Thursday, March 01, 2007

Phila. Inquirer's "Shame of the State" Investigation

On February 25, 2007, after an eight-month inquiry, the Philadelphia Inquirer published an extended article examining the condition of assisted living facilities in Pennsylvania. The conclusion appears in the article's first line: "Peer into the files of Pennsylvania's assisted-living industry and confront a catalog of horrors."

In "Shame of the State", Inquirer Staff Writer Ken Kilanian concludes: "Troubled facilities and lax state oversight have for years put residents of Pennsylvania's assisted-living homes at risk of assault, neglect -- and tragedy."

Since 2000, at least 55 assisted-living residents have died across the state under circumstances that raise questions about whether they were cared for properly and whether their deaths could have been prevented, an eight-month Inquirer investigation has found.

Uncounted others were beaten or neglected at the state-regulated facilities, which are also known as personal-care homes. At least five were raped. The
Inquirer's examination of Pennsylvania's assisted-living industry - based on thousands of pages of public records and hundreds of interviews - found a long list of health and safety violations, a history of substandard care, and a system of state oversight that, until recently, often allowed deficient operators to violate safety rules with virtual impunity.

While most personal-care homes appear to provide reasonably good care, a significant segment of the industry has been so problem-ridden for so long - and the regulation of it has been so lax - that elder-care experts call it one of Harrisburg's worst failures.

"The situation with personal-care homes really is the shame of the state," said Sue Walther, executive director of the Mental Health Association of Pennsylvania and chairwoman of a state coalition of personal-home advocates.
The Inquirer indicates that this situation has been known, but has not been addressed in the past due to influential organizations with contrary interests.

When the state set out in the late 1990s to overhaul health and safety rules for personal-care homes, lobbyists and legislators dragged out the debate for years -- and significantly diluted key provisions of the original proposals, according to public records and interviews.

Top Rendell administration officials at the agency in charge of protecting assisted-living residents -- the Department of Public Welfare -- acknowledge that regulation was inadequate for many years, including two years under their watch.

The state's enforcement effort has been hobbled by low resources and few staff.

That regulator, Karen Kroh, has replaced half her staff, boosted enforcement actions by 55 percent, and revoked the licenses of 75 facilities.

But in an interview, she acknowledged that her tiny complement of inspectors - 31 for nearly 51,000 Pennsylvanians in 1,590 homes - was overwhelmed. While trying to keep up with investigating complaints, they have fallen badly behind on inspections, she said.

"This program has so many systemic problems that have gone unnoticed, unchecked and unregulated for a decade," Kroh said. "I don't have enough staff to fix it.

"By the time we get out to them, many homes are in so much trouble that they can't fix the problems - or somebody's already been harmed." Regulators continue to find shockingly unsafe conditions, Kroh said, "and I'm sure there are many more to be found."

The article is very long, very detailed, and very disturbing. You should read it. The complete article may be read online here.

Accompanying the article are further research findings, case studies, & resources, as follows:

Its message should not be ignored, particularly now, when long-term care in Pennsylvania is under study. See:
PA's "2020 VISION" Project: Part II (02/23/07); Long-Term Care Study Award in PA (01/22/07); State Rep Calls for LTC Study Commission (12/28/06).

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Update: 03/02/07:

"Shame of the State" was the first of four articles that appeared in the Philadelphia Inquirer on this topic. Following are links for all four articles, published serially (Feb 25-28, 2007), under the title "A Failure to Care":

The three additional parts of the series listed further helpful research, stories, or resources, as follows:
Part Two (published 02/26/07):

Part Three (published 02/27/07):

Part Four (published 02/28/07):
* * *

Update: 03/06/07:

On March 4, 2007, the
Philadelphia Inquirer published an Editorial about Personal-Care Homes, entitled "Bringing down the giant", reflecting upon the four-part series published by that newspaper. It stated, in part, as follows:

Pennsylvania should narrow the personal-care-home definition, which now includes every adult boarding facility that isn't a nursing home.

Specifically, the state needs to define "assisted living," now just a misleading marketing term. Although the name implies more, assisted-living homes are required to offer no greater services than personal-care homes.

Assisted living should be the middle ground between people who need minimal help bathing or remembering medication and those who need constant attention from a medical professional.

More than 40 states have three distinct levels of care, which help ensure proper worker training and qualifications. Clearer definitions also might raise shamefully low pay and reduce high turnover at all types of adult care.

Most important, consumers need accessible information on the quality of various homes. Some provide excellent services. Like nursing homes, which have a national clearinghouse for fines and enforcement actions, personal-care homes should have to disclose inspection reports and violations - in layman's terms.

Ultimately, many personal-care homes should be phased out.

Update: 03/07/07:

For a related matter -- the introduction in February, 2007, in the House, of proposed legislation in Pennsylvania to regulate personal care homes -- see the later posting on this Blog, Legislation on "Personal Care Homes" in PA (03/07/07).

Update: 03/12/07:

On Sunday, March 11, 2007, a letter, entitled "Protect the elderly", was published in the Philadelphia Inquirer, in response to the series of articles published by that newspaper about personal care homes in Pennsylvania.

Ray Landis, Associate State Director for State Advocacy, of AARP, in Harrisburg, wrote:

The Inquirer series chronicling neglect at Pennsylvania assisted-living and personal care-facilities should serve as a wake-up call for older residents and their families ("A failure to care," Feb. 25-28). Reading about regulations watered down by special interests and overwhelmed government watchdogs certainly isn't reassuring to families struggling every day caring for older loved ones.

Pennsylvania simply must do a better job providing safe and compassionate care for our most vulnerable residents. No matter who is footing the bill, there is no excuse for unsafe conditions, lax regulations, and a shortage of inspectors.

Many of the problems can be traced to Pennsylvania's outdated approach to long-term care. Our state ranks near the bottom in funding for nursing-home alternatives, despite a record surplus in the state lottery fund, which is dedicated to senior programs.

Under current Pennsylvania law, assisted living is not even recognized as a form of long-term care. Establishing a legal definition and separate regulations for assisted living would allow some of those eligible for nursing homes to move to less expensive facilities where they would be happier, and where federal Medicaid dollars could be used for their care. The end result would be significant cost savings for Pennsylvania over time, money that could be used to hire more inspectors.

Update: 03/16/07:

For a letter containing clarifications & rebuttal about some points made in the Philadelphia Inquirer's March 4th editorial based on its series, see: "Taking Exception: Lobbyists call the shots in assisted care", by Thomas Earle, CEO, Liberty Resources Inc., Center for Independent Living, Philadelphia:

The March 4 editorial on the need to fix the personal-care home fiasco in Pennsylvania ("Bringing down the giant") rightly stated that "many elderly would fare better in their own homes with services coming in." But the editorial was 100-percent wrong with its conclusion that "funding prohibitions rule out those options."

The Home and Community Based Waiver program explicitly allows federal Medicaid funding for elderly persons and persons with disabilities to be used to provide services in consumer-friendly forms in the community rather than in nursing homes or personal-care homes.

There is, however, a bias against community-based alternatives in the way that the state of Pennsylvania provides its funding. * * *

Update: 04/16/07:

For a proposed plan put forward by the PA Department of Public Welfare in partial response to the original articles, see: PA EE&F Law Blog posting "PA DPW's Plan for Personal Care Homes?" (04/16/07).