Sunday, May 01, 2011

Florida Assisted Living Facilities Are A Disaster


For more than a decade, Bruce Hall ran his assisted-living facility in Florida’s Panhandle like a prison camp.

He punished his disabled residents by refusing to give them food and drugs. He threatened them with a stick. He doped them with powerful tranquilizers, and when they broke his rules, he beat them — sending at least one to the hospital.

“The conditions in the facility are not fit even for a dog,” one caller told state agents.

When Florida regulators confronted Hall in 2004 over a litany of abuses at his facility in the rolling hills of Washington County, they said he chased them from the premises while railing against government intrusion.

Under state law, regulators could have shut down Sunshine Acres Loving Care or suspended the home’s license, but they did neither. Instead, they ordered the 50-year-old Hall to see a therapist for his anger and to promise not to use “any weapon or object” on his residents — allowing him to keep his doors open for five more years.

In that time, Hall went on to break nearly every provision of Florida’s assisted-living law: He threw a woman to the ground, and forced her to sleep on a box spring for six days after she urinated on her covers. Though the temperature outside reached 100 degrees, he forced his residents to live without air conditioning. And during a critical overnight shift, he fell asleep on the job while a 71-year-old woman with mental illness wandered from her bed, walked out the door and drowned in a nearby pond.

In a state where tens of thousands reside in assisted-living facilities, the case of Hall’s Sunshine Acres represents everything that has gone wrong with homes once considered the pride of Florida.

Created more than a quarter-century ago, ALFs were established in landmark legislation to provide shelter and sweeping protections to some of the state’s most vulnerable citizens: the elderly and mentally ill.

Tragedies revealed

But a Miami Herald investigation found that the safeguards once hailed as the most progressive in the nation have been ignored in a string of tragedies never before revealed to the public.

In Kendall, a 74-year-old woman was bound for more than six hours, the restraints pulled so tightly they ripped into her skin and killed her.

In Hialeah, a 71-year-old man with mental illness died from burns after he was left in a bathtub filled with scalding water.

In Clearwater, a 75-year-old Alzheimer’s patient was torn apart by an alligator after he wandered from his assisted-living facility for the fourth time.

The deaths highlight critical breakdowns in a state enforcement system that has left thousands of people to fend for themselves in dangerous and decrepit conditions.

The Miami Herald found that the Agency for Health Care Administration, which oversees the state’s 2,850 assisted-living facilities, has failed to monitor shoddy operators, investigate dangerous practices or shut down the worst offenders.

Time and again, the agency was alerted by police and its own inspectors to caretakers depriving residents of the most basic needs — food, water and protection — but didn’t take action.

When AHCA agents were forced to end their inspection of Sunshine Acres in 2008 because of threats by the owner — the second time in four years — the agency didn’t return for eight months.

By the time agents went back, they found a resident eating from a filthy food bin, four inches of dirt on the floor of a dorm room and six residents drugged on tranquilizers without doctors’ orders.

“Lord help us all if he gets mad,” one resident told state regulators about the owner.

Frustrated over the state’s inability to close Sunshine Acres, neighbors began gathering at the local fire station to launch a plan to prompt regulators to act.

“It took the whole damn neighborhood,” said Dewayne Anderson, 55, who lives next door to the home.

A representative of the group fired off several e-mails to AHCA, demanding the state enforce its laws and pointing out a litany of problems created by the facility.

After 14 years of running the home and racking up more than 100 violations, Hall was finally told by AHCA to sell Sunshine Acres. But once again, regulators struck another deal: Hall was given a year to find a buyer.

Failure to protect

The Miami Herald spent a year examining thousands of state inspections, police reports, court cases, autopsy files, e-mails, death certificates and conducting dozens of interviews with operators and residents across the state.

Reporters found that as the ranks of assisted-living facilities grew to make room for Florida’s booming elderly population, the state failed to protect the people it was meant to serve.

For example:

• Nearly once a month, residents die from abuse and neglect — with some caretakers even altering and forging records to conceal evidence — but law enforcement agencies almost never make arrests.

• Homes are routinely caught using illegal restraints — including powerful tranquilizers, locked closets and ropes — but the state rarely if ever punishes them.

• State regulators could have shut down 70 homes in the past two years for a host of severe violations — including neglect and abuse by caretakers — but in the end, closed just seven.

• While the number of new homes has exploded across the state — 550 in the past five years — the state has dropped critical inspections by 33 percent, allowing some of the worst facilities to stay open.

