Related stories in the Growing Old Series
Read the second part of this series: Unmet needs
Read the third part of this series: Citations for homes top 100 in 2006
Citations in 2006 were many
More than half of the assisted living homes inspected in Oklahoma
last year were cited for medication
problems, violating patient rights
or housing patients whose needs
exceed the level of care the homes
are licensed to provide, a Tulsa
World analysis shows.
The World's study of 2006 inspections of the state's assisted-living centers found that despite
promises made in their glossy brochures, some centers fail to keep
those promises, which can result in
injuries and deaths.
Meanwhile, many consumers
seeking housing for elderly relatives are unaware of the differences
between assisted-living centers
and other types of care, particularly
the lack of federal regulation.
Some centers had nearly perfect
records in 2006, with 11 receiving
only one or two deficiencies during
the entire
year, records show.
Three centers received zero deficiencies: Alterra Sterling House in
Norman, Green Country Village
Assisted Living in Bartlesville and
Dogwood Creek Retirement Center in Muskogee.
While one Tulsa facility -- Sunflower Place -- had a high number
of problems on paper, its owner
says the inspection was the facility's first since opening and
many of the problems amounted to paperwork issues. Sunflower is an anomaly because
it is located in a private home
and is licensed for only four
residents.
Dorya Huser, chief of long-term care for the state Health
Department, said the department's inspectors have been
finding more cases of neglect
and other serious issues as
they work through a backlog
of overdue inspections. Because assisted-living centers
do not accept Medicare or
Medicaid, there is no federal
reimbursement for state inspections. Regulations are also much less specific than
those nursing homes must follow.
''We have placed a few fines
in the past, very few, and we
are probably faced with that
picture changing a bit because
of the medical neglect we are
seeing,'' Huser said.
Diane Hambric, whose company Gold Medallion Senior
Housing and Health Care
owns five long-term care facilities, said the industry serves
its residents well.
Hambric worked with the
state in 1997 to develop regulations for assisted-living centers. She went on to found the
Oklahoma Assisted Living Association and is chairwoman
of the governor's long-term
care advisory board.
Hambric said the regulations are designed to allow
centers to be flexible in what
types of residents they take.
Most have tiered prices depending on the amount of assistance residents need.
''What is wonderful about
assisted living is the fact that
each assisted-living community develops a program that
they are comfortable with,''
she said.
A system coming of age
Two decades ago, most elderly or disabled people who
could no longer stay home
went to a nursing home. The
homes, based on a medical
model, weren't designed for
residents who could do most
things for themselves.
Kathleen Cameron, chairwoman of the Consumer Consortium on Assisted Living's
board of directors, said assisted-living centers evolved 25
years ago ''for people who
didn't necessarily need the
level of care that is provided in
nursing facilities but needed
some assistance with activities
of daily living.''
The centers range from
large buildings owned by national corporations to small,
family-owned operations with
a few beds. The new model
proved popular with consumers and more than 1 million
people nationally now live in
assisted living, Cameron said.
Meanwhile, the percentage
of adults 65 and over in nursing homes declined from 4.2
percent in 1985 to 3.6 percent
in 2004, a decline that continues today, according to a
study last year by The Lewin
Group. The decline was greatest among those 85 and older.
With an influx of older residents, assisted-living centers
are experiencing new challenges.
Cameron said that oversight
varies dramatically from state
to state.
''There are absolutely no
federal regulations over assisted living.''
In Oklahoma, the state has
licensed 125 homes with an assisted-living unit, including
''continuum of care'' facilities
that also provide nursing-
home care, records show.
The World's investigation
found lapses among some of
the state's homes, including
one resident who died after an
aide accidentally gave him the
wrong medication, and residents who fell and were left on
the floor for hours when aides
neglected to check on them.
Windsor Manor Assisted
Living, in Oklahoma City,
topped the list with the most
deficiencies: 27 in 2006. The
43-bed center went through
foreclosure and receivership
last year and had no administrator for 22 days, records
show.
