Acknowledging these difficulties, some assisted living operators have elected to evade some of the laws by morphing their facilities into something new and different--- and not subject to the regulations applicable to them.

One of the largest operators of assisted living facilities, Assisted Living Concepts, has grabbed news headlines when they announced that they were going to reorganize some of the assisted living facilities that they operate in Iowa and begin to operate them as 'senior housing communities' where they simply own the building, but utilize the services of a different company to provide health care services to the residents.

On the surface, the change in operating procedure may seem like little more than a corporate shakeup, but a closer look quickly reveals the real intention behind the change is to evade the pesky regulation applicable to the the operation of an assisted living facility. 

Turns out, despite its massive operation, Assisted Living Concepts wasn't so good at safely operating their facilities.  At its Dubuque facility, Iowa officials found numerous problems including:

• Poorly formed care plans
• Unreported resident injuries
• Medication errors
• Staff that were inadequately trained to care for patients
• Neglect

All told, the (former) assisted living facility was fined more than $65,000 for its violations. 

Recognizing this legal loophole, the Iowa legislature has drafted legislation that attempts to hold facilities-- regardless of their title-- responsible for their care of their residents.  

As we begin to see the proliferation of alternative type senior housing arrangments, it is crucial that legislatures take a proactive approach to the regulation of the facilitiles that operate under misleading titles.  Let's see if other states have the foresight to identify this developing issue in the senior care industry.

Related:

Who Needs To Abide By Regulations? All Troubled Assisted Living Facilities Need To Do Is Re-Organize In Order To Avoid Compliance With Safety Laws

Dubuque facility headed to court over fines, Des Moines Register by Clark Kaufman, June 11, 2011

Another Iowa Assisted Living Facility Chooses To Abandon Its License

Pesky Government Regulations No Problem For Assisted Living Facility In Iowa

But what happens when the care at the facility is just plain bad?

Well... unfortunately, the decision may result in harm to both spouses as evidenced by a lawsuit filed on behalf of a husband and wife who sought the services of a residential care facility for the elderly in California.  

The daughter of Patricia and Robert Blakeslee has filed an elder abuse lawsuit against the owners of Woodlake Senior Care following poor care at the facility that allegedly resulted in the death of her father and loss of her mother's leg. 

The lawsuit claims that the senior care facilities poor care and unsanitary living conditions resulted in a rapid deterioration of her parents. The facility was further negligent in the manner they handled the development of the apparent injuries due to their delay in seeking medical care for the couple while they suffered from visible conditions such as advanced pressure sores on her legs and buttocks.

While this matter may proceed to trial, there is a possibility that this matter will be resolved prior to the swearing in of a jury.

Certainly, situations where husband and wife choose to remain in each others company as long as feasible, it is incumbent upon facilities to properly assess each partner individually to determine if the facility is indeed capable of caring for both partners.  By accepting the couple together, their is an implicit understanding that the facility can care for both people as if each were on their own.

Particularly, in the case of alternative care facilities such as: group homes, residential care facilities for the elderly or assisted living facilities, it is crucial that the facility explain exactly what type of care they can--- and can not provide.  

All too frequently, I see long-term care facilities eagerly accept an elderly couple where one partner has significantly more needs than the other--- to appease the couple and to obtain maximum occupancy.  Nonetheless, when the care provided is insufficient or neglectful, as evidenced by this case, we can see the troubles that follow.

As we follow the civil portion of this elder abuse lawsuit, the owners of this residential care facility have been already been stripped of their license by the California Department of Social Services with respect to Woodlake Terrace as well as any other facility like it.

Related:

Woodlake senior's death leads to suit, by Reggie Ellis, The foothills Sun-Gazette, 5/25/11

Are seniors in residential care facilities and other alternative living arrangements at risk for developing bedsores?

Recent Problems Highlighted In Article About Residential Care Facilities For The Elderly In California

Now That We Rate Nursing Homes, Is It Time To Rate Other Adult-Care Facilities?

Are Group Homes A Viable Alternative To Nursing Homes?

Depending on where you live, some of these facilities may be know as group homes or residential care facilities for the elderly (RCFE).  They are simply not called skilled nursing facilities, because they do not offer any nursing or medical care to patients.

Certainly in some circumstances, these nursing home alternatives can offer a tremendous opportunity for elderly people who may not require the level of care provided in nursing homes.  However, despite the differences between nursing homes and RCFE's on paper, I am beginning to see more and more instances where these alternative care facilities providing inferior care in the following circumstances:

• Admitting patients who require more care than they can provide
• Neglecting patients
• Failing to obtain medical care for patients who are sick or have a medical condition that is significantly deteriorated

I recently saw an article in the Visalia Times-Delta, that highlighted some of of the problems encountered at two RCFE's in California. 

Woodlake Senior Care

The owners of Woodlake Senior Care had their residential care license stripped by the California Department of Social Services following an investigation that determined the operators of the small facility severely neglected the residents they were caring for.  On at least three occasions the owners of Wooklake allegedly failed to transfer residents to facilities where they could obtain necessary skilled nursing care.