• Though the state has the power to impose fines on homes that break the law, the penalties are routinely decreased, delayed or dropped altogether.

• The state’s lack of enforcement has prompted other government agencies to cut off funding and in some cases refuse to send clients to live in homes AHCA won’t close.

For example, the Miami-Dade Court’s mental health project won’t send clients to All America ACLF, where Angel Joglar, a 71-year-old man with schizophrenia, was scalded in a bathtub after his caretaker left him alone in 2006, dying from the burns weeks later.

Since his death, AHCA has cited the home for at least 100 violations — including untrained staff failing to stop residents from beating each other with two-by-fours.

After Hillandale ALF was caught locking residents with mental illness in a closet to punish them — along with a host of other violations — the state Agency for Persons with Disabilities cut off hundreds of thousands of dollars it was sending to the home in Pasco County.

Both facilities are still licensed by AHCA.

AHCA, which is empowered with tough tools to enforce the law, said its goal is to get facilities to obey the rules — and imposing fines or other penalties are secondary measures.

Reluctant to punish

The agency, which would only respond to questions in writing, said pushing to revoke a home’s license is a “very harsh penalty” used as a last resort. Before doing so, it considers several issues, including the immediate danger to residents and the ability to relocate them to a new home.

Each penalty is considered based on “unique circumstances,” and other actions are explored “prior to the most serious sanction of revocation,” the agency wrote.

However, The Miami Herald found that AHCA repeatedly catches homes breaking the law but fails to act, at times with dire consequences.

At Hampton Court in Haines City, regulators caught caretakers 11 times in the past five years failing to give out medication, not keeping records of drugs given to residents and falsifying records to show drugs had been given when they hadn’t. The state could have imposed emergency measures, including a ban on new residents until the home cleaned up its practices, but never did.

Eventually, someone died.

Norman Dube, a 74-year-old retired postal worker suffering from diabetes and depression, went 13 days last March without crucial antibiotics — and several days without food or water. As he slipped into unconsciousness, he began telling people “things were crawling on his skin,” a state report said.

At the same time, the home failed to tell his doctor he wasn’t getting his drugs, which included blood pressure medications and anti-psychotics.

The next month, Dube died. A state Department of Children & Families investigation concluded the home committed medical neglect.

But the problems didn’t end. On June 25, two months later, state agents returned to the home and found two more residents languishing without their medication, despite doctor’s orders.

The home promised to correct the problems, but in August it happened again — this time, three more residents were not getting their drugs. Two months ago, the facility was taken over by a new owner.

When it comes to imposing fines, AHCA said it doesn’t routinely drop or reduce them, saying it only lowered fines by 7 percent this fiscal year.

But an analysis shows the agency rarely asks for what’s allowed by law. Consider: In 2009 — the same year lawmakers expanded AHCA’s power to levy fines — the agency could have imposed more than $6 million, but took in just $650,000.

Homes of horror

The law that empowered the state to discipline homes was passed three decades ago in response to a growing crisis: Elderly people moving to Florida were ending up in group homes run by abusive caretakers.

The state passed a celebrated Residents Bill of Rights in 1980 — championed by veteran Miami congressman Claude Pepper — pledging that people in those homes would be protected and treated with dignity.

The homes would shelter two of the state’s fastest-growing groups — the elderly and mentally ill — and at the same time offer an alternative to nursing homes.

Now, people who needed help with everyday chores but didn’t require 24-hour nursing care could live independently.

But as the industry boomed, the state began a series of crucial moves that would change the way it regulated homes.

Instead of inspecting ALFs once a year like most large states — including Arizona, Texas, Pennsylvania, North Carolina and Illinois — Florida cut inspections to just once every two years.

The same trend took place with investigations of serious incidents like deaths and injuries — known as adverse incidents — which were slashed by 90 percent between 2002 and 2008.

Regulators never investigated Isabel Adult Care III after the owner reported that Aurora Navas, an 85-year-old grandmother with dementia, had quietly wandered from the Miami-Dade home and drowned in a pond in the backyard in 2008.

“Her lack of ability to find her way back caused her accidental death,” wrote the home’s administrator, Isabel Lopez, in a report to AHCA. “We found that all procedures were followed. The facility has door alarms, proper door locks, and a fenced backyard.”

But records show that if regulators had carried out what was once a routine exercise, they would have found just the opposite: The door alarm and video cameras weren’t working, the back gate was unlocked and an attendant had fallen asleep, Miami-Dade police records show.

Navas, who had a history of wandering, was found floating in 18 inches of water, clad only in her lavender sleeping gown, a blue slipper on the ground nearby.

