A Laurel to the Seattle Times

For investigating the state’s adult care homes

We’ve become accustomed to newspaper exposes of nursing homes. But other places that house the frail elderly are another matter. These “other” places are growing in importance, even though the care they provide may be questionable, if not downright harmful. So we were pleased to see the Seattle Times tackle adult family homes, a subject the media often overlook. In my many years of covering long-term care, I often observed atrocious conditions, and so have other journalists—but the three-part series by Michael J. Berens went beyond the horror stories.

This was not just another “buyer beware” series about the neglect of old people. The title of the series, “Seniors for Sale,” said it all. There’s money to be made—sometimes big money—for homeowners who have three or four bedrooms to spare that can accommodate sick, old people whose families are seeking a warmer, cozier environment than a nursing home offers. The series begins:

Adult family homes in the state are seen as a national model, and in King County alone, they’ve become more plentiful than Starbucks stores. But the explosive growth, fueled by profiteers and a lack of careful state regulation, is leaving thousands of people vulnerable to harm.

In Part 1, Berens reported that elderly residents were sometimes imprisoned in their rooms, roped into their beds, strapped to their chairs, drugged into submission or left without medical treatment for weeks. “In scores of cases, owners raked in monthly payments while they pinched pennies and eliminated meals, turned off the heat, or left residents in urine-soiled clothing for days,” he reported.

It’s not only homeowners exploiting the elderly, we’re told. A new crop of profiteers called senior placement agencies has sprouted to help desperate families find care for their relatives. The Times learned that these agencies earn hefty commissions from owners of the adult homes, usually between $2000 and $7000, the equivalent of a resident’s first month’s rent. These potential conflicts of interest are rarely disclosed to families. Anyone with a computer and a website can become a placement agency.

There’s no licensing, education, or training required, and these mom and pop operations take the place of a government clearinghouse that would give cost and quality information to families needing care. I would have liked to see the paper investigate the state’s neighbor to the north, the province of British Columbia, which has had experience with the government providing a single entry point into the long-term care system with evaluations, placement options, and all. That might have made a nice contrast to the U.S. model Berens so aptly described.

What makes the series so compelling is not the recitation of horror stories about needless deaths and poor care, or the use of data to prove a story’s thesis. (The paper did use data to identify 236 suspicious deaths.) Those techniques are becoming almost too familiar in reporting these kinds of stories perhaps causing readers to say “so what else is new?” The “so what” in this series is the paper’s indictment of the system that allows these abuses to flourish.

Berens reported that the state of Washington blessed these homes, giving them almost carte blanche to run their businesses any way they saw fit, even if abuse and neglect went unchecked. The state encouraged these homes as a way to save its Medicaid costs. In the 1990s, the state began to move elderly residents into these homes, and in 2008, it saved $105 million in Medicaid funds that would otherwise have gone to nursing homes.

“Owners were given freedom,” Berens wrote. The state imposed few regulations. There were no requirements for minimum staffing levels or liability insurance. Even the head of the nursing home trade association, who knows a thing or two about poor care (and, of course, has a self interest) told the paper that the Department of Social and Health Services “has pushed so hard and developed these homes so quickly that they have little ability to oversee them. It should scare people.”

Berens made that point. In Part 2 of the series, he told the tale of one Arlie Leno, who Berens said “committed perhaps his most brazen violation. He sneaked an extra resident into Narrows View.” The law said he could only care for six residents, but he added a seventh, “apparently to squeeze out more profits,” the paper reported. Leno had a long history of violations, but the state seemed to overlook them. Higher-ups overruled field supervisors who recommended that he should lose his license, but when the story ran, Leno’s facility, which had racked up more serious violations than any other home, was still in business.

In Part 3, which ran a few weeks ago, Berens further investigated “the system,” noting that the medical examiner and the police had created a plan to review these homes. A police detective had planned to visit each home where a death had occurred. The plan faced “instant opposition” from families, adult home owners, and doctors who didn’t like their judgments questioned.

The series has brought a few results. Adult homes must post inspection reports and violations and the Department of Social and Health Services will publish online its enforcement actions. While this disclosure is helpful, it doesn’t get at the systemic rot. It certainly hasn’t for nursing homes, where such disclosures are plentiful. We hope the paper will take this series to the next level and dig deeply into the payment system with its screwy incentives that allow such abuse to continue. That leads to money and politics. If Washington is a model for adult home care, it’s only fitting that the state’s premier newspaper become a model for the kind of journalism that can change the system.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.