Assisted Living, Erratic Regulation

With No Federal Regulation And Limited State Laws, Negligence Cases Are Growing

(CBS)  Dennis Camarata lost his father in a way no child could imagine.

At age 83, Mike Camarata was healthy and active — but dementia had turned him almost childlike. So his family placed him in an assisted-living facility in Michigan because it would feel more like home, CBS News chief investigative correspondent Armen Keteyian reports.

"They encouraged you to wander around," says daughter-in-law Mary Camarata. "He would go in the refrigerator and drink orange juice out of the jug."

In April 2004, Mike Camarata drank from a jug he found in an unlocked kitchen cabinet. But he wasn't drinking juice — it was a toxic, industrial dishwashing detergent containing lye.

"The chemical just literally burned his entire mouth and then burned him all the way down," says Dennis.

Four days later, Mike Camarata died what Dennis calls "a horrific death."

So how could a toxic chemical be stored, unlocked, in an Alzheimer's wing? One reason: Unlike nursing homes, the nation's 36,000 assisted living facilities — places designed for seniors who don't need constant medical attention, just a little extra help — are not subject to any kind of federal regulation. A CBS News investigation has found that state laws are literally all over the map.

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Read Armen Keteyian's Reporter's Notebook
Elder Abuse Resources

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For example, only 32 states require CPR and first aid certification. Just 24 require a nurse on staff, and Alabama is the only state in which the medical director must be a doctor.

"No real policies. No real sanctions. No accountability," says
Jules Olsman, an elder-care attorney.

And no way, say elder-care experts and industry insiders, to track what they say are a growing number of negligence cases.

In Pennsylvania, 69-year-old Angelita Torres was an Alzheimer's patient who wandered away from an assisted living facility. She was found drowned in a nearby canal.

In Georgia, 70-year-old Ann Wideman should have been moved from assisted living to a nursing home after she became bedridden. Instead, the facility kept her; she developed a massive bedsores and died from the infection.

"They knew and they didn't do anything about it," says Toni Godfrey, her daughter. "They let her die."

In Michigan, where Mike Camarata died, facilities outnumber inspectors 100-to-1. There is no requirement that staff members for Alzheimer's residents receive any special training. As for regular caregivers, they must be "awake and fully dressed."

Keteyian asked Marianne Udow, the woman in charge of assisted living in Michigan, who writes the laws that basically say "awake and fully dressed" is enough in some people's mind to provide resident care.

"Those are probably old regulations," she says. When told that they date from March 2006, she adds that the laws "probably been in place for many, many years and have not been updated."

When asked if families know what the quality or lack of quality of some of the care is in the state's assisted living facilities at the moment, she says, "I think they don't."

After Mike Camarata's senseless death, the state's only response was a letter, asking the facility if a "corrective active plan" was implemented.

"So you're father's death boils down to a 'don't do this again' memo?" Keteyian asks.

"Pretty sad, isn't it," says Dennis Camarata.

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Correction: This story was updated Nov. 14, 2006, to reflect new information from the state of Minnesota. Minnesota recently implemented laws specific to assisted living that include background checks for all staffers and a nurse on-call at all times; last week the state confirmed to CBS News it had no staff requirements.

[mlhunt]

The problem I have with ALFs is that they accept people who need far more help than they are prepared or equipped to provide. Most of the ads and websites for ALFs show people who are able to get around easily by themselves and just need some help with housework and other simple assistance. But many ALFs are now claiming to have "specialized memory care units" designed for people with Alzheimer's. When ALFs start taking in people with advanced dementia and other complicated medical issues, they are dealing with situations that would be better handled in a nursing home. The results are the types of tragedies documented in this story, as well as in articles that have appeared in the Washington Post, USA Today and many other publications. It is not at all unusual for patients to suffer fatalities in ALFs, but the facilities seldom face serious consequences. They need the same regulations as the nursing homes.

[ap646668]

The death of the gentleman is inexcusable. Chemicals should always be under lock.