To this day, Alfredo Navas says he’s enraged the state never investigated his mother’s death at the quiet suburban home just north of Kendall.

“You don’t follow up when it comes to human beings who are supposed to be watching other human beings. They get nothing,” said Navas, 59, adding that his mother was afraid of water most of her life. “The safeguards you thought in place weren’t in place.”

In an interview, Lopez said she was ordered by fire inspectors to remove the locks from the rear door. But county records show that was not the case: Inspectors simply told her to get new locks.

Cases skyrocket

While inspections of homes were dropping across the state, another troubling trend was under way that would set new records.

The state Department of Elder Affairs ombudsman program was uncovering more cases of abuse and neglect than it had seen in the last three decades, with numbers doubling in the past five years.

Though the program sends its findings to AHCA, regulators failed to investigate the vast majority of the cases, records show. In fact, a state audit in 2008 found that AHCA couldn’t locate two-thirds of the complaints sent to the agency.

“It’s baffling to me,” said Brian Lee, the ombudsman program’s past director. “We find things, and it’s like, how did they not see the same things?”

Even when AHCA does find problems — including people dying from abuse and medical neglect — it rarely moves to close homes, allowing the same dangerous violations to turn up again.

Though Briarwood Manor has been the target of more than 1,200 police and rescue calls in the past five years — with residents stabbing, fighting and suffering psychiatric breakdowns — the Broward County facility has been allowed to stay open.

The drab, stuccoed home in the heart of Lauderhill has been slapped with scores of violations by AHCA — 100 in the past five years — including an episode in which a man slashed his roommate with a knife during a crack binge while the night caretaker was nowhere to be found. Twice in the past five years, the state could have revoked or suspended the home’s license, but did neither.

Instead, AHCA allowed Briarwood to operate for four years while it owed massive fines that peaked at more than $370,000, with AHCA eventually agreeing to reduce the amount by 74 percent in 2008.

Briarwood is among the hundreds of ALFs that opened their doors in the past decade, driven by the closing of state mental health institutions.

But as the industry boomed, AHCA failed to keep up with the growth, with state agents taking longer to respond to dangerous breakdowns. A Miami Herald analysis shows it took inspectors an average of 37 days to complete complaint investigations in 2009, 10 days longer than five years earlier.

At least five times, other agencies were forced to take the lead in shutting down homes when AHCA didn’t act.

One Hardee County sheriff’s detective said he was unable to prod AHCA to shut down Southern Oaks Retirement Center last year after he found residents sleeping on torn, urine-soaked mattresses surrounded by moldy, cracked walls and boarded-up windows.

Though AHCA had turned up the same hazards at the Central Florida home for eight years — including just a month earlier — the facility stayed open until fire officials ordered the evacuation of all 49 residents on June 22, 2010.

Not until the home made critical repairs five weeks later was the order lifted.

For Rosalie Manor, it was a longer battle.

For years, Pinellas County sheriff’s deputies had been forced to round up dozens of residents with mental illnesses found wandering the small town of Dunedin, breaking into a school and homes, and shoplifting from businesses.

When deputies finally investigated, they found Rosalie Manor owner Erik Anderson had placed a 53-year-old man just released from a psychiatric ward in charge of dispensing powerful psychotropic drugs to others in the home.

When two residents suffered breakdowns after not getting their crucial medications, detectives sent a warning to AHCA: Shut the place down.

But regulators dropped the case a month later, citing a lack of evidence — prompting an angry response from Sgt. J. Michael Daily, who slammed AHCA for its “inability to take action on this and other valid complaints at Rosalie Manor,” records show.

During the next two months, deputies joined prosecutors in a rare effort to close the 34-bed facility.

Detectives brought forward reams of paperwork in 2006 detailing abuse and neglect inside the cluster of cottages near downtown Dunedin — including violations turned up by AHCA year after year.

They found Anderson had covered up crucial evidence in death investigations of the home’s residents.

In one case in 2003, he threatened to fire any employee who called police after finding blood splattered on the walls of a 72-year-old man’s bedroom and a suicide note on the dresser.

In 2005, he drove a male resident with a criminal history to a pharmacy to fill a prescription for powerful narcotics, but failed to collect the drugs from the man, who then fed them to a 20-year-old female resident with mental illness. She was then raped by the man and died in her bedroom from an overdose.

Administrator charged

In the end, prosecutors charged Anderson, 60, with neglect, witness tampering and falsifying medical records. He pleaded guilty and surrendered his ALF license. His sentence: probation.

