Nov 8, 2011

Time to ban ALF caregivers who abuse, state is told

Time to ban ALF caregivers who abuse, state is told
By Carol Marbin Miller and Michael Sallah The Miami Herald

Florida disability administrators are recommending a ban on caregivers who have harmed residents living in ALFs.
By Carol Marbin Miller and Michael Sallah
When a mentally ill resident of the Hillandale assisted living facility left the home before dawn in August 2007, administrator John Ross instructed a caregiver not to search for him until the next day’s staff arrived. By then it was too late: the man, Co Dang, was struck by a car and killed.
Elder abuse investigators put the blame for Co’s death partly on Ross, saying the administrator had left him in harm’s way by failing to act.
But the Department of Children & Families’ finding had no consequence: Ross was allowed to continue running the Pasco County ALF, and one other, for another four years while the home racked up dozens of new violations. Ross continues to run the home even as the state seeks to close it.
Now, the leaders of Florida’s disabilities agency are recommending that administrators or caregivers who are held responsible for the abuse or neglect of a resident be permanently barred from working at an ALF.
That’s the way the law used to be, but it was changed. Current law states that “information in the central abuse hotline may not be used for employment screening.”
The proposal is a key recommendation before members of a special task force that is looking for ways to improve conditions at the state’s roughly 2,960 ALFs, many of them in South Florida. The work group will hold its final meetings Monday and Tuesday at Florida International University’s main campus in Miami.
The task force, whose members were appointed by Gov. Rick Scott, was formed in response to a series of stories, called Neglected to Death, in The Miami Herald last May. The reports said state healthcare regulators had allowed scores of homes to stay open , even go unpunished altogether, for sometimes severe violations of state law.
The state Agency for Persons with Disabilities submitted several recommendations to the work group, some of them prompted by their frustrations over Hillandale, which housed many clients of the agency. The disabilities agency went so far as to cut all funding to Hillandale under a program that sets aside Medicaid dollars to encourage disabled people to live in community settings. But the cutoff had no effect as a separate government entity, the Agency for Health Care Administrators, continued to both fund Hillandale and allow it to remain open.
“I was dumbfounded,” Jim de Beaugrine, former director of the disabilities agency, said of his reaction when administrators realized Ross was allowed to continue running an ALF for disabled people after he was held responsible for the death of a resident. “It was shocking.”
“If they are that callous, they should be barred from working with [residents] further. The past is the best predictor of the future when it comes to behavior.”
Disability administrators also are recommending that lawmakers require healthcare inspectors to report suspicions of abuse or neglect at an ALF to the state’s abuse hotline, and to allow the healthcare agency to use DCF’s abuse database to “pursue sanctions” against homes that repeatedly are held responsible for mistreating residents. The disabilities agency proposes that the AHCA be allowed to deny, revoke or suspend the license of an ALF if the owner is named in a verified abuse report.
What’s more, the disabilities agency would like the healthcare agency to change its rules to prohibit ALF staffers from working directly with vulnerable residents while an adult-abuse investigator is looking into allegations of abuse or neglect.
Current law “allows for the verified perpetrators of abuse, neglect or financial exploitation to continue working with vulnerable populations as long as none of those cases subsequently results in prosecution and conviction,” agency leaders wrote. Bentley Lipscomb, a former secretary of the Department of Elder Affairs, said only about 3 percent of elder abuse or neglect cases referred to state’s attorneys offices are ever prosecuted.
Ross, who still operates Hillandale, said ALF owners will vigorously fight any change to state law that allows regulators to use the state’s confidential abuse registry to screen employees. Ross said it would be unfair to screen caregivers based on reports to which they do not have access. “DCF never said anything to me about that case whatsoever,” he said.
The Florida Assisted Living Association “would never let that fly,” Ross said, referring to the state’s ranking industry group.
Hillandale is not the only home that employed, or was run by, caregivers found directly responsible for the death or neglect of an elderly or disabled Floridian. The Herald found scores of cases in which an employee or administrator was the subject of a report that investigators “verified” as a case of abuse or neglect. In many cases, the caregivers remained on staff, even after they were caught beating, starving or illegally restraining vulnerable residents.
DCF put the blame squarely on three caregivers in the death of Magdalena Marrone. Staff failed to give her life-saving heart medication for four days in 2009 — and then gave her the wrong drugs on the day she died.
An assistant administrator who lost track of her medical charts and two nurses were named in the 82-year-old woman’s death at Emeritus at Crossing Pointe, an Orlando home that’s now an independent living facility.
Authorities could not say how many times Co Dang had run away from Hillandale; a state report says “the staff did not document or log an incident report in such instances.” But one staff member suggested Co had left the home at least eight times, and the Pasco Sheriff’s Office reported returning him to the ALF at least twice.
Nevertheless, when the lone caregiver supervising 17 residents called Ross before dawn on Aug. 21, 2007 to report that Co was missing, Ross, investigators said, instructed the staffer “to just wait until day shift staff arrived and they could look for him.”
Ross insists neither he nor the home did anything wrong: “You cannot lock someone into an ALF; you can’t do that,” Ross said Friday. “The client has rights.”
But Lipscomb, the former elder affairs secretary, said the state has no business operating an abuse registry if caregivers found to have committed egregious abuse or neglect are allowed to continue working with elders.
“It’s just a waste of taxpayer dollars,” Lipscomb said.
The father of a 27-year-old woman whom police say was raped by a caregiver at Hillandale last May said he and his wife would have looked elsewhere for a home for their disabled daughter had they known about the administrator’s record.
“We would not have even considered it,” said the 61-year-old Safety Harbor resident, who is not being identified to protect the privacy of his daughter. “No one in their right mind would.”
“So much could have been prevented had that law been in effect,” the man added. Read more: