When families place a loved one in an assisted living facility, there’s an expectation that if something goes wrong, there will be consequences. Mistakes will be addressed. If crimes are committed, they will be prosecuted. Or at least investigated by law enforcement.
But that’s not always what happens.
Take the case of Stacey Siriani of San Diego County. Her experience with assisted living began four years ago when she got an awful phone call from Houston. Her father was involved in an auto accident that left him brain damaged.
“It was very tough,” she recalls. Siriani is an only child; her father is a widower. There was nowhere else to turn for support.
First, her father spent some time in a Texas hospital trauma unit, and then in rehab. After that, Siriani moved her dad to California, into an assisted living facility so close to her home in Carlsbad that she could visit two or three times a day.
Just as important, it had a memory care unit, meaning extra supervision — and locked doors to block wandering residents. She’d spied the facility driving past, and really, that was the extent of her research. That, and a tour.
“At that time, I didn’t know what citations were,” she says. “I just went off the marketing lady that takes you on the tour and promises you the world, just like they do everybody else.”
Her dad didn’t qualify for public assistance, so this cost him about $3,300 a month, out of pocket.
A few months later, Siriani got another awful phone call. A staff member from the facility said her father had fallen and cut his chin. That turned out to be an understatement, as the surgeon at the hospital later explained to her:
“He’s got double mandibular condyle fractures on both sides of his face,” meaning he broke his jaw in two places. “We’re going to need to go in, obviously, and do surgery and wire his mouth shut,” Siriani says the doctor told her.
Siriani’s dad has had to live in a nursing home ever since, fed through a feeding tube. She still doesn’t know exactly what happened that night. Every staff member had a different story. The stories changed. There was no apology. She filed a complaint with the California Department of Social Services, or DSS.
“I must have called the state once a week, for at least the first three months,” Siriani recalls. “And I was just always told, ‘We’re working on it. We’re working on it. We’re working on it.'”
It was a year before Siriani got an official report in the mail.
DSS did send out an investigator who cited the facility. He also fined the operator of the facility the maximum amount allowed by law: a mere $150. In comparison, the maximum penalty in a California nursing home is $100,000. “You know,” says Siriani, “a couple hundred dollars to these places is absolutely nothing.” But her life and her father’s life was “turned around forever.”
By then, Siriani had hired a lawyer. His investigators uncovered chronic under-staffing, poor training, and a known issue with the lock on the door her father passed through. The facility settled for an undisclosed sum. (And as part of the settlement, Siriani agreed not to name the facility publicly.)
Pat Leary is chief deputy director for the California Department of Social Services, the primary agency responsible for oversight of assisted living facilities. Leary acknowledges the criticism that $150 isn’t big enough to serve as a deterrent. As part of its annual budget proposal this year, the DSS suggested raising the fine, but that requires an act of the state legislature.
“Civil penalties are set in statute, and most of those statutes haven’t changed over time for many, many years.”
There is legislation pending that would address some of the issues raised by Siriani’s experience. AB 2236 would raise the maximum fine from $150 to $15,000. AB 1554 would require the DSS to investigate within one working day if the complaint alleges abuse or imminent danger and then report back within 10 days. [UPDATE: AB 1554 failed to make it out of the Senate Appropriations Committee.]
What’s less clear is how the agency’s 462 inspectors are going to meet that new standard if it’s signed into law. They’re not just responsible for the state’s 7,800 assisted living facilities, but all of the 66,000 facilities DSS oversees, including foster care homes.
“We issue thousands of citations in any given year,” Leary says. “The last year I had data was for 2012-13, we issued over 55,000 citations.” But, she adds, not all complaints are equal. “Understand it’s a complete range — from the most serious and extreme critical issues death and serious bodily injury — to not finding a parking place in front.”
Leary says there is no average time for processing a complaint — and no way to say, for instance, what the most common kinds of complaints are, or how long it typically takes to investigate a complaint.
“We don’t categorize, due to the antiquated nature of our technology. We don’t have a good data reporting system that gives us our most average complaint. But the ones that we clearly give the highest priority are ones that deal with immediate health and safety issues.”
Other organizations do categorize the data. According to the Assisted Living Federation of America the number one kind of complaint in California in 2008 was about cleanliness.
If a DSS investigator uncovers evidence of a possible crime, a DSS spokesman says a referral would be made to the appropriate law enforcement agency — but the agency does not maintain statistics on the number of referrals. State Attorney General’s offices report they’ve gotten a few — at least since 2000, when a Congressional act gave them the jurisdiction to pursue these kinds of cases.
But in San Diego, the county district attorney’s office has not gotten referrals. Deputy District Attorney Paul Greenwood says the county DA’s office has not gotten any referrals. And he’s the one who would know. Greenwood has specialized in prosecuting elder abuse in San Diego for 18 years, unusual for a DA in California. He says he can’t think of a single case brought to his attention by the DSS.
But he’s quick to add all that may be water under the bridge now. A couple of months ago, he was invited to a stakeholders’ meeting — at the local DSS office.
“In their office!” Greenwood exclaimed. “First time I’ve ever been involved in one of those. At the table was the sheriff’s department, paramedics, the police department, attorney general, me, city attorney. I mean, in 18 years, I’ve never seen this happen before.”
Greenwood credits a change of personnel. Others suggest political pressure may have something to do with it: particularly, a series of articles published last fall by San Diego Union Tribune/Center for Health Reporting. “Deadly Neglect,” as the series was called, detailed 27 deaths in assisted living in San Diego County — deaths caused by neglect and abuse.
“It didn’t surprise me, on one hand,” Greenwood says of the reports, “but there were some things that were being revealed through these articles that even shocked my conscience, and I was hoping that someone would take notice. Well, they did!”
Indeed. The reports were so dramatic, they inspired a round of legislative reform in Sacramento not seen in 30 years. [UPDATE: The governor has signed two bills into law. Another 10 are still pending.]
Meanwhile, county supervisors, led by Diane Jacob, decided not to wait for the state to act. They gave Greenwood’s office $1.3 million dollars to launch a one-year pilot program to focus on assisted living facilities. It’s the only unit of its kind in a California county DA’s office.
When Greenwood started, he found it difficult to get the kind of tips that would lead to a criminal investigation, let alone prosecution. But over the years, he built up a network of sources. “By the end of year one,” he recalls, “I issued 16 felony cases. Well, this is year 18. We’ll probably have issued about 400.”
Under the pilot program, Greenwood expects to be swamped with leads shortly.