WASHINGTON — It was an early morning awakening that Alfredo Navas said he'll never forget: His sister on the phone, telling him that their 85-year-old mother had drowned in a shallow drainage pond behind the facility that was caring for her.
But the safeguards his family had assumed were in place to monitor an elderly woman with dementia — cameras, door locks and vigilant caretakers — failed his mother in 2008, Navas told the Senate's Special Committee on Aging on Wednesday.
Those abuses and others were chronicled in a Miami Herald series "Neglected to Death," which focused this spring on critical breakdowns in Florida's enforcement system, including failures by the state's Agency on Health Care Administration to fully investigate deaths or to shut down some of the worst offenders among Florida's 2,850 assisted-living facilities.
"This is America in the year 2011, and these kind of things shouldn't be happening," said Sen. Bill Nelson, D-Fla., who read aloud of the worst examples of abuse Wednesday.
They include a 75-year-old Alzheimer's patient in Clearwater torn apart by an alligator after he wandered away from his assisted-living facility for the fourth time; a 71-year-old mentally ill Hialeah man who died from burns after he was left in a bathtub filled with scalding water; and a 74-year-old Kendall woman who was restrained for six hours until the bindings cut into her skin and killed her.
Federal regulators and lawmakers both said Wednesday that they're uninterested in the federal government being responsible for regulating living facilities. Although more states are using Medicaid money to pay for some portion of assisted living care for the poor, the federal government has a limited role in the facilities their oversight has been and will likely continue to be a state duty.
But federal regulators do want more of an ability to ensure states are doing their part to enforce laws and safety regulations already on the books, said Barbara Edwards, who directs the disabled and elderly health programs group at the Centers for Medicare and Medicaid Services at the Department of Health and Human Services.
"We don't have a lot of sanctions available," Edwards said, adding that it's not practical to invoke what she called the "nuclear option" of holding up all state Medicaid funding when there are problems with assisted-living facilities. "We'd like to have additional sanctions when states are not aggressively pursuing corrective action."
Shortly after The Miami Herald series appeared, the agency's civil rights office forwarded it to her office, Edwards said. Her office demanded answers of state regulators.
"We talked with high-level state officials within a couple of days of those articles to ask for more detail about what the state was doing to respond to those situations," Edwards said. "The state did report back to us on their activities to respond. We actually view this as still an open issue with the state and are continuing to gather information."
She said federal regulators believe the state is taking "responsive action" to investigate and review its own policies — exactly the sort of response they want.
"We continue to monitor what the state is doing and continue to offer assistance, but also to encourage the state to be assertive and aggressive in its efforts to ensure that its systems are adequate," she said.
There are some concerns that as the state considers Medicaid reform, it could shift more people into community residential programs, said Larry Polivka with the Claude Pepper Center at Florida State University. Polivka also heads a working group examining the regulation and oversight of assisted-living facilities in Florida in the wake of The Miami Herald series.
The working group worries that assisted-living facilities could become "sloppy, less expensive nursing homes" with sloppy, less-expensive regulations, he said.
"We have to keep a close eye on that possibility," he said.
Among those with concerns about who will be monitoring assisted-living facilities is the corps of volunteer ombudsmen. Earlier this year, state lawmakers wanted to do away with their key mission: performing yearly inspections of nursing homes and assisted living facilities. That move came even as its corps of trained volunteers was turning up a record number of abuse and neglect cases in assisted-living facilities across the state.
As baby boomers age, assisted-living facilities are expected only to grow as an option for people who are too frail to live on their own, but who don't require the intense care provided by more heavily regulated — and more expensive — nursing homes.
"All Americans — no matter which state they live in — should have the tools that they need to make the right choice," Nelson said.
But disclosure isn't the only solution, Nelson said, and problems aren't limited to Florida. California requires inspections only every five years, he noted. In Texas, there is no schedule — only when inspections are deemed necessary.
"When something goes wrong, folks need to know that their complaints will be heard, and that someone will be held accountable," he said.
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