Caretaker Mary Pressley, 47, who worked at Rosalie for nearly a decade, said she couldn’t understand why AHCA never moved to close the home. “I don’t know how he got away with what he did,” she said.

Since 2005, Rosalie was among more than 40 homes found to be placing residents in immediate danger — the most serious breach of Florida’s ALF law — with a quarter of the homes going on to do it again.

Even after AHCA inspectors warned their own agency that Bruce Hall was running a dangerous facility in 2004, he was allowed to renew his license and expand the home to make room for eight more beds.

It was the third time the troubled facility was granted a renewal by AHCA, despite breaking the state’s ALF law 51 times.

The next year, Hall fell asleep on night watch duty just long enough for 71-year-old Elnora Shuler to wander out the door with her baby doll and slip into a pond on the premises.

When AHCA investigators asked Hall why the fence around the pond was only half finished, an inspection report states he responded: “My complacency is the reason… I knew I’d find [Shuler] down there in that pond someday.”

When agents visited the ramshackle 52-bed home in North Florida to investigate a tip that Hall threatened residents with a gun, he flew into a rage, referring to the residents as “deranged, mental retarded sons of bitches,” while lashing out at state agents, reports showed.

In the end, inspectors Patty McIntire and Kara Cowart, along with a Washington County sheriff’s deputy, left the property without completing their investigation, citing “safety concerns.”

For his tirade, Hall was fined $1,756 and ordered to visit a therapist because of his anger. But just 17 days later, he shoved a woman diagnosed with mental retardation to the ground, sending her to the hospital with a sprained ankle and cuts on her arm, elbow, knee and shin.

Hall told regulators he was protecting his wife after the resident grabbed her arm, but state agents cited him for abuse.

In an interview with The Miami Herald, Hall said regulators were “bureaucrats” who didn’t understand the challenges of dealing with people with mental disabilities — and that he had a right to impose force on residents when they got unruly.

“If one of them jumps on you and you got to beat the hell out of them to get them off you, then you get held responsible,” he said. “I’m the damn culprit that’s the bad guy in all this?”

He blamed residents and his neighbors for bringing unwarranted scrutiny to the facility.

“These mentally handicapped residents, they know the game,” he said. “They will play you. They are of the system, they know the system — just like a prisoner. They know what they can get away with.”

He said if he hadn’t imposed discipline on his residents, they would have taken control of the facility. “They’re going to realize they can continue to treat you like a dog,” he said.

During a state inspection in 2006, 14 residents at Sunshine Acres refused to give their names to AHCA agents, saying they feared retaliation.

Between 2007 and 2008, five employees quit their jobs, saying they were tired of the abuse at the home, state reports show.

During that same period, sheriff’s deputies and rescue workers were called to the home more than 400 times for, among other things, fights between residents and people suffering psychiatric breakdowns.

“It was like a damn nightmare,” said Dewayne Anderson, a next-door neighbor who joined the community coalition to close the home.

In 2008, Hall ran AHCA agents off the premises a second time after berating an elderly female resident who was trying to talk privately to them.

Hall “dropped to his knees in front of the resident” and with “flushed face, clenched jaw, rapid, loud speech, flaying [flying] arms,” he said he was throwing her out for complaining about him.

“The survey was discontinued at this point due to a fear for the safety of the surveyors,” inspectors wrote.

After the event, the state threatened to kick Hall out of the business.

In April, agents sent a letter saying Sunshine Acres’ license would not be renewed. But it was. In October, regulators told Hall to get out — but once again, bargained the punishment down, giving him a year to sell the troubled home.

Through it all, agents continued to find more problems: Six residents were illegally given powerful drugs known as “chemical restraints,” designed to keep them under control — without a doctor’s consent, agents wrote.

Finally, after more than 115 citations from AHCA, Hall sold the home in September 2009 — still holding the mortgage in a deal that will earn him $1.1 million during the next 10 years.

Wandering resident meets a grisly end


Caretakers at the Beckett Lake Lodge assisted living facility struggled to keep track of Walter Stowman Cox.

The 75-year-old man with dementia was once found in bank lobby after wandering from his Pinellas County ALF. Months later, he wandered into a nearby condo complex and had to be escorted back.

But the last time he left Beckett Lake Lodge — his home for more than a year — he never returned.

The former Episcopal priest and social worker was found a week later floating face down in a thatch of cattails in a nearby lake, his body ripped apart by alligators.

