Anatomy of a Crackdown: Florida gets tough on assisted living facilities

By Kenny Malone

 

Florida’s assisted living industry is critically broken with deadly consequences. That was the finding of our series Neglected to Death, which first aired last May. The collaborative investigation between the Miami Herald and WLRN turned up dozens of deaths from abuse and neglect in Florida’s assisted living facilities.

 

In Clearwater, one resident wandered from his home three times. The fourth time, he was torn apart by alligators.

 

In Miami, a woman wandered so frequently that the facility strapped her down. The restraints tore into her skin and killed her.

 

In total, the Neglected to Death investigation uncovered more than 70 deaths from abuse and neglect.

 

The Agency for Health Care Administration or AHCA, which oversees eldercare facilities, could have shut down every single one of those homes. It closed just 7.

 

But in the months since that investigation first ran, some of Florida’s worst facilities have been shut down – at least 8 in total.  This is story of one man from one of those facilities:

 

Paul Encin lives in a much better assisted living facility now. He’s particularly impressed that he gets toilet paper, soap and towels, not to mention decent food. But Paul hasn’t forgotten how different it was when I met him a year ago.

 

“Yeah, I remember that morning when you showed up,” recalls Encin. “I wanted very much to tell you what was actually going on. But I was afraid to. But I got a little bold that morning maybe because it was Christmas Day.”

 

It’s Christmas day 2010 at Shalom Manor, an assisted living facility in the City of Lauderhill – about 6 miles west of Fort Lauderdale. A caretaker goes room to room, rounding up the nearly three-dozen residents for Christmas breakfast.

 

She pokes her head into Paul Encin’s room.

 

“Wake up for dining room please,” she shouts.

 

Like all the rooms I saw, Paul’s room is cramped and smells of body odor. Paul’s desk has a teetering stack of books including one on Paranoid Schizophrenia – the disease that landed him in Shalom. “My situation deteriorated over a period of time,” says Encin, “and I ended up in an assisted living facility. Now I’m on the rebound. It’s just a question of putting it back together financially until I get my own place again.”

 

Over the course of my conversation with Paul, he kept hinting that there were problems at Shalom Manor.

 

“Well, some of the staff isn’t particularly, shall we say, sociable or humane. To put it politely,” he first said.

 

“Inhumane in what ways,” I asked.

 

“Some of the staff is, shall we say, almost abusive at times.”

 

“Almost?”

 

“Almost abusive,” Paul says, “they walk a fine line.”

 

And that’s where Paul leaves it. We head to the dining hall where Christmas breakfast is cornflakes and scrambled eggs.

 

There’s not a whole lot of holiday spirit here other than resident Nancy McPhail’s Santa Claus hat. She mouths a spoonful of cornflakes and agrees, “yeah, I’m the only one.”

 

Shalom Manor is closed now. Since our series Neglected to Death ran in May, the state has forced eight homes to shut down.

 

AHCA has been working with law enforcement and other state agencies to shut problem facilities down.

 

“We’re looking at our full array of regulatory tools,” says Molly McKinstry, deputy secretary for health quality assurance at AHCA, “I think those coordinated efforts have been improved over the past several months.”

 

AHCA has shutdown more facilities in last four months than in the entire two-year period studied during the Neglected to Death investigation.

 

There was Sunshine Acres in the Panhandle where state inspectors found raw sewage spewing onto the property.

 

In St. Petersburg, at the Hilcrest Retirement Residence, AHCA found five sets of sheets stained with blood: The gruesome evidence of bed bug bites

 

And at Shalom Manor in Lauderhill, it was a more a grizzly incident that finally got the state’s attention.

 

It started with a call to the police just eight days after our investigative series first ran. The call came around 6:40 in the morning, according to Captain Constance Stanley with the Lauderhill Police Department. Caretakers at Shalom noticed one of their residents slumped over in his wheelchair. He wasn’t responding.

 

“What the staff proceeded to do rather than contact police or paramedics,” says Stanley, “they covered him up with a sheet or a blanket and then proceeded to go about their daily duties at the facility.”

 

It was almost 40 minutes before anyone called the police. The resident was dead once the police did arrive.

 

AHCA cut off funding to Shalom and banned it from taking new residents. When agents showed up for another inspection, the facility was abandoned.

 

There’s more pressure than ever on problem assisted living facilities, and not just from AHCA.

 

Governor Rick Scott convened a working group to follow up on the abuse and neglect documented in our investigation.

 

Members of both the state house and senate have promised to tighten regulations on the industry when they convene in January.

 

“We needed to fix it yesterday and get the job done,” says Eleanor Sobel is a Democratic state senator.

 

Sobel’s the vice chair on the senate’s Health Regulation Committee, which just finished its own investigation into the assisted living industry. The committee recommended more than two dozen changes to the law – including the mandatory closure of any facility where caretaker negligence results in death.

 

Sobel’s been impressed with AHCA’s recent crackdown, “their new behavior is good,” she says, “but it needs to be codified in the law. People have died and people have gotten sick and people have been treated very badly.”

           

Paul Encin would agree. He watched state inspectors come in an out of Shalom Manor for three years.

 

During that time AHCA turned up more than fifty different violations. Inspectors documented residents languishing without medication.

 

One resident lost a third of their weight – AHCA finally took note when the resident weighed just 95 pounds.

 

From his new home, Encin feels safe enough to tell me what he wanted to say on Christmas morning. When he said, “almost abusive at times…they walk a fine line,” what he really wanted to say was that he’d seen caretakers beat the frail residents with a broomstick.

 

And even worse, just days after I visited, a mentally ill resident soiled herself. So a caretaker dragged the woman outside by the hair and sprayed her down with a hose.

 

Two other residents who were at Shalom with Paul saw the same abuses.

 

The former owner of Shalom Manor did not respond to repeated calls for comment.

 

“You know, I don’t understand,” said Encin, “how anybody from the state can come to a place like Shalom Manor and investigate thoroughly the whole situation and not see immediately that there are all kinds of inadequacies. I just don’t get it.”

 

In the two years we looked at for the Neglected to Death investigation, AHCA could have shut down more than 70 facilities due to deaths from abuse and neglect. The agency did little or nothing.

 

But the case at Shalom was different.

 

Paul Encin says he’s still in a state of shock. He spent so much time “living in rat holes,” he forgot that assisted living was supposed to actually help people.

 

Miami Herald reporters Michael Sallah and Carol Marbin Miller contributed to this report. You can see the Miami Herald’s continued ALF coverage at www.miamiherald.com/neglected.