While investigating the care provided to the three residents, the facility failed to notify any people outside of the facility that residents had developed advanced decubitus ulcers that had become infected and had progressed to the point that underlying tissue and bones were exposed.

Rainbow Gardens

The Visalia Times-Delta reported how similar violations were discovered at Rainbow Gardens, another residential care facility for the elderly, when the facility failed to meet take basic care precautions such as:

• Maintaining doctors orders for patients
• Keeping the facility clean
• Ensuring that there was adequate food at the facility

Lack of Regulation For Residential Care Facilities For The Elderly

Like other states, RCFE are subject to the same regulations that foster homes and child-care facilities are-- not the more stringent nursing home inspections.   In California, this means that residential care facilities for the elderly only get inspected once every five years!

As a lawyer who has worked on cases involving elder abuse and injury in alternative care settings, I strongly encourage lawmakers to reevaluate cost cutting measures that really endanger elders.  I would also add, that many of the people living in these facilities are particularly-- or completely isolated from the outside world-- thereby making such inspections of their living conditions even more critical than likely envisioned.

Related:

Are seniors in residential care facilities and other alternative living arrangements at risk for developing bedsores?

Now That We Rate Nursing Homes, Is It Time To Rate Other Adult-Care Facilities?

Elder Abuse: Captured On Video At California Facility

Nursing Home Injury Laws: California

Officials from the North Carolina Department of Health have confirmed that unsafe diabetes care practiced by staff at Glen Care of Mount Olive was to blame the patients deaths.  It was estimated that needles used to test patients’ blood sugar levels were reused by staff at the facility, which resulted in the hepatitis outbreak.  Further, none of the staff involved in the incidents had taken any training course related to infection control.  Nor, were there any regulations requiring them to do so.

Unlike nursing homes, where laws generally specify who may administer drugs, at assisted living facilities and other types of non-traditional senior living arrangements, few laws address how drugs are to be administered to patients.

In fact, assisted living facilities (and other types of residential care facilities for the elderly) are not permitted to render any type of medical care.  Rather, when and if a patient requires medical attention it is the duty of the facility to either relocate the individual or seek outside medical care.

As evidenced by the situation in North Carolina, some assisted living facilities are squirming around regulations restricting medical care, by asserting that the administration of medications to patients is not ‘medical care’.  Because assisted living facilities aren't medical facilities and thus cannot employ nurses or other formally trained medical staff, some facilities have implemented the use of medication aides.

After obvious lapses in basis sanitation, North Carolina legislators are now introducing legislation that would impose stricter training and higher performance standards for medication aids and others who provide medication to people in assisted living facilities.  The bill introduced by Representative Jennifer Weiss would impose requirements such as: 

• Competency requirements for adult care medication aides
• Specialized infection control guidelines
• Authorize state human services inspectors to review assisted living facilities on an annual basis or needed to insure the requirements are met
• All new employees of assisted living facilities would be required to take an infection control class beginning in 2013

The Growth of Assisted Living Faculties Needs to Be Accompanied By Regulation

As the cost of long-term care continues to climb, assisted living facilities, group homes and residential care facilities for the elderly have become increasingly popular as less costly alternatives to nursing homes.  While many of these facilities do provide emotional support and assistance with daily living needs, other facilities need to be reminded of their limits with respect to providing medical care for people.

As we see by the situation at this North Carolina assisted living facility, even relatively basic medical care does require specialized training of staff.  Hopefully, the new legislation will take hold to protect these particularly vulnerable people and will draw attention importance of intensified regulation of these living arrangements.

Related:

Dirty Needles May Be Cause Of Hepatitis B Outbreak In Nursing Home

Investigation Determines Serious Safety Violations At Sunrise Assisted Living Facilities That Threaten Patient Safety

Are Group Homes A Viable Alternative To Nursing Homes?

Are seniors in residential care facilities and other alternative living arrangements at risk for developing bedsores?

The Chicago Tribune recently had an insightful article, "Memo: Ill knew of group home abuses before death" highlighting the recent death of McCann who apparently died from injuries he sustained when he was assaulted by two staff members at a group home operated by Graywood Foundation in January.  

Unknown to McCann's family, the facility had been cited for similar abuse of residents by various staff members months before McCann's death.

Despite the fact that the Illinois Department of Human Services, the agency responsible for regulating group home, actually found the conditions to to so heinous that they blocked the facility from accepting new residents.  A 2009 memo prepared after an investigation at Graywood by the Illinois Department of Human Services Office of Inspector General further concluded that:

• The facility was obstructing investigations
• Had substantially higher rates of substantiated complaints related to abuse
• Fostered an environment of no employee accountability

Even after documented concerns regarding patient safety were filed with the state, no warnings were communicated to other residents or their families---simply because such disclosure is not mandated by the state. Which in turn, highlights the lack of applicable legislation to disclose information about group homes in Illinois.