As a nursing home administrator with over 20 yrs of experience, I would pose the following question. Where are the families? The only good I see coming from the lopsided report, is to encourage families to do some research before placing a loved in any tpye of living facility. My wife is the administrator of an ALF. Just last week she was offered 2x the going rate if she would take back a resident (dementia)that she had to discharge because the ALF could not meet her needs nor provide a safe environment.

Having operated 5 LTC centers and filled 10 interim positions, I observed that the best care was always provided by the facilities that had the most interaction with the families. As a former educator, I can make the same observation. In most cases, parental involvement resulted in a better learning environment.

The whole concept of involvement is called teamwork.

Unfortunately we spend more time shopping for a new car than we do for healthcare for a loved one or daycare for our children. Care and safety should take presedence over location and convenience. Thank you. Augie Pepple

[hehobson]

As the President and CEO of Plymouth Harbor, CCRC,in Sarasota, FL who has spent the past 26 years at assisted living and nursing homes in Ohio, Virginia and Florida and exposed to over 100 other's nationwide, I found this story to be unbalanced, sensationalisitic, yet sufficient to create further anxiety among not only those who currently reside in assisted living facilities and nursing home; but, those who are planning a move for either themselves or a loved one.

My question is what was left on the "editing room floor" as programs such as this one are produced and edited. Witnessing the loving care of a nurse, aide or visitor is also important. Observing the way we preserve the dignity of those who need us most is important and newsworthy.

Katie, et al, you owe it to the public to show the balance that you know exists.

We welcome you to Sarasota to spend not just a few minutes, but perhaps a few days to view our care at Plymouth Harbor which I believe is more representative of long-term care. Send someone in undercover, but if you do a story ("60 min. style") may I have an opportunity to sit in on the editing session to make sure what you show has balance?

Respectfully,

Harry Hobson

[tomm9050]

What "OTHER SIDE OF THE STORY" is there here? The ALF was negligent and lax and a person who was entrusted to their care, died! Or more correctly; was killed.

The fault is entirely with the facility. What would the other side of the story be? Mr. Camarata should have known better? Those here defending and shilling for the ALF industry, should be ashamed.

[thkh95]

Maybe CBS should look beyond one or two states and one or two ALFs. 1000's of ALFs throught all 50 states provide excellent, loving, care to the nation's senior citizens. But I guess CBS would not have a story to air if it was about a 84 year old lady that lived in a house alone, had few visitors, ate one meal a day, mismanaged her medications and then made a life changing decision to move to an ALF where she got loving, nurturing care from mission driven people. She ate three delicious, well-balanced meals a day and took her medications with the help of loving staff. And this lady, turned around and became the social butterfly that started up a bridge club and coffee group in the cafe every morning. This 84 year old lady now has a dignified, social, healthier, dignified, improved quality of life, but I guess that would be a story worth airing on a national news show, now would it?

[thkh95]

Okay - let's federally regulate assisted living, because federally regulating nursing homes have improved them greatly, right? I don't believe so, no, the increased regulations, the increased paperwork, the increased liability, the increase fines, the increase requirement, and the decreased reimbursement have left nursing homes in shambles. Now let's run the ALF's down the same road, because we proven oh so well that federal regulation works!

[cab555-2009]

I believe the most significant issue here is that CBS news chose to present a story as complete fact, obviously failing to report both sides accurately. This is such a disappointment; much like reading a tabloid. I will have trouble believing CBS news in the future.
Three tragic stories were told, but we know that those are anomalies, not the norm. The assisted living industry is state-regulated, not a bad thing. They are not nursing homes, they do not need physician leadership, nor RN's on duty. If people need daily RN assessment, they should be in skilled nursing facilities, not assisted living. ACF's provide help with dressing, bathing, meals, housekeeping, laundry, medication administration and activities. A safe place to be when they can no longer be safe at home. And living with families is not always optimal. They are sometimes left alone frequently, and family dynamics often prove stressful for everyone.
Every industry has good and bad, in ours it is certainly the good that prevails. Your news story was more like a tabloid story, with sensationalism and catch phrases like, "Assisted living business, risky business?" Oh, dear.
Would you please consider doing the story again, but with a more equal content?