It is now owned by Dr. Raj
Narula, an Oklahoma City
doctor.
The center was cited for
problems including failure to
follow care plans, keeping residents in restraints, failure to
have a nurse or pharmacist review medications, failure to
have a dietitian and employing
untrained staff. According to
an August inspection report,
16 of 17 direct-care staff lacked training in CPR or first aid.
The facility was also cited
for neglect after a bipolar resident climbed through an open
window, crossed four lanes of
traffic and was found in a storage shed across the street.
''He has tried to get out of
the windows before. He was in
a (prisoner of war) camp and
tries to escape,'' the administrator told inspectors. The report notes the center had no
plan to deal with the resident's
''tendency to elope.''
Crystal Russell, administrator since October, said the facility is now under new ownership.
''I think the reason we went
through a tough time is we
were switching ownership and
switching management and
things got kind of lost along
the way,'' she said.
A Tulsa-area facility, Alterra
Sterling House of Broken Arrow, ranked second in terms
of the numbers of problems
cited by inspectors: 25.
The center was cited for neglect of a resident with a urinary catheter. The resident,
who was bedfast and needed
to be turned every two hours,
developed a pressure sore that
grew larger.
''The resident was not consistently turned every two
hours and the urinary drainage bag was infrequently emptied or recorded,'' the report
states.
The patient died Feb. 27.
Before the resident was admitted, ''The facility assured
the family they could care for
the resident, although one
family member thought the
resident needed a higher level
of care,'' the report states.
An administrator for the facility referred comment to the
corporate office, which issued
a written statement.
''As a company, Brookdale
seeks to comply with all applicable state regulations,'' the
statement says. ''In the event
that a deficiency is cited, we
work quickly and responsibly
to address it.''
'But nobody came back'
Sommerset Assisted Living
Residences in Oklahoma City
was one of 16 centers cited for
violating patients' rights.
Records show the home
was cited in February for neglecting a female resident who
suffered a stroke on a Saturday night.
An employee told inspectors that the doctor was not
called until Monday because,
''We don't call the doctor at
night.''
The employee said the
home's emergency plan
''would be to send her to the
(emergency room). We didn't
send her to the ER. No one
called the doctor. I called the
doctor on Monday when I got
to work.''
Three months later, Sommerset was again cited for neglecting a resident.
A 92-year-old man fell in his
bathroom and lay on the floor
all night with several broken
bones, the report states. A call
light cord was wrapped
around a grab rail in the bathroom and staff did not check
on him, despite an agreement
with the family to check on
him at least twice each night.
A relative told inspectors:
''He asked the nurse to help
him with a shower. She said
she would be back or she
would send her aide to help
him, but nobody came back.''
The patient suffered a fractured back, broken hip and
broken shoulder and no one
found him until 7 a.m. the next
day, the relative told inspectors.
The facility's owners referred comment to their attorney, who said he could not
comment because a lawsuit is
pending against Sommerset.
Hambric and others in the
industry say such incidents,
while tragic, are not an accurate picture of how residents
are cared for in assisted-living
centers. Hambric points to a
statewide survey commissioned by the industry last
year of residents in assisted
living.
The survey found that nearly 90 percent of residents responded that the services they
received fit their needs.
She said regulators need to
remember that assisted-living
residents pay with private dollars for their care and regulations should not mirror those
in nursing homes, which accept Medicare and Medicaid.
''As an association, OKALA
and myself personally, we
don't want bad players in our
line of work but don't hamstring what I'm doing in this
building because of a bad player across town,'' she said.
World news researcher Hilary
Pittman contributed to this story.
Ziva Branstetter 581-8378
ziva.branstetter@tulsaworld.com
Related stories
Living with care
Medication error, death point to problems
Read the names of the assisted-living centers in Oklahoma and the number of violations for each in 2006.
Read a list of all the assisted-living centers by county, including the number of beds and those dedicated to
Alzheimer’s patients.