Praised by some as an alternative to institutional settings, Illinois groups homes house and residential care facilities for the elderly (RCFE) care for more than 9,300 mentally and physically disabled people across the state.  Though many facilities indeed provide a tremendous opportunity for disabled people to live with an sense of pride in a supportive arrangement, we certainly need to re-evaluate the need more intensive inspection and regulation of this expanding living arrangement.

Related Nursing Homes Abuse Blog Entries:

Abusive Events In Adult Homes Go Unreported & Unprosecuted

Is This An Attempt To 'Control' A Patient? Or Is This Simply Another Attempt To Cover Up Abuse In A Group Home?

Thankfully, We Now Have Many Laws To Protect The Elderly From Abuse In A Variety Of Settings. However, Laws Are Worthless, If The People For Whom They Are Intended To Help Are Unaware Of Them

Group Homes Plagued By Patterns Of Abuse & Lack Of Employee Accountability

Of the more than 13,000 cases of alleged abuse reported in 2009, less than 5% of the cases were transferred to law enforcement for follow-up.  Just a handful of the cases reported to law enforcement resulted in criminal prosecutions or employee discipline.

Rather, a strong group home employee union consistently opposed any abuse charges brought against employees-- even when the evidence presented against them was substantial.  The prosecution of the group home abuse cases were further impaired by the fact that many of the victims suffered from conditions such as Down Syndrome, cerebral palsy and autism-- making testimony against alleged abused consistently inconsistent -- or impossible.

The resulting situation begs for more state oversight and control of these particularly vulnerable living arrangements.  Particularly when a specific facts relating to abusive acts carried out against disabled people living in group home are uncovered by newspaper reporters, it is particularly troubling that the regulatory agencies failed to take any disciplinary action against the perpetrator or move to protect the victim.

Certainly, I don't have all the answers, but it seems like a system needs to be effectively implemented that both utilizes better oversight of all group homes and importantly holds employees who witness abuse-- yet fail to report it equally accountable for fostering an environment where abuse thrives.

Lastly, as a lawyer who has prosecuted matters involving group home abuse, I encourage families to immediately report abusive conditions to law enforcement as soon as the situation comes to bear.  Further, if there is any physical evidence of abuse, I encourage families to document the same with their own photos and videos.

Related Nursing Homes Abuse Blog Entries:

Are Group Homes A Viable Alternative To Nursing Homes?

Thankfully, We Now Have Many Laws To Protect The Elderly From Abuse In A Variety Of Settings. However, Laws Are Worthless, If The People For Whom They Are Intended To Help Are Unaware Of Them

Is This An Attempt To 'Control' A Patient? Or Is This Simply Another Attempt To Cover Up Abuse In A Group Home?

Abusive Events In Adult Homes Go Unreported & Unprosecuted

Nursing Home Injury Laws: New York

Recently, Illinois officials held meetings with child advocacy groups and representatives from facilities that care for disabled children in order to get input regarding legislation to help protect this vulnerable group from mistreatment.

In response to a similar series of articles the Chicago Tribune did regarding the problems encountered at more 'traditional' nursing homes, legislation was quickly passed to protect the growing nursing home population. 

However, despite the improved regulation from the new legislation in the traditional nursing home setting, the legislature exempted facilities that care for people with developmental disabilities-- facilities that commonly car for children.

In addition to considering the expansion of current legislation to facilities that care for children, advocacy groups seek more extensive rules such as higher fines for improper care and mandatory notification of the medical examiner in cases where a child dies at the facility.  The inclusion of the medical examiner would theoretically assist in determining the if the child's death was indeed related to mistreatment.

Representatives from nursing facilities that care for disabled children, encourage application of any new legislation to encompass all facilities that care for children and young-adults-- such as group homes.

I strongly support the prospect of this much needed legislation to protect children living in facilities and away from their families.  I look forward to watching this legislation progress and certainly will keep Nursing Homes Abuse Blog readers updated with developments.

Related:

Advocated urge tougher rules for nursing facilities for disabled November 15, 2010 Chicago Tribune by Sam Roe and Jared S. Hopkins

Nursing Home Abuse: The Deaths Of 13 Children Linked To Poor Care At Chicago Nursing Home Child Injury Law Blog

New Website Provides A One-Stop-Shop For Families In Need Of Assistance Selecting A Nursing Home

Illinois Nursing Home Task Force Holds Public Meeting Today

Nursing Home Safety Bill Provides Promise Of Improved Care In Illinois

On the other hand, operators of retirement homes and other group living arrrangements have it relatively easy.  They pretty much get to run their facilities as they choose with little direction from regulatory authorities.

I recently read about the state's crackdown of a retirement home in the Chicagoland area that was apparently approaching the boundary of what type of care retirement homes can provide under the auspices of assisted living.  

Under pressure for the State of Illinois, Bowes Retirement Center in Elgin, IL will close its doors after more than 20 years of operation.  In addition to financial concerns, the retirement facility was providing services considered by the state to mimic those provided in a nursing home settings such as: 

• Bathing patients
• Treating patients with incontinence
• Providing medications to patients
• Providing oxygen for bedridden patients

Some residents at the facility were saddened that the place they may have called home for some time is no longer operational; however when unlicensed facilities provide skilled nursing care, patient safety is increasingly put at risk.  

