Investigation Uncovers Fatal Care Issues at Assisted Living Facilities
Deaths that result from poor care at assisted living facilities in San Diego often go unreported and care providers largely are not disciplined for such incidences, according to an investigation by U-T San Diego and the California HealthCare Foundation's Center for Health Reporting, U-T San Diego reports.
The center is supported by a grant from CHCF, which publishes California Healthline.
Background on Assisted Living in San Diego
There are about 14,500 residents living in 640 residential care facilities for the elderly, or RCFEs, in San Diego.
The facilities offer assistance with:
- Eating; and
They also offer services for those with dementia or who need hospice care (Schoch et al., U-T San Diego, 9/7).
Residents can pay $3,000 or more each month for room and board (McDonald, U-T San Diego, 9/8).
California is one of two states where RCFEs are not overseen by the health department. The state Department of Social Services oversees such facilities in California.
According to DSS data, the number of licensed RCFEs nearly doubled in the past two decades, from 4,075 in 1990 to 7,695 in 2012. Most are for-profit businesses.
David Kyllo -- executive director of the National Center for Assisted Living -- said the average age of assisted living residents is 87 years old, compared to an average of 83 years old in 1998.
Details of Investigation
During a six-month investigation, reporters reviewed documents from:
- The county medical examiner;
- Court cases; and
- A local consumer group.
According to the investigation, state law requires RCFEs to undergo an inspection once every five years, but DSS said it is changing the requirement to once every 30 months. The maximum fine when an RCFE resident dies as a result of poor care is $150, compared with a $100,000 fine for a similar death at a nursing home.
The investigation found that since 2008, 27 elderly residents in San Diego County assisted living facilities died from injuries and neglect.
In some of the cases, DSS never investigated or penalized the facilities. In addition, the cases never were made public by regulators or law enforcement.
DSS investigated 18 deaths that it deemed preventable. The maximum fine was levied on caregivers in 12 of the cases, which took place at various facilities, such as:
- Wesley Palms in San Diego;
- Merrill Gardens in Oceanside; and
- Mission Home IV in San Diego.
However, state regulators have said they are not able to determine if more seniors' deaths could have been prevented because they use an antiquated computer system that cannot track such deaths.
In addition, at least 196 deaths in such facilities were reviewed by the county medical examiner, who is not required to report findings to DSS.
Investigators also found that the number of complaints about poor care at RCFEs increased by 13% in the past five years to nearly 3,000. Meanwhile, the number of penalties against such facilities fell by 30% during that time period to 6,787.
Pat Leary -- senior deputy director of DSS -- said safety in RCFEs is "an area of great concern" that the department takes "very seriously."
Leary said the agency's regulatory actions "have more of an economic impact" and are more of a deterrent against poor care than the $150 penalties. Currently, four San Diego County assisted living facilities are on probation, including:
- Brookdale Place in San Marcos;
- Country Gardens in Fallbrook;
- Cabanas Adult Care Home in San Diego; and
- Cabanas Care Home in Oceanside.
Eric Carlson -- an attorney with the National Senior Citizens Law Center and president of the Assisted Living Consumer Alliance -- said that "training standards are deplorable" at assisted living facilities, noting that workers only have to complete 10 hours of initial training to care for residents (Schoch et al., U-T San Diego, 9/7).
Alleged Bribery at RCFEs
The investigation also found several cases in which DSS workers took bribes from the operators of assisted-living facilities to expedite applications or give position inspections.
In 2010, the owner of Ambassador Senior Retreat in Mira Mesa admitted to paying a state investigator $2,800 not to document problems at the facility.
The case exposed "the first glimpse of what may have been a widening extortion racket," according to U-T San Diego (McDonald, U-T San Diego, 9/8).
Advocacy Group Details
In related news, a not-for-profit group has posted records online for nearly all of the 640 licensed RCFEs in San Diego County.
Chris Murphy and Chrisy Selder founded Consumer Advocates for RCFE Reform after working at or having loved ones cared for in such facilities.
The state does not post records for RCFEs online, so the group scans copies of the reports and posts them online.
Murphy said the group is "doing what the state should be doing" (Schoch, U-T San Diego, 9/7).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.