[ced15]

As a employee of the assisted living community in Milwaukee for over 15 years, I have witnessed unfortunate incidents. But, to say that an ALF is not regulated is incorrect. The DHFS in Wisconsin has set rules and regulations which must be followed to ensure proper care and resident safety. Caregivers are screened, have background checks run with the State and must complete several training courses in order to complete resident care and maintain employment. This also includes continuing education on a monthly basis during their employment. Surveyors from the BQA do visit, and they do cite when problems are found.

What CBS has showed is the worst that could happen. To assume that all facilites provide this type of care to their residents is wrong.
I have been employed over the years for several companies and have worked side by side with incredible caregivers, nurses, and other providers who ensure that their residents are given the love, dignity, and respect that they deserve.

How about airing a follow up story showing the other side of the coin? You will without a doubt find thousands of families and residents who are extremely happy with the care that they recieve.

[griffinj3]

The story is beyond sad and my heart goes out to the families affected.

However, I do not understand the neglectful way the media presented the story. It almost came across that ALL assisted living facilities were amoral in the care they provide their residents.

In the state of Florida, the state regulations are written for the protection of the residents. I believe that every possibility is covered. Let me assure you when a state survey is performed they do not cut anyone any slack for any infraction and you are not simply slapped on the wrist. Providers know that they are held to high standards and if they cannot live up to those standards they should not enter the assisted living arena and if they do, they won't last long unless their standards meet the state requirements.

There may be states that do not require high standards and that is wrong. But please do homework and give credit to the states that are striving to meet the needs of our true assets - our elderly.

[tomm9050]

Bravo CBS! This is an important story that needs to be told! It mirrors our experience with an ALF precisely. Although there may be a lot of well intentioned and sincere individual caregivers, this has become a corporate business, more concerned with the "bottom line" than the actual well being of the elderly and infirm. A business preying on those least able to defend themselves and on the guilt of family members overwhelmed by the demands of an aging spouse or parent. There was NOTHING in this report that was untrue or one sided, although it was curious that the facility refused to participate. This industry needs to be investigated and more thouroughly regulated! What they do borders on criminality.

[moneysmith]

The CBS Evening News team has done a real service to families by providing a very accurate picture of the serious shortcomings in ALFs, something I have been trying to do with a blog for the past few months (http://parenttraps.blogspot.com). I started the blog because the experiences my sister and I had when our father, an 88-year-old disabled World War II veteran with Alzheimer's disease, moved into an ALF in Buchanan, Michigan. The ALF's website and brochure portrayed what appeared to be a spa-like environment, and touted employees specially trained to deal with Alzheimer's patients. After a few months, it became clear that none of this was true. When my sister and I questioned some of their practices, including medication errors and staff incompetence, the manager issued a 24-hour emergency discharge, even after we had agreed to a $1,000 increase in monthly fees. In dealing with the state agencies, we discovered that we had no options or recourses. Furthermore, no one in the agencies that we reported these events to really seemed very interested or concerned. America's senior citizens deserve so much better than this. The irony is that many of the Baby Boomers are going to be ready for ALFs before too much longer. After our ALF experience -- and believe me, we are far from alone -- I think I'd prefer to go straight to a nursing home. At least they have standards to live up to and there are consequences when they don't.

[moneysmith]

The CBS Evening News team has done a real service to families by providing a very accurate picture of the serious shortcomings in ALFs, something I have been trying to do with a blog for the past few months (http://parenttraps.blogspot.com). I started the blog because the experiences my sister and I had when our father, an 88-year-old disabled World War II veteran with Alzheimer's disease, moved into an ALF in Buchanan, Michigan. The ALF's website and brochure portrayed what appeared to be a spa-like environment, and touted employees specially trained to deal with Alzheimer's patients. After a few months, it became clear that none of this was true. When my sister and I questioned some of their practices, including medication errors and staff incompetence, the manager issued a 24-hour emergency discharge, even after we had agreed to a $1,000 increase in monthly fees. In dealing with the state agencies, we discovered that we had no options or recourses. Furthermore, no one in the agencies that we reported these events to really seemed very interested or concerned. America's senior citizens deserve so much better than this. The irony is that many of the Baby Boomers are going to be ready for ALFs before too much longer. After our ALF experience -- and believe me, we are far from alone -- I think I'd prefer to go straight to a nursing home. At least they have standards to live up to and there are consequences when they don't.