His gruesome death in 2004 led to an investigation by the Agency for Health Care Administration, which turned up several violations, including a citation for failing to keep track of Cox’s whereabouts. But in the end, no fines were imposed and no penalties issued in the death of the elderly grandfather.

AHCA said the home committed a minor infraction that didn’t call for a penalty. But records show AHCA initially slapped the home with a serious violation for putting Cox in danger — punishable by a $5,000 fine. The agency later agreed to lower the severity of the violation.

In the year before Cox died, records show he was growing confused, with a psychologist noting the Air Force veteran was suffering from “memory impairment” and in need of an anti-anxiety drug. Though Beckett Lake Lodge had a section for people with dementia — where residents are more closely monitored — Cox was never placed in the ward.

The home’s director of care, Audrey Malin, later said in a deposition she didn’t think he should have been allowed to leave the facility “because I would already have known that there were risks.”

Home administrator Michael Payne declined to talk about the death.

Cox had wandered at least three times, but his daughter, Sharon Sandoval, said no one from the home told her — including one episode seven months before he died when police had to conduct a nighttime search for him. Had she known, she said, she would have asked he be placed in the more secure setting.

The day before Cox wandered into the woods for the last time, he was found confused outside a nearby development. The next day, when he wanted to go for a walk, the home sent an aide to watch him. But Cox soon bolted into the woods, and the aide, who wasn’t carrying a cellphone, didn’t follow, returning to the facility before calling rescue workers.

After a week of searching, law enforcement officers on an airboat found Cox’s partially clothed body in four feet of water on the edge of Harbor Lake, his upper torso ripped by alligator bites and both arms missing.

In the year before his death, regulators cited the home twice for not keeping key medical records, including doctor’s orders detailing the specific care each resident was supposed to receive. In fact, the home didn’t complete those documents for Cox until he’d been missing four days, records show.

After initially finding the home had lost track of Cox when he ran into the woods, AHCA reversed its decision, saying workers at the home “were aware of the whereabouts,” said Shelisha Coleman, an agency spokesperson. But records show no one knew where Cox was until police pulled his badly mauled body from the water seven days later.

Sandoval, 52, whose family recently settled a lawsuit with the home for an undisclosed amount, said she was haunted by whether her father was still alive when his body was attacked by the alligator.

“I kept going around and around in my head all the different possibilities,” she said. “I was just driving myself crazy. Finally, I just came to the conclusion that I will never know.

A history of violence ends in fiery rampage


Pedro Sanchez set his bed on fire with a red disposable lighter. Then, clutching a large, jagged rock, he struck the frail, elderly people who tried to flee the deadly inferno.

“Aqui vamos a morir todos!” witnesses said Sanchez shouted as he beat a 55-year-old man in a wheelchair. “We are all going to die here.”

Though five residents of the K&K Adult Care Center in Miami escaped the Oct. 1, 2005, blaze, 78-year-old Graciela Labastilla would succumb to the toxic fumes.

In the coming days, state agents turned up evidence that the facility had failed to safeguard its elderly and disabled residents, leaving a violent man with a criminal past to prey on vulnerable adults.

Just days before he ignited the fire, Sanchez was allowed back to the home after being committed to a psychiatric ward for threatening a resident and throwing a rock into a neighbor’s house.

The Agency for Health Care Administration determined the home did not protect the residents, but no penalty was ever imposed.

In addition, Miami-Dade fire officials said the fact that hurricane shutters were fastened to the home’s windows — with no impending storms — increased the danger to the residents.

The only person charged in the death of the grandmother of 10 was Sanchez — arrested for arson and homicide — who remains in Atlantic Shores State Hospital, incompetent to stand trial.

Two weeks before the blaze, Sanchez had erupted in anger after a staff member tried to stop him from leaving the home.

The 78-year-old, who was on felony probation for carrying a concealed weapon before moving into the home, threw a rock at a neighbor’s house and threatened to hit caretakers with a stick, witnesses said.

Miami-Dade police officers finally subdued him, taking him to Palmetto General Hospital’s psychiatric ward, where he stayed for 10 days before returning to the ALF.

Over the following days, resident Omar Buttari said Sanchez repeatedly threatened “to burn the place down.”

On Oct. 1, 2005, a caretaker awoke before dawn to a wailing fire alarm. Griselda Cruz, 52, said she grabbed a fire extinguisher, but couldn’t put out the flames. Sanchez, she told detectives, was trying to keep residents from leaving by slamming their bedroom doors and screaming that everyone was going to die.