There is little doubt that many of the people living in the Elgin retirement home will initially be disoriented, but as a lawyer who has seen the end result of what can happen when facilities go unregulated, I feel that this closure is in the best interest of patient safety and long-term well-being.

Related Nursing Homes Abuse Blog Entries:

Are Group Homes A Viable Alternative To Nursing Homes?

Thankfully, We Now Have Many Laws To Protect The Elderly From Abuse In A Variety Of Settings. However, Laws Are Worthless, If The People For Whom They Are Intended To Help Are Unaware Of Them

Abusive Events In Adult Homes Go Unreported & Unprosecuted

As people look for additional living options instead of traditional nursing homes, adult group homes (characterized as facilities that care for six or few people) theoretically provide an attractive alternative offering more flexibility and a less-expensive alternative to nursing homes.

However, as the Times investigation points out, the adult home facilities are riddled with situations involving apparent abuse and neglect-- that are frequently brushed aside.  Times reporters determined that more than 357 adult family homes concealed cases of abuse or neglect of a patient over the past five years in Washington.

Unlike nursing homes and hospitals that are tightly regulated by federal and state regulations, adult homes have traditionally received little-- if any regulation by legislative entities. 

Forged medical records, employees lying to state inspectors and owners threatening patients with eviction if they cooperate with authorities, were just a some of the tactics commonly used by adult home operators to conceal abusive events. 

The obvious desire to cover-up cases of obviously negligent conduct was highlighted in the case of Suzanne Moore, a 68-year-old adult home patient who sustained catastrophic burns to her face and ears after she was apparently smoking while connected to an oxygen pump.  Despite the fact that Ms. Moore was partially blind and physically incapable of lighting a cigarette on her own, all staff at the facility denied any role in the incident when questioned by police investigators.

If not for Mr. Moore's retrieval of his wife's melted wheelchair, damaged oxygen pump and burned clothing, investigators would have been completely at loss for prosecuting that matter criminally.

As a lawyer who has civilly prosecuted cases involving group home abuse and other types of patient mistreatment, I can hardly say that such intentional attempts to cover up problems is unique.  However, I believe that when law enforcement officials get involved early on in the primary stages following an incident the chances of discovering what really happened are far greater.

Yet, as this Seattle Times article demonstrates, we certainly need additional regulation of non-traditional living arrangements, such as group homes, in order protect vulnerable people living in facilities never conceived of in the past.

Related Nursing Homes Abuse Blog Entries:

Are Group Homes A Viable Alternative To Nursing Homes?

Is This An Attempt To 'Control' A Patient? Or Is This Simply Another Attempt To Cover Up Abuse In A Group Home?

Unsupervised Nursing Home Resident Dies From Burns

Smoking-Related Fires Are A Real Threat To Nursing Home Patients. Is It Time To Put Out The Fire?

A TRIAL OF ANNUAL IN-HOME COMPREHENSIVE GERIATRIC ASSESSMENTS FOR ELDERLY PEOPLE LIVING IN THE COMMUNITY (pdf) The New England Journal of Medicine, November 2, 1995

Too often in my world as a lawyer for the injured in nursing homes and other long-term care facilities, I see a disconnect between the type of injury a client sustained versus the explanation provided by a facility.  In other words, I've seen many facilities claim an injury, such as a complex leg or arm fracture is due simply to a patients 'old age' when in reality such injuries rarely occur absent trauma.

Sure, its nice to think that as a diligent lawyer, I may be able to dig through the rubble (or medical records as is usually the case) and begin to piece together the real reason my client sustained the injuries they did-- and in some cases this really does happen.  Yet in other cases there really is no way of connecting the dots between the actual injury and the likely source of it.

As a realist I know that the success of the case is very much dependent on thoughtful employees or other witnesses decision to report the situation to authorities and their investigative efforts.  Without someone stepping forward to report a suspicious situation or an injury to authorities, many cases involving abusive conduct simply remain hopelessly difficult to prove.

In this sense of an obviously suspicious situation getting vetted to authorities, I came across a news report involving a disabled man who suffered a fractured shoulder and severe bruising at a Florida Group Home.  According to the report, the facility contacted authorities following the incident, claiming that his caregivers at the group home were just trying to restrain him after he had gotten 'upset' before bedtime.

Of course-- especially in situations involving the disabled, sometimes staff are faced with the unpleasant task of restraining a person against their will in order to prevent them from harming themselves or others.  However, in this case, the this young-man who suffered from cerebral palsy and paralysis in his body-- except for use of his left hand-- essentially making him completely dependent on the staff for everything which makes me question such a seemingly innocent explanation. 

It's always disheartening to see the images of a person suffering, but hopefully the attention focused on this incident by the news station will lead to a witness coming forward or perhaps more scrutiny heaped on this facility.  Hopefully, the increased attention will result in an explanation for  this man's injuries.  Perhaps at some point we will lean if the injuries are indeed related to staffs' attempt to subdue or-- dare I say-- another abusive situation attempted to be covered up by a facility?

