, leaving the decision to ALF operators.

Over the next two years, hundreds of residents were found languishing in homes unable to provide for their needs, nearly twice the rate than before the protection was cut, The Herald found.

In one facility alone, three people died, including an elderly resident who fell 24 times and was hospitalized nine times for head wounds, broken ribs and two fractured hips.

A second resident, 82-year-old Charlene Webb, suffered fatal burns after falling for the fifth time on the floor and urinating on a power strip, causing electrical surges to rip through her body.

At no point during the residents’ stay at the Pasco County home did caregivers note they were in danger before they died. Karen Lucas, a company spokeswoman, said Emeritus at La Case Grande has since taken steps to resolve the problems, including increasing staff and training.

Gaetz said he was unaware of issues created by his bill and could not recall the portion that stripped the state’s right to call in medical teams. “I just don’t remember,’’ said the GOP lawmaker from Destin, adding that AHCA had a major role in reviewing the language.

AHCA spokeswoman Shelisha Coleman said the agency rarely turned to the practice of calling doctors when residents were in danger, instead placing the burden on ALF owners.

While lawmakers were making the changes, another trend was under way that left residents at risk: AHCA was slashing investigations of serious incidents — including deaths and abuse — by nearly 90 percent through most of the last decade.

While the agency was struggling to perform what were once routine duties, it agreed to numerous cuts by lawmakers, saying it supported “streamlining regulation” and reducing paperwork, according to annual reports.

AHCA told lawmakers the costs of supporting Storms’ bill — one of the few to crack down on bad homes — would run $2.6 million a year and force the agency to hire 46 new people.

The agency also said new rules forcing homes to buy heart-saving devices known as defibrillators would trigger an “increase [in] the workload of AHCA staff,” because ALF workers would have trouble running the machines.

“They said nothing about saving lives,” said Brian Lee, past director of the state’s ombudsman program who supported putting the devices in ALFs.

While a struggle emerged between industry groups and elderly advocates, a dangerous pattern was unfolding in ALFs across the state: Residents were dying at the hands of their caregivers.

At least 70 residents died from causes including starvation, gangrene, scalding burns and overdoses of powerful narcotics. And those are just the known cases: More than 200 others died under questionable circumstances, but the records are sealed under state law — even the names withheld.

Despite the deaths, lawmakers took another step to remove a key enforcement tool: the automatic shutdown of homes caught repeatedly putting residents in mortal danger.

The bid by Garcia, the Hialeah lawmaker, to strip the state’s power to revoke the licenses of homes with two or more Class I violations — breaches often found in death cases — was one of the many proposed cuts he pushed in his bill this year. In addition, it would have stripped the state’s power to impose additional fines when regulators catch workers breaking the law -- a key enforcement tool to crack down on bad homes.

Championed by industry leaders, the plan called for regulating homes in a “less restrictive way,” including allowing the state to cut back on mandatory inspections.

The bill would have removed a key protection from the Residents Bill of Rights that allowed residents to step forward to report wrongdoing in the homes to state agents without fear of retaliation by ALF owners.

“It was damning legislation as far as residents are concerned,” said Brian Lee. “I didn’t see one thing that actually helped residents. It was for the industry.”

Garcia, who received $8,100 from industry contributions, said he didn’t favor removing the protections from residents, adding that much of the legislation was started by FALA.

He also said he was unaware of language in the bill to slash the state’s authority to revoke licenses of homes caught repeating severe violations. “I just don’t recall that,” he said. “FALA came to me with this massive deregulation bill. We went back and forth, but my intent was to help [the industry and AHCA] create its own chapter’’ of enforcement.

At one point, lawmaker Michelle Rehwinkel Vasilinda said she was struck by the furious pace of the proposals, but after carefully reading a bill that tried to stop the state from providing lists of troubled ALFs to the public, she drew a line.

“This is where the rubber hits the road,” said the Democratic House member from Tallahassee. “I wasn’t going to vote for that.”

The bill, co-sponsored by Daphne Campbell, a Miami-Dade Democrat who owned group homes until she lost her state funding when several vulnerable residents died in one of her facilities, ultimately passed, but was vetoed by Gov. Rick Scott.

Another bill would have removed the power of the state ombudsman to make yearly visits to ALFs with a checklist to make sure homes were safe for residents.

Supporters of that bill, including House sponsor Matt Hudson, argued the group was just duplicating work already being done by state regulators: AHCA.

But The Herald found that was not the case: AHCA was actually cutting back on inspections of homes — down by 33 percent in the past five years — at the same time the ombudsman program was turning up more cases of abuse and neglect than any time in the program’s history.

Hudson, a Naples Republican who received more than $5,000 in industry contributions, said he believes in “less government,” and if AHCA was not enforcing the law, that’s the issue that needs to be addressed.

While several bills appeared to be headed for passage this year, at least 16 were put on hold, including Garcia’s and most of Hudson’s, after a Herald investigation in May revealed sweeping breakdowns in ALFs — with lawmakers deciding to wait until next year to resurrect the bills.

One legislator, Mike Fasano of New Port Richey, said the momentum created during the legislative session was a part of a larger culture pervading the capital this year. “The governor and lawmakers were all pushing to deregulate the professions.”

The Republican senator said one of his own bills — the requirement that homes carry the life-saving heart devices — was attacked by fellow lawmakers who tried to repeal the law this year in two separate bills. “It’s outrageous,” he said. “I shake my head in disbelief. The cost is minimal to what the cost of a life is.”

By Michael Sallah, Rob Barry and Carol Marbin-Miller
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