[kathypete-2009]

I am from Massachusetts & take great umbridge,re:your Assisted Living piece Monday evening with Katie Couric. We in this state have very set in stone regulations regarding our Assisted Living legislation. We, as Directors, Resident Care Directors and All staff members work tirelessly to promote the well-being and independence of our residents. Our regulations mandate that we be certified & regulated in such a manner as to not-portray-what you had a nation watch Monday eveningWhat a one sided story!!!! If you could only see our written regulations & our adherence to those policies. We work long, hard hours to meet the goals of our residents & do so with the greatest of PRIDE & JOY. We work along with residents and families to ensure that our residents are in the right place & at the right time. Should they need more care than our industry warrants, we meet with both parties to ensure their well-being is met in a timely fashion.-- I've always looked up to Katie Couric as one who is fair & reports in a positive manner-However this one you blew Katie{along with your producers} I shall re-think long and hard about your ability to convey an important message in the proper manner-that which all facts are presented. CBS needs to do their homework regarding the Assisted Living Industry in the USA- not just a few states-that, sad to say-dealt the rest of us a low blow. WE deserve more than that piece--SHAME SHAME.

[sternthalw]

In response to your report "Aging in the Shadows", it was clearly a one-sided and barely investigated report. I am the Director of Assisted Living in a wonderful facility in West Virginia. After seven years, we have been found to be deficiency free each and every year by the state surveyors.

Although, I feel very badly about the outcome of the three residents in the report and do hold the facilities to a higher degree of liability, these three people had no business being in an assisted living facility. At no time, have I ever brought a resident in because I had an apartment to fill or kept a resident because there was no one on the wait list.

Your "investigative" report has frightened families and may cause many to keep their loved ones at home longer. Caretakers of dementia residents are often burned-out by the constant care demands and some may abuse out of frustration. Your report was one-sided and you owe those of us who do a great job a voice. The public would have been better served if they were given some information about how to make the best decision for appropriate placement of their loved one.

[nelaj-2009]

As a employee of an ALF, alot of the things reported do not surprise me. As soon as my employer heard about this story they instantly went into damage control mode, hoping thaq our already struggling community/residents didn't see or here about this story! The company I work for have been in business for 25 yrs, run more than 400 communities and service 43,000 residents worldwide. They should have known better than to let something like this happen to Mr. Camarata, then the only thing the company could do is have an in-service on new locks! I know that there are excellent ALF in the world, but the State of MI should regulating theirs more carefully. Although the company I work for claim that "they staff each of their communities to meet and often exceed the needs of it's resident population in compliance with state regulations" our community is often under staffed. Management rarely offers a helping hand. They do often make the staff who is already hard working and under payed feel inferior. Of course such things as call-ins, and emergencies will happen, but what do they do to supplement staff? Nothing! They often hire employees that are there only for a paychck and could care less about the care the residents receive. I agree with several of the comments made, require more certification of your employees, make them feel they count, and stop worrying about your profits. You claim that resident care is priority #1, then put your money where your mouth is!

[nelaj-2009]

As a employee of an ALF, alot of the things reported do not surprise me. As soon as my employer heard about this story they instantly went into damage control mode, hoping thaq our already struggling community/residents didn't see or here about this story! The company I work for have been in business for 25 yrs, run more than 400 communities and service 43,000 residents worldwide. They should have known better than to let something like this happen to Mr. Camarata, then the only thing the company could do is have an in-service on new locks! I know that there are excellent ALF in the world, but the State of MI should regulating theirs more carefully. Although the company I work for claim that "they staff each of their communities to meet and often exceed the needs of it's resident population in compliance with state regulations" our community is often under staffed. Management rarely offers a helping hand. They do often make the staff who is already hard working and under payed feel inferior. Of course such things as call-ins, and emergencies will happen, but what do they do to supplement staff? Nothing! They often hire employees that are there only for a paychck and could care less about the care the residents receive. I agree with several of the comments made, require more certification of your employees, make them feel they count, and stop worrying about your profits. You claim that resident care is priority #1, then put your money where your mouth is!