Reporting Abuse In Long-Term Care Settings

I am a huge proponent of getting authorities from law enforcement as well as state regulatory agencies involved as soon as feasible after any suspicious incident occurring during an admission to a long-term care facility.  While many situations of suspected poor care may go explained indefinitely, I can vouch for the fact that there most definitely is a correlation between getting real explanations and getting the incident investigated quickly. 

Simply put, as a caregiver when you suspect something isn't right, you should get it checked out.

The move comes after the well publicized problems regarding younger, mentally-ill patients living amongst a predominately elderly nursing home community.

A time-line for providing the new housing options has not been released.

My take:

Nursing homes are medical facilities for people who require skilled nursing, not for the mentally ill.  In this sense, I do feel as though moving younger, mentally ill patients out of nursing homes is a good step towards improving the safety of the fragile nursing home population.

However, my reservation regarding this development is the current lack of facilities on hand to accommodate these mentally ill people.  I hope that every facility, be it new or old, receive a complete review of credentialing to assure that the mentally-ill are appropriately cared for in their new living arrangements.  

As I have seen firsthand, quasi-nursing facilities such as group homes, day facilities and other alternative living arrangements can be dangerous for the patients' physical and psychological well-being when staff at the facilities fail to monitor patients and take necessary protective actions.

Related Nursing Homes Abuse Blog Entries:

Illinois Attorney General 'Cracks The Whip' At Violent Criminals Living Amongst Nursing Home Patients

Feds Yank Funding From Another Chicago Nursing Home With A Troubled Past

Family Claims Assisted Living Facilities Neglect Resulted In Death Of Mentally Disabled Woman

Are Group Homes A Viable Alternative To Nursing Homes?

What is elder abuse?

Elder abuse is the abuse, neglect, and financial exploitation of elderly persons. Older adults are particularly vulnerable to this type of abuse because of their isolation, illness, or fear. In the United States, an estimated 1 to 2 million Americans age 65 and older have suffered from abuse.

In Illinois, an estimated 76,000 persons over age 60 suffer from elder abuse, but only 10,000 elderly victims report this abuse to the Elder Abuse and Neglect Program each year. The 2008 Illinois Elder Abuse and Neglect Program Annual Report, Demographics reveals that of reported cases of abuse in Illinois in 2008: almost one in four victims are age 86 or older, the most common report received involved financial exploitation followed closely by emotional abuse, 77% of abusers were either the spouse, child, or other relative, and 70% of victims were female.

What is the Elder Abuse and Neglect Act?

The Elder Abuse and Neglect Act (320 ILCS 20/1 et seq.) is an Illinois law established to “design and manage a program of response and services for persons 60 years of age and older who have been, or area alleged to be, victims of abuse, neglect, financial exploitation, or self-neglect.” This program is administered by the Illinois Department on Aging and is coordinated locally through 45 provider agencies. The Program provides investigation, intervention, and follow-up services to victims of elder abuse.

The Elder Abuse and Neglect Program responds to the following types of abuse (320 ILCS 20/2(a)):

Physical abuse – inflicting physical pain or injury upon an older adult

Sexual abuse – touching, fondling, intercourse, or any other sexual activity with an older adult who is unable to understand, unwilling to consent, threatened, or physically forced

Emotional abuse – verbal assaults, treats of abuse, harassment, or intimidation

Confinement – restraining or isolating an older adult, other than for medical reasons

Passive neglect – caregiver’s failure to provide an older adult with life’s necessities (food, clothing, shelter, medical care)

Willful deprivation – willfully denying an older adult medication, medical care, shelter, food, therapeutic device, or other physical assistance which exposes that person to the risk of physical, mental, or emotional harm

Financial exploitation – misuse or withholding of an older adult’s resources by another, to the disadvantage of the elderly person, or the profit or advance of someone else

In order to encourage people to report elder abuse (call Elder Abuse Hotline at 1-866-800-1409), the Act provides that a person who reports suspected elder abuse in good faith or cooperates with an investigation will be granted immunity from criminal or civil liability or professional disciplinary action and their identify will not be disclosed without written permission or a court order. The Department on Aging, Office of Elder Rights started a campaign called Break the Silence (brochure) to increase public awareness of elder abuse.

Illinois law requires that persons delivering professional services to older adults (social services, adult care, law enforcement, education, medicine, state service to seniors, and social workers) report suspected abuse of older persons who are unable to report for themselves. This mandatory reporting requirement only applies if the reporter believes that the older person is not capable of reporting the abuse themselves. Any physician who willfully fails to report as required by the Act is referred to the Illinois State Medical Disciplinary Board. Any other mandated reporter required by the Act who willfully fails to report is guilty of a Class A misdemeanor.

The Department also encourages people to report suspected elder abuse even when not required. If the older person is a nursing home resident, reports are made to the Illinois Department of Public Health’s Nursing Home Hotline (1-800-252-4343).

