Elder Care Industry Problems RemainOct 20, 2002 | Trenton Times The details were grisly.
A health aide who allegedly kicked an 83-year-old Alzheimer's patient at the Alterra Clare Bridge assisted-living facility in Lower Makefield, Pa., breaking five ribs and puncturing a lung, was charged with murder.
Four co-workers, accused by prosecutors of covering up the abuse and failing to summon help, face charges as well.
But don't count Dave Cohen, who has handled 50 lawsuits alleging abuse and neglect at senior care facilities for the Lawrence-based Stark & Stark law firm, among the ranks of those shocked by the September 2000 death of William Neff and the filing of criminal charges two weeks ago.
"I'm dismayed but not surprised, because this happens all over," Cohen said. "The only issue is will we find out about it."
Advocates for the elderly and recent data say that abuse and neglect remain persistent problems in New Jersey and nationally - in nursing homes and the fast-growing assisted-living industry.
Officials of trade groups representing the nursing home and assisted living industries say that while problems do occur with abuse and neglect, they are not widespread, due largely to strict governmental oversight.
William Isele, ombudsman for the state's institutionalized elderly, said assisted-living facilities often look spectacular but are beset by the same issues as nursing homes - insufficient staff and inadequate training.
"Chandeliers and wallpaper and carpeting don't provide care," Isele said. "People provide care."
Assisted-living facilities are meant as a transition for senior citizens who have limited medical needs but with assistance in dressing, eating and bathing still can live independently.
But assisted living is a new phenomenon, having sprung up in the last decade. Efforts to study nursing homes and reform them date back much further.
A recent congressional report found that more than 30 percent of the nation's 17,000 nursing homes were cited for an abuse violation in a two-year span of 1999 to 2000.
The most frequent violation was failure to properly investigate and report allegations of resident abuse, neglect or mistreatment or to do background checks on staff, the report found.
The national percentage of nursing homes cited for abuse violations during annual state inspections has almost tripled since 1996, although it's unclear if that is due to better enforcement and reporting or an increase in cases, the report found.
In New Jersey, Isele said, the number of complaints - on issues from abuse to more common problems with food or other less serious concerns - is increasing, but at a slower pace than recent years.
Statistics filed by his office to the U.S. Administration on Aging show the total number of complaints of abuse, gross neglect or exploitation of residents rose from the 2000 fiscal year to the 2001 fiscal year.
There were 1,485 incidents reported at nursing homes in 2001, up 13 percent from 2000.
There were 109 incidents reported in assisted-living and similar facilities, a 17 percent increase.
Criminal complaints are rare because of the level of proof required, Isele said.
A promising statistic was a drop in physical abuse cases. There were 628 cases reported in 2001, an 8 percent drop, with 24 at assisted living and other facilities, a 17 percent drop.
Assisted living complaints are fewer than for nursing homes but the number of units is also considerably fewer.
Paul Langevin, president of the Health Care Association of New Jersey which represents nursing homes and assisted-living facilities, said there are 16,000 licensed assisted-living units in New Jersey.
That is out of 120,000 to 130,000 overall units for residential elderly care estimated by Isele.
Frank Byrne, vice president of public policy for the New Jersey Association of Non-Profit Homes for the Aging, said he does not believe abuse and neglect problems are widespread, largely because of stringent reporting requirements and stiff potential penalties. His group represents one-third of the state's 1,000 elderly care facilities.
In his four years, Isele said he has never seen as dramatic a case as Neff's death. Still, he said, improvement is needed.
Neglect is far more common than abuse, Cohen said, but the consequences can be just as serious.
Bed sores, which occur in patients left in one position too long, cause skin to rot away, Cohen said. The attorney said he represents many who have died as a result, having been left with indentations near the tailbone the size of a softball.
"To me, that's the No. 1 problem in nursing homes - bed sores," Cohen said. "It's horrible and the level of pain is incomprehensible. And people live with that level of pain. These are the ones that don't have family."
Meyer Schreiber of the New Jersey Coalition for Nursing Home Reform alleged that reduced Medicaid reimbursements contribute to inadequate staffing, including at assisted living homes.
"The calculus is money," Schreiber said. "The Italian marble is supposed to make the family feel good and to look successful. But there's no real investigative reporting on assisted living facilities."
Langevin, president of the Health Care Association of New Jersey, disagreed.
Of assisted-living apartments, he said, only 12 percent are paid by Medicaid. The rest are private.
"It's a red herring," Langevin said.
As for nursing homes, the U.S. Department of Health and Human Services reported to Congress this year, staffing is inadequate at nine in 10.
Schreiber also contended that regulations in New Jersey are insufficient and that one-year inspections fail to do the job.
Senior facilities often are tipped off to what are supposed to be surprise inspections, Cohen said.
Also, Cohen said, it takes six to eight weeks for investigators to check on a complaint, by which time the problem might have been cleared up.
Isele, however, said the problem is a matter of enforcement, not regulation. With a staff of only 14 investigators, the time lag is inevitable.
Isele insisted that facilities are never tipped off to inspections.
Marilyn Riley, spokeswoman for the state Department of Health and Senior Services, said assisted living oversight has kept up with that of nursing homes.
Although companies can begin construction plans by certifying a need for beds, they must go through considerably more documentation on their intended operations before receiving a license to open.
In Pennsylvania, a grand jury in the Neff case issued a scathing report, saying the state provided infrequent inspections and offered few standards on staff training or resident care.
One inherent problem with assisted living facilities, Isele said, is that some are set up exclusively for Alzheimer's patients or have Alzheimer's units.
While an assisted-living facility can provide proper care for patients with adequate staff training, he said nursing homes tend to be a better setting for those with memory problems.
"I'm concerned that the assisted living concept is not consistent with the level of care needed for individuals in these facilities," Isele said.
Alterra Healthcare Corp.'s Lower Makefield facility is dedicated to Alzheimer's patients.
Cohen said he believes assisted-living facilities often retain patients too long rather than transferring them to nursing homes as their health deteriorates.
Langevin said the allegation is off base. New Jersey requires that 20 percent of assisted-living units be set aside for those needing nursing-home level of care.
The requirement, he said, was enacted to allow seniors to "age in place" rather than deal with the trauma of being transferred.
Rep. Rush Holt, D-Hopewell Township, commissioned a report in 2000 that found that one in six nursing homes in his Central Jersey district had violations where residents suffered harm from neglect, abuse or failure to prevent accidents.
Holt has sponsored a law requiring the posting of certain statistics in nursing homes such as the amount of nursing staff hours but said more reform is needed. He said he is still pushing legislation to provide $1 billion for more nurses and for grants to increase training.
"I think this kind of negligent or even malicious treatment is very rare," Holt said, referring to the Neff case, "but violations of standards in individual instances bed sores, malnutrition is not as uncommon as we would like."
Isele recommends that those seeking to place parents or other loved ones in nursing homes or other facilities check thoroughly.
Visit the unit more than once, including on weekends, where you can be freer to talk to families and employees. Make sure to observe mealtimes and use your sense of smell to check for cleanliness.