“Que has hecho?” she asked Sanchez after noticing his bed engulfed in flames. “What have you done?”

The five residents could escape only through the front and back doors because the home had not removed the aluminum shutters barricading the windows. As Cruz tried to help the elderly residents toward the front door, Sanchez struck her in the mouth with the rock. He beat Buttari on the head.

Rescue workers found Labastilla sprawled on the floor and took her to Memorial Hospital Miramar, where she died two days later of carbon monoxide toxicity.

The rock was still in Sanchez’s pocket when police confronted him down the street.

Police estimated the damage at $200,000, and K&K was shut down for good by its owner.

Family members said they were stunned to learn their mother, a retired seamstress who owned a small business in Hialeah, was living in a home with a convicted felon who had been threatening residents for days.

Under Florida law, homes are supposed to evaluate residents to determine whether they are appropriate for placement in their facilities.

“I didn’t know there was anybody like Pedro Sanchez in there,” said the victim’s son, Manny Labastilla. “If you have someone who has that type or degree of mental illness to the point where he’s going to threaten a person, he should be at a different type of facility.”



• Landmark U.S. Supreme Court decision bans states from confining citizens to institutions if they are non-dangerous and capable of living by themselves or with relatives — leading to the closing of psychiatric facilities and leaving a large number of people in need of housing.

• Licensing of Adult Congregate Living Facilities in Florida begins, with passage of state law setting basic standards for people living in boarding-house settings with a staff to prepare meals and manage medications for residents.


• The Florida Legislature passes the first comprehensive regulations for ACLFs, establishing licensing standards, a fraud enforcement unit to protect Medicaid funds, and a bill of rights for group-home residents.


• Federal legislation creates a program allowing states to use long-term care money available through Medicaid to pay for residents’ room and board at group homes.


Amendments are passed in Florida drawing clear distinctions between nursing homes and assisted-living facilities, where people need help with everyday chores but not 24-hour nursing care.


• The state has 1,400 assisted-living facilities housing 42,000 people.


Florida’s population nearly doubles between 1970 and 1990 — from 6.7 million to 12.9 million — creating waves of elderly and disabled people in need of housing and care.


• The creation of the Florida Department of Elder Affairs with Bentley Lipscomb as the director. One of the agency’s goals: protect the rights of the elderly in assisted-living facilities and nursing homes.


• Agency for Health Care Administration becomes chief regulator of ACLFs after splitting from the state Department of Health and Rehabilitative Services.

• There are now 1,568 ACLFs throughout the state.


• The Florida Legislature refuses to increase funding for inspections of ACLFs despite their growth across the state. As a result, inspections are reduced from once a year to once every two years.


• The state renames Adult Congregate Living Facilities as Assisted Living Facilities (ALFs), an emerging housing model that’s expected to surpass nursing homes as the signature facilities for elderly and mentally ill people.

• A newly revamped Elder Abuse Law in the Florida Legislature makes it easier for prosecutors to push for felonies against people who abuse or exploit elderly and disabled people.


• The state adopts a law requiring ALFs housing people with mental illness to obtain a special license. It also requires facilities that care for people with Alzheimer’s disease and other disorders to meet standards of operation, including requirements that homes with 17 or more residents have an awake staff member on duty at all hours, and that all employees have a minimum level of training.

• The state is now home to 1,922 ALFs.


Operation Spot Check: Attorney General Bob Butterworth expands a program that draws together multiple agencies to carry out surprise inspections of troubled homes that received Medicaid funding. The agencies include the state attorney general’s Medicaid Fraud Control Unit, AHCA, the Department of Children & Families, Florida’s Long Term Care Ombudsman Council, state attorneys, and local fire and code inspectors. The goal: rooting out neglect and abuse.


• Florida now has 2,305 ALFs.


• State legislators pass sweeping tort reforms that slash the amount of insurance ALF owners are required to carry, set limits on lawsuits — making it more difficult for lawyers to sue facilities — and end the practice of awarding attorneys’ fees in cases that do not involve death or serious injury.

• The state House of Representatives passes a bill that


Florida adopts new laws raising the penalty for aggravated abuse of elderly and disabled people to a first-degree felony.


The state now has 2,850 ALFs housing more than 80,000 people.

Toxic sore fatally undetected

Already heartbroken by his wife’s deterioration through Alzheimer’s, Theodore Archer then watched her die needlessly from an ignored poisonous sore.