[nelaj-2009]

As a employee of an ALF, alot of the things reported do not surprise me. As soon as my employer heard about this story they instantly went into damage control mode, hoping thaq our already struggling community/residents didn't see or here about this story! The company I work for have been in business for 25 yrs, run more than 400 communities and service 43,000 residents worldwide. They should have known better than to let something like this happen to Mr. Camarata, then the only thing the company could do is have an in-service on new locks! I know that there are excellent ALF in the world, but the State of MI should regulating theirs more carefully. Although the company I work for claim that "they staff each of their communities to meet and often exceed the needs of it's resident population in compliance with state regulations" our community is often under staffed. Management rarely offers a helping hand. They do often make the staff who is already hard working and under payed feel inferior. Of course such things as call-ins, and emergencies will happen, but what do they do to supplement staff? Nothing! They often hire employees that are there only for a paychck and could care less about the care the residents receive. I agree with several of the comments made, require more certification of your employees, make them feel they count, and stop worrying about your profits. You claim that resident care is priority #1, then put your money where your mouth is!

[smithsma]

thank you for your report on assisted living. there is no excuse that regulations are not forced on these facilities nationwide. would anyone place their child in a facility with such sub-standard regulations. now it is our parents that become our children and every effort should be made to give them the same protection and safe environment given to children attending school. This is a big money maker for those involved; unfortunately they choose to have huge profits rather than paying for superior staff. I know there are very good facilities and wonderful staff at many facilities however, the trend seems to be going in the wrong direction. Everyone better wake up because it may soon be our turn to become assisted living residents.

[freebirdtu]

My mother began showing signs of "dementia" within a week of being prescribed medication - hallucinating, disorientation, confusion, apathy, extreme drowsiness, inability to eat, etc. When she was admitted to the emergency room, it was found that she was experiencing toxicity brought about by digoxin, her blood was far too thin from the warfarin, and that interfered with her insulin. Statistically, these three drugs are the most common causes for emergency room visits.

The doctor who prescribed the meds insisted her "dementia" was progressive, suggesting we "trick" her into going to a nursing home(he actually winked when he said this)and he recommended a home in which I know he has established a very lucrative practice.

How many doctors like him are out there, preying on the elderly by prescribing medication that makes them appear "demented"? How many nursing home residents are simply overmedicated by geriatric practitioners and how many families believe these doctors?

It is a scene that is played out daily in doctors' offices across the country. As the boomer generation moves into their golden years, the time has come to subject the standards and practices of geriatric medicine to closer scrutiny. And to bring it to the attention of the general public.

[floridaadmin]

I found your report on "Aging in the Shadows" to be very disappointing and one sided. As an ALF Administrator in the State of Florida I can tell you that the industry is regulated. The state of Florida "Agency for Health Care Administration" (AHCA) is one of several regulatory agencies providing oversight to the hospital, nursing home and assisted living industry. Employees of Florida ALF communities must undergo background checks, health screenings and are required to attend specific training courses. The call for federal regulation is not the answer to abuse and neglect. As a point of interest, I recall a special that aired on a news program reporting the appalling conditions, abuse and neglect in many of the Veterans Hospitals throughout the country; this is your federal government at work. If you are interested in the efficiency of federal regulation I suggest that you research further. There is another side to this story that should be reported. Did you look at your own article today...abuse, neglect and victimization of the elderly is most prominent in the home environment and at the hand of ones own family! As someone who genuinely cares about the residents of my community and is committed to their safety and happiness, your report was a slap in the face. Abuse and neglect of the elderly is a very real and serious problem that must be addressed, but to attack the assisted living industry is irresponsible at best!