Applicability of Elder Abuse & Neglect Laws to Nursing Homes and Group Homes

Nursing homes and group homes are intended to provide a safe and secure home for your family members when they are unable to live on their own or need special care and services. These facilities promise to take care of our loved ones with the care, respect, and safety that they deserve. However, many cases of elder abuse and neglect occur in these very facilities.

Illinois nursing homes are subject to federal and state laws including the Illinois Nursing Home Care Act (210 ILCS 45), which establishes minimum standards for the facility. The Illinois Department of Public Health (IDPH) is responsible for licensing nursing homes in order to ensure that they provide adequate and proper care for their residents. In addition, Illinois nursing home residents are guaranteed certain privileges according to the rights and protections afforded under State and Federal law (Resident’s Rights brochure).

When you enter a long-term care facility, you maintain the right to safety and good care, privacy, manage your own money, participate in your care, safety of your personal belongings, and keep living in your facility. It is important to remember that you do not lose your rights just because you enter a nursing home facility.

One of the most important rights you have is freedom from abuse, neglect, financial exploitation, and self-neglect. If a nursing home employee, medical worker, social services worker or other mandated reporter who is engaged in carrying out their professional duties suspects that a nursing home resident is being abused or neglected, they have the responsibility to report their suspicions to IDPH under the Elder Abuse and Neglect Act. Additionally, any person who suspects abuse or neglect may also voluntarily report their suspicions to IDPH.

IDPH is responsible for investigating allegations of abuse or neglect in long-term care facilities, including: nursing home facilities, assisted living facilities, group homes or residential care facilities for the elderly (RCFE). When a mandated reporter or any other person who suspects elder abuse reports an allegation to IDPH, an investigator responds to the complaint to ensure that the elderly person is not living in an abusive situation. An investigator will usually visit the facility in question and perform a face-to-face assessment with respect to a complaint report along with any casework and follow-up as required by Department protocols.

If you suspect that an older adult, age 60 or older, is being subjected to abuse, neglect, or exploitation, it is important to report your suspicions to the Illinois Department on Aging or the Illinois Department of Public Health if the person is a nursing home resident. Older adults, especially those with mental disabilities or illness, are particularly vulnerable to abuse and neglect. It is important to be vocal proponents of the safety and well-being of older adults to ensure that they receive adequate care and services while maintaining their rights.

Resources:

ILGA: Elder Abuse and Neglect Act
State of Illinois: Elder Abuse and Neglect Act and Related Laws
Illinois Department on Aging: Resident’s Rights Brochure
Senior Services Inc: Elder Abuse Intervention

Related Nursing Homes Abuse Blog Entries:

A Legal Victory For Nursing Home Residents. State Laws Can Supersede Federal Arbitration Act

Elder Abuse: Why Bruises Can Be Tell-Tale Signs Of Poor Care

Bone Fractures In The Elderly Require Special Attention To Improve Recovery & Prevent Complications

Unlike a current three-star system currently in place, the four-star system is intended to more accurately categorize facilities according to the quality of the care they provide.  Additionally, the newer rating system is intended to penalize facilities for providing inadequate care for stemming from problems such as medication errors and patient wandering.

Not surprisingly, some industry groups believe the new rating system may not provide a complete picture of each facility.  In this respect, I could not agree more.  No rating system-- no matter how well conceived-- can take the place of an in person visits (and preferably visits).  

Nonetheless, I certainly am a fan of any system that can help families with the difficult decision of what facility to select for a loved one.  As a lawyer who handles cases involving abuse and neglect in a group home setting, I wish other states would implement more intensive regulations of these facilities to protect our elderly population.

Read more about the new rating system for group homes here.

Related:

Are Group Homes A Viable Alternative To Nursing Homes?

Nursing Home Rating System Reveals Inferior Care Provided At For-Profit Facilities

What Is It Like To Live In A 1-Starred Nursing Home?

One year after the implementation of the Medicare nursing home rating system, where do we stand?

Adult Group homes may provide an alternative to nursing homes for older adults who are at risk of living alone but do not require nursing care.  These homes allow elderly family members to have more autonomy, while still providing convenient access to services.  Adult group homes refer to housing for groups of unrelated adult individuals with disabilities.  In Illinois, there are several categories of adult group homes:

• Shared Housing Establishment (SHE) – Residence for ≤ 16 persons, at least 80% of whom are age 55 or older. 
• Assisted Living Facility (ALF) – Residence for at least 3 unrelated adults, at least 80% of whom are age 55 or older.
• Supportive Living Facility (SLF) – Residential setting that combines apartment-style housing with personal care and other services. 
• Residential Care Facilities for the Elderly (RCFE) - Provides non-medical care to elderly people in a group living arrangement, frequently providing meals and assisted with laundery and housekeeping.
  

Cost is an important and often limiting element when determining what type of facility you and your family can afford.  Medicaid can pay for all SLF facility services except room and board, and SLFs cannot charge more than the Supplemental Security Income (SSI) rate.  Medicaid does not pay for ALFs or SHEs, so most residents pay with their own financial resources or with long-term care insurance.  ALFs and SHEs vary in building size (from single family homes to large communities), room size (studio to suites or apartments) and can be freestanding or part of a retirement community.   