Theodore and Dorothy Archer retired to sleepy Hernando County in 1981, but never really settled down. For the next 20 years, the Archers did the Lord’s work, driving a recreational vehicle from Florida to Canada, California to Maine, renovating churches with a group called Servants on Wheels.

It was the sudden onset of Alzheimer’s disease that finally slowed Dorothy Archer.

Unable to cope with his wife’s forgetfulness and agitation, Theodore Archer moved her to a nearby assisted-living facility called Edwinola Manor in late 2008. There, he thought, she would get the care and service she had given so selflessly as a church outreach worker.

Instead, nurses failed to treat a gaping pressure sore on her lower back that filled her body with raging toxins.

“There is no valid reason for such a wound developing undetected in an ALF resident,” wrote Tim McClain, a registered nurse who investigated the case for the state Department of Children & Families.

Archer, 90, was not the first Edwinola resident to fall victim to shoddy care.

In April 2008, Carmen DeArmas was hospitalized with a rotting, oozing foot, requiring immediate surgery. Family members told investigators the injury was so bad, the 79-year-old woman’s sock was “embedded into the skin,” a DCF report says.

Two months later, Edwinola administrators told the Agency for Health Care Administration they had retrained workers to better recognize and report signs that residents’ health had deteriorated.

But in October that year more problems emerged: AHCA found the home had failed to keep records on three more residents whose health had deteriorated — including one whose pressure sore was severe enough to force a hospital stay.

Once again, Edwinola administrators submitted a detailed plan for doing better.

The plan had just been put in place when Dorothy Archer was admitted to the retirement home, diagnosed with acute psychosis — the result of a quickly progressing case of dementia.

The Archers had been inseparable for 37 years, living in the Philippines, Hawaii, South Africa, Panama, Virginia and a host of other places where Theodore’s second career as a combustion engineer took him.

“We were always together,’’ Theodore Archer said. “Everywhere I went, she was with me.’’

The couple had planned to grow old together — and die together.

But the retired naval chief petty officer — who survived the sinking of the USS Hornet at the Pacific battle of Santa Cruz in 1942 — was no match for his wife’s Alzheimer’s.

Confused and agitated, Archer had been hospitalized under Florida’s involuntary commitment law when a neighbor suggested Edwinola, a 170-bed home in Dade City, just north of Tampa Bay. Archer said he visited his wife every day — usually more than once.

Medical notes suggest Archer was faring well in the facility until March, when nurses feared a raspy cough might be the first signs of pneumonia.

When Archer was sent to a nearby hospital for treatment, the home’s notes documented only a “small” skin lesion, described two days earlier as a “red area” on her lower back.

But doctors immediately said the home’s description of the wound was far from accurate. The festering sore, as large as a grapefruit, had become so infected it had turned black — and her kidney was failing, said Dr. Keith Rosenbach at Pasco Regional Medical Center.

“The poison is all throughout her body. There’s no way I can save her,’’ her husband said he was told by a doctor.

Archer was transferred to a local hospice. Aides cleaned her, and put on a crisp new gown. Within 30 minutes, she was dead.

After her death in 2009, state investigators questioned the home’s treatment of Archer’s blackened sore.

“It is obvious that ALF staff should have noticed the buttock wound,’’ McClain, the DCF nurse, wrote. “It is also clear that there was a serious systemic failure at the ALF.’’ Archer, he concluded, “was inadequately supervised and medically neglected.”

Janice Merrill, an Orlando attorney who represents Edwinola, declined to comment, citing ongoing litigation.

Even after Archer died, the problems at Edwinola continued.

A month after her death, a woman was hospitalized with bruises on her arm, wrist, chest and buttocks. Doctors discovered she had been given so high a dose of blood-thinners that she needed several transfusions. She also had been given three pain patches — triple the dose prescribed by her doctor.

The woman, a DCF investigator wrote, had been “overmedicated to the point of losing consciousness.’’

During the investigation, the home’s director of nursing resigned. The facility once again told state agents it had “incorporated new safety measures and training to prevent recurrence,” DCF records show.

But in November 2010, regulators found more breakdowns — this time, after relatives complained a resident of the home was “acting strangely and no one knew why.” When inspectors showed up, they found the home had failed to give the resident crucial psychiatric and heart medications.

Once again, Edwinola promised to retrain its workers to make sure the problems didn’t happen again, records state.

For Theodore Archer, 91, who is suing the home, learning that the facility had been warned twice before his wife’s death to pay better attention to residents’ health has made his loneliness even more difficult.

“Miss her? God, yes,’’ Archer said. “I guess it’ll be a long time missing her till I go.’

