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Lawmakers pushed to cut oversight of assisted living facilities

When Sedrek Singleton, a career criminal with a violent past, checked into the Nueva Vida assisted living facility, caretakers at the cluster of cottages in Miami-Dade County never took any precautions to protect other residents.

They never had to.

But then months after moving in, the 30-year-old man flew into a rampage, beating his roommate to death with a brick — nearly tearing off the disabled man's ear — before bolting from his new home.

The brutal assault came just weeks after Florida lawmakers rejected a bill that would have put the burden on owners of assisted living facilities to safeguard people in their homes when accepting residents with criminal histories.

The defeat in 2008 to bring more protections to vulnerable residents was just the beginning.

Powers stripped

Over the next three years, lawmakers rejected other key plans to toughen Florida's assisted living facility law — often at the urging of industry leaders — while stripping away enforcement powers that left residents to fend for themselves in dangerous conditions.

While the number of homes was rising across the state, lawmakers pushed three dozen pieces of legislation since 2007 to cut crucial protections, including targeting the Residents' Bill of Rights.

The changes in Florida's assisted living facility law created even more gaps in a state enforcement system that was already failing to investigate dangerous practices and shut down the worst offenders.

For example:

• Lawmakers said state regulators no longer have to report abuses and deaths to the Legislature, instead allowing them to keep the cases from the public.

• Even as homes were caught breaking the law — including caregivers beating residents, doping them with powerful tranquilizers and locking them in closets — lawmakers rejected a plan to crack down on rogue operators.

• Though abuse cases have risen over five years, lawmakers blocked efforts to heighten checks on bad homes — including inspections every 15 months — saying they were too costly.

• As the state was finding hundreds of people languishing without care, lawmakers stripped the authority of inspectors to call doctors and get them removed — leaving the decision to assisted living facility operators.

The moves to change the state's historic assisted living facility law — one of the oldest in the country — came as abuse and neglect cases were rising in homes across the state.

Anti-regulation push

Led by Florida's largest assisted living facility industry group, a dozen lawmakers in the past five years introduced 36 pieces of legislation to remove regulations.

The effort peaked this year, with legislators pressing 23 bills, including a plan by Sen. Rene Garcia — a powerful Hialeah Republican who chairs the Senate's health committee — to overhaul assisted living facility law.

The 37-year-old lawmaker, whose district includes more than 100 assisted living facilities, pushed to cut back penalties against caretakers and reduce the state's power to close troubled homes.

Garcia said that he was pressing for changes raised by industry leaders who were working with the state's chief regulator: the Agency for Health Care Administration. "This was just the beginning of a long process," he said. "You file a bill. Some things stay, some things don't."

But a Miami Herald investigation found Garcia's proposal would have stripped critical enforcement tools from a state system that has allowed dozens of the worst facilities to stay open.

Ironically, the push to slash regulations started with an effort to bring about reforms.

The gruesome discovery of an 85-year-old man who was ignored by his caregivers in Manatee County as a cancerous tumor engulfed his face prompted Republican Sen. Ronda Storms of Valrico to push the most sweeping changes in the assisted living facility law in a generation.

But her effort to increase inspections, criminal background checks and penalties on bad homes in 2008 was not only defeated but it also backfired, triggering the most intense effort in state history to cut back on oversight.

The lobbyists win

Over the next three years, key lawmakers, with the support of the Florida Assisted Living Association, introduced major legislation to strip away regulations in place since the 1980s.

Months after the Storms bill was rejected, the association named Hugh Gibson — the House sponsor who ended up killing the measure — its legislator of the year.

"It was like a snowball," said Don Hering, former chairman of the state ombudsman council, which opposed many of the industry's proposals. "There was no way we could compete with these people. It's the money and the staying power."

While industry leaders were pouring hundreds of thousands of dollars into the coffers of key lawmakers, the number of new bills to cut state oversight rose every year, records show.

The Legislature gave up its right in 2009 to see what was taking place in the homes. No longer were regulators required to provide lawmakers the number of adverse incidents like deaths and injuries. The law also ended the state's power to bring in medical teams to decide whether residents should be removed from homes failing to provide care, leaving the decision to assisted living facility operators.

Over the next two years, hundreds of residents were found languishing in homes unable to provide for their needs, nearly twice the rate it was before the protection was cut.

In one facility alone, three people died, including an elderly resident who fell 24 times and was hospitalized nine times for head wounds, broken ribs and two fractured hips.

A second resident, 82-year-old Charlene Webb, suffered fatal burns after falling for the fifth time on the floor and urinating on a power strip, causing electrical surges to rip through her.

At no point during the residents' stay at the Volusia County home did caregivers note they were in danger before they died. Karen Lucas, a company spokeswoman, said Emeritus at La Case Grande has since taken steps to resolve the problems, including increasing staff and training.

While lawmakers made changes, another trend was under way that left residents at risk: The Agency for Health Care Administration was slashing investigations of serious incidents — including deaths and abuse — from 99 in 2002 to 11 in 2008.

While the agency was struggling to perform what were once routine duties, it signed off on many of the cuts, saying it supported "streamlining regulation" and reducing paperwork, according to annual reports.

As a struggle emerged between industry groups and elderly advocates, residents were dying at the hands of their caregivers.

At least 70 residents died from causes including starvation, gangrene, scalding burns and overdoses of powerful narcotics. Those are just the known cases: More than 200 others died under questionable circumstances, but records are sealed by state law.

Despite the deaths, lawmakers took another step to remove a key enforcement tool: the automatic shutdown of homes caught repeatedly putting residents in mortal danger.

Bills put on hold

The bid by Garcia, the Hialeah lawmaker, to strip the state's power to revoke the licenses of homes with two or more Class I violations — breaches often found in death cases — was one of the many proposed cuts in the bill he pushed this year.

Championed by industry leaders, the plan called for regulating homes in a "less restrictive way," including allowing the state to cut back on inspections. It also targeted a key protection from the Residents Bill of Rights that allowed residents to report wrongdoing to state authorities without fear of retaliation by assisted living facility owners.

Garcia, who received $8,100 in contributions from the industry, said he didn't favor removing the protections from residents, adding that much of the legislation was started by FALA.

While several bills appeared to be headed for passage this year, at least 16 were put on hold, including Garcia's and most of Hudson's, after a Miami Herald investigation in May chronicled sweeping breakdowns in assisted living facilities — with lawmakers deciding to wait until next year to resurrect the bills.

Miami Herald staff writer Laura Figueroa contributed to this report.

ALF task force

Gov. Rick Scott's Assisted Living Workgroup, which includes 14 appointees from the industry, the Legislature and advocacy groups, will meet today from 1 p.m. until 4 p.m. Beginning in the fall, a panel of state senators will begin drafting broad new legislation, including proposals to ramp up inspections of ALFs, beef up the requirements for administrators and increase penalties for facilities.

ALF task force

Gov. Rick Scott's Assisted Living Workgroup, which includes 14 appointees from the industry, the Legislature and advocacy groups, will meet today from 1 p.m. until 4 p.m. Beginning in the fall, a panel of state senators will begin drafting broad new legislation, including proposals to ramp up inspections of assisted living facilities, beef up the requirements for administrators and increase penalties for facilities that fall short. The twin efforts followed a Herald series that showed state regulators repeatedly caught homes breaking the law — including sometimes deadly abuse and neglect of frail elders — but failed to shut down or even seriously punish the worst offenders.

Lawmakers pushed to cut oversight of assisted living facilities 08/07/11 [Last modified: Sunday, August 7, 2011 9:31pm]
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