SHEs and ALFs do not have age requirements except that 80% of the residents must be age 55 or older.  However, in order to be accepted for residency or remain in residence at a SHE:

• The facility must be able to provide or secure appropriate services for you
• You need a level of service or type of service for which the facility is licensed
• The facility must have sufficient staff with appropriate skill to provide those services

There are also circumstances that may preclude you from being a resident at an ALF or SHE.  Potential residents may not be accepted and current residents cannot be maintained if any of the following circumstances exist:

• You pose a serious threat to yourself or others
• You are unable to communicate your needs
• You need help with an activity of daily living from more than one paid care-giver at any given time
• You need total assistance (staff or another individual performs the entire activity without your participation) with two or more activities of daily living
• You need more than minimal assistance in moving to a safe area in an emergency
• You have a severe mental illness where you are substantially disabled in the areas of self-maintenance, social functioning, activities of community living, and the mental illness is expected to persist for more than one year (this does not exclude persons with Alzheimer’s disease and other forms of dementia)
• You need treatment that cannot be self-administered or administered by a qualified licensed health care professional (intravenous therapy, replacement of catheter, sterile wound care, feeding tube feedings, routine insulin injections for diabetics)
• You need treatment of stage 3 or 4 pressure sores
• You need five or more skilled nursing visits per week for three consecutive weeks or more

Before being admitted to an adult group home, a doctor must perform a comprehensive assessment of your condition including an evaluation of your physical, cognitive, and psychosocial condition, as well as a test for tuberculosis.  Residents with Alzheimer’s disease may be subject to additional evaluations before admission in order for the facility to determine whether it can provide secure and appropriate care. 

Based on this assessment, the facility will develop a service plan that will serve as the basis for the service contract between you and the facility.  This plan must be reviewed and revised, if necessary, every year or immediately after a significant change in condition. 

In Illinois, the Illinois Department of Public Health (IDPH) must license all ALFS and SHEs (list of licensed ALFs and SHEs in Illinois).  Illinois ALFs and SHEs are subject to the Illinois Assisted Living and Shared Housing Act (210 ILCS 9) and the Assisted Living and Shared Housing Establishment Code (77 Administrative Code 295).  These regulations are in place to provide protection to elderly residents who are at risk of abuse and neglect.  Licensed group homes are required to offer certain mandatory services including:

• Secure housing
• Laundry
• Housekeeping
• Three meals per day
• 24-hour security
• Emergency communication response system
• Assistance with some activities of daily living (eating, dressing, bathing, toileting, transferring, and personal hygiene)

Optional services include:

• Medication services – Medication reminders, supervision of self-administered medication, medication administration, medication storage, and medication records.
• Transportation to the doctor
• Money management or banking
• Beauty shop
• Postage or mailing
• Help with shopping
• Meals for visitors and guests

Most ALFs and SHEs are not required to have nurses on staff; however, the facility must employ a sufficient number of qualified staff to meet the 24-hour needs of the residents.  At all times, at least one direct care staff person who is CPR certified must be on duty. 

SHEs must have at least one staff member on site at all times, except in emergency situations or short trips.  ALFs must have at least one staff member awake, on duty, and on-site 24-hours a day.  There are also building requirements for ALFs and SHEs.  Both must conform to the applicable building, fire, and life safety codes and must meet the accessibility standards of the Americans with Disabilities Act (ADA).  The facility must also meet environmental requirements designed to maintain a clean, healthy, and safe environment. 

 As a resident of a SHE or ALF, you have all the rights guaranteed under the Constitution of the United States, the Constitution of the State of Illinois, federal resident’s rights, and resident’s rights guaranteed by Illinois statutes.  These include the right to:

• Live in an environment that promotes and supports your dignity, individuality, independence, self-determination, privacy, choice, and to be treated with consideration and respect
• Direct and negotiate the terms of your own care
• Be free of chemical and physical restraints
• Privacy in financial and personal affairs
• Review and copy your personal files

The facility must execute a contract between you and the facility and provide you with a copy.  If the facility reasonably believes that you have been a victim of abuse, neglect, or financial exploitation, the facility must remove the alleged perpetrator from direct contact with residents, notify IDPH, conduct its own investigation, and submit a written report to IDPH. 

The federal Fair Housing Act prohibits discrimination on the basis of handicap (mental or physical impairments which substantially limit one or more major life activities).  Adult group homes are subject to state regulations that help protect the health and safety of the residents. 

Abuse and neglect in adult group homes are major concerns for adult group homes.  Elderly adults, especially those suffering physical or mental impairments, are particularly susceptible to nursing home abuse and neglect.  While residents of adult group homes are not as dependent upon staff as nursing home residents, they are still unable to perform all activities of daily living, relying on group home staff members to provide proper services and assistance.  Several recent news stories reveal horrific violations of the law and human decency, when group homes mistreat their adult residents. 