Protecting yourself and your loved ones

If you are considering an assisted-living facility for yourself or a relative:

• Consult your doctor. If your relative is suffering from the infirmities of aging, make sure they are able to live at an ALF. ALF residents must be able to perform most of their activities of daily living — such as going to the toilet, dressing, and getting around — with only minimal assistance. An elder who is bed-bound, for example, cannot live safely in an ALF.

• Consider a facility that’s close to family and trusted friends. Advocates say ALF residents who are visited regularly by involved and inquisitive family members generally receive better care. Residents who are isolated from family, and who do not have strong-voiced advocates, are more likely to be overlooked.

• Seek help from a financial advisor. If you do not have long-term care insurance, you won’t want to deplete your savings too quickly, because facilities that accept rent from government insurance programs, such as Medicaid, as their only source of revenue often operate on the thinnest of margins. Look for ways to stretch out your savings so you can live in the home best suited to meet your needs.

If you are choosing among different assisted-living facilities:

• Consult the Long-term Care Ombudsman Council in your community. The councils maintain several resources that are available to the public.

• Review the Agency for Health Care Administration’s website at The results of the agency’s inspections, once every two years, complaint investigations and other resources are available to the public.

• Visit the facilities that interest you at different times of day. A home that seems cool in the evening may be hot at mid-afternoon. Tour the entire facility, not just the lobby. Look inside residents’ rooms. Pay attention to all your senses, especially smell.

• Reach out to the facility’s family or residents’ council. Attend a residents’ council meeting, if you can, and ask lots of questions.

• Check the ALF’s activities calendar, and ask to observe daily activities. Boredom and inactivity are unhealthy for elders, so look for a facility that will keep you or your loved one busy and entertained.

• Visit at mealtime, and not just one meal. Records show ALFs often are faulted for having menus with a variety of healthy, enticing options — and then cooking meals that don’t match the menu. Be sure that the facility you pick is capable of providing a diet that meets your needs, such as offerings for people with diabetes. A Sunday night visit is recommended, because Sunday evening meals often are the most overlooked by facility staff, records show.

• Talk to a lawyer before signing any contracts. If you sign a contract that allows only binding arbitration when something goes terribly wrong — such as a death or disabling injury — you will lose the right to sue, and you could forgo significant damages that you might otherwise be entitled to.

• Ask to see the résumé of the home’s administrator and director of resident services, who may be the only manager on site with a degree or professional experience.

When you move in to an assisted-living facility:
• Know and document the names of every caregiver who works with you or your loved one. Don’t be afraid to ask for names and birth dates, and vet the people who spend the most time with them. Caregivers often are the difference between life and death if your loved one experiences a severe fall or other healthcare emergency.

Check the details of your loved one’s medications at least once monthly. Does the medication match the prescription? Is the dosage accurate? Read the fine print. If your loved one is taking several prescriptions, are there any interactions that may prove lethal? Is your loved one being prescribed medications by a doctor other than your family physician? If so, what do you know about that doctor?

What you should you do if something goes wrong:

• If your loved one dies at an ALF, and you suspect the death was not natural, request an autopsy by the county medical examiner.

Be sure to document everything. Your observations and impressions may be helpful to authorities who investigate what happened.

You have a right to call or write authorities if you suspect an ALF resident has experienced abuse, neglect or financial exploitation. The state Department of Children & Families investigates all such reports and can be reached at 800-96 ABUSE. The Agency for Health Care Administration also investigates reports of maltreatment, and can be reached at 888-419-3456.

You also can report concerns of improper care to the Long-term Care Ombudsman Council in your area.


- Spencer Kuvin
Cohen & Kuvin, LLC


Los Angeles Assisted Living said...

Hi all,

Assisted living facility may be a good choice if you need more personal care services than you can get at home or an independent living retirement community, but you don’t needs the round the clock medical care and supervision of a nursing home. Thanks a lot...

Retirement Living Hayward said...

Assisted living facilities provide an instrumental service for many senior adults or individuals who may need help performing routine daily tasks, but who do not require the services of a nursing home. For many, assisted living homes provide a sense of independence and community. Thanks a lot.

Senior Housing Union City said...

Hello all,

Florida is one of the most popular states among seniors and retirees due to the great climate, senior care options and assisted living facilities that the state has to offer. Thanks a lot...

Long Term Care Costs said...

Families should really be involved in the selection of nursing homes prior to their loved ones moving in. It's important to give some time and effort researching and doing a background check on these facilities to ensure that your loved ones will be safe under their roof

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