Unlicensed group home

California investigators recently shut down an illegal and unlicensed adult group home in San Bernardino, CA, that was described as having prison camp conditions.  The facility was surrounded by razor wire fences and padlocked gates.  Investigators reported that 22 elderly adults, some suffering from mental impairments, were abused, crammed into converted chicken coops, and forced to use buckets as toilets.  Some of the residents were living in rooms as small as 6 by 15 feet, with two beds and a mattress in the room.  The owner, 61-year-old Pensri Sophar Dalton, was arrested and charged with 16 counts of causing harm to elderly adults.  After the facility was shut down, most residents were picked up by family members or taken to licensed facilities. 

Physical and emotional abuse of residents in a group home

NBC news reported that a Michigan special investigative report revealed that residents at a group home in Flint, MI suffered emotional and physical abuse at the hands of the owner and her boyfriend.  One resident alleged that he was locked in a closet after not following orders.  Neighbors are concerned for the elderly residents because they are not being removed immediately because of a complicated appeals process. 

Adult group homes can be a helpful alternative to nursing home facilities; however, residents are still susceptible to elder abuse and neglect.  Therefore, families should thoroughly investigate facilities before placing their loved ones in the hands of an ALF or SHE. 

Rosenfeld Injury Lawyers is committed to the the safety of all individuals living in group homes-- young people, teenagers, adult and elderly.  

We are proud to have successfully represent individuals living in group homes who have suffered many types of injuries including: sexual abuse, food poisoning, physical abuse, as well as other types of injuries due to improperly maintained property.

If you suffered an injury in a group home, we welcome would be honored to speak with you.  As we have done for more than 30 years, all consultations are completely free and confidential.  Should you wish to retain our office, there is never an attorney fee charged, unless we recover for you.

Providing nationwide legal representation: (888) 424-5757 

 

Thanks to Heather Keil, J.D. for her research with this important topic.

Resources:

Illinois Department of Public Health: Assisted Living / Shared Housing Licensed Establishments

Illinois Department of Public Health – Assisted Living / Shared Housing Initial License Application

Illinois General Assembly: 77 Illinois Administrative Code 295 – Assisted Living and Shared Housing Establishment Code

U.S. Department of Justice: Group Homes, Local Land Use, and the Fair Housing Act

Section 295.100 Purpose of the Act and this Part

a) The purpose of the Act is to permit the development and availability of assisted living establishments and shared housing establishments based on a social model that promotes the dignity, individuality, privacy, independence, autonomy, and decision-making ability and the right to negotiated risk of those persons; to provide for the health, safety, and welfare of those residents residing in assisted living and shared housing establishments in this State; to promote continuous quality improvement in assisted living; and to encourage the development of innovative and affordable assisted living establishments and shared housing with service establishments for elderly persons of all income levels. It is the public policy of this State that assisted living is an important part of the continuum of long term care. In support of the goal of aging in place within the parameters established by the Act, assisted living and shared housing establishments shall be operated as residential environments with supportive services designed to meet the individual resident's changing needs and preferences. The residential environment shall be designed to encourage family and community involvement. The services available to residents, either directly or through contracts or agreements, are intended to help residents remain as independent as possible. Assisted living, which promotes resident choice, autonomy, and decision-making, should be based on a contract model designed to result in a negotiated agreement between the resident or the resident's representative and the provider, clearly identifying the services to be provided. This model assumes that residents are able to direct services provided for them and will designate a representative to direct these services if they themselves are unable to do so. This model supports the principle that there is an acceptable balance between consumer protection and resident willingness to accept risk and that most consumers are competent to make their own judgments about the services they are obtaining. Regulation of assisted living establishments and shared housing establishments must be sufficiently flexible to allow residents to age in place within the parameters of the Act. The administration of the Act and services provided must therefore ensure that the residents have the rights and responsibilities to direct the scope of services they receive and to make individual choices based on their needs and preferences. These establishments shall be operated in a manner that provides the least restrictive and most homelike environment and that promotes independence, autonomy, individuality, privacy, dignity, and the right to negotiated risk in residential surroundings. It is not the intent of the State that establishments licensed under this Act be used as halfway houses for alcohol and substance abusers. (Section 5 of the Act)

b) The purpose of this Part is to establish standards for assisted living and shared housing establishments. The standards support the concept of aging in place and promote the availability of appropriate services for elderly and disabled persons in a homelike environment that enhances the dignity, independence, individuality, privacy, choice and decision-making ability of the resident.

c) This Part requires assisted living and shared housing establishments to address standards in the delivery of services to residents and to design the physical environment to support dignity, independence, individuality, privacy, choice, and the decision-making abilities of individual residents.

Why didn't authorities act quicker in this situation?  The fact that Ms. Stockton brought evidence of her disabled sons injuries to authorities attention and without any results is sickening.  These prosecutors should look for another job if they put the burden of obtaining evidence in the hands of a disabled person's mother.

Read more about this incident here.

Related:

Nursing Home Injury Laws: Connecticut