Put simply, there is a lot of bad stuff happening within the service system vulnerable people live in here in Oregon.
Senior care center faulted
Investigation, verdict expose wider problems at Avamere and other for-profit elder care facilities in tri-county area
BY LEE VAN DER VOO AND CHRISTIAN GASTON
The Forest Grove News-Times, Jun 25, 2008
An unprecedented verdict against a Lake Oswego senior care facility last month levied more than $900,000 in damages for an incident that left an 86-year-old woman bruised and in handcuffs.
The woman’s son says he hopes the verdict puts for-profit care companies on notice to improve senior care in Oregon. And a Pamplin Media Group analysis shows there is plenty of room for improvement.
The analysis showed that three for-profit senior care groups with a large presence in the Portland area are being cited for problems more often than their nonprofit counterparts.
Two of those senior care groups, Alterra and Marquis, have facilities in Forest Grove.
The analysis also showed that one for-profit group, Avamere Health Services – which owns and runs the Lake Oswego facility where the woman was injured – has been cited far more frequently than the others.
A Multnomah County jury awarded a landmark penalty against The Pearl at Kruse Way, an Avamere Health Services facility, in a civil trial last month. The $904,200 verdict is believed to be the most money an Oregon jury has ever levied against a care facility for endangering an elderly person and compromising his or her dignity.
The woman, Elvera Stephan, died during the trial from unrelated health problems. The sum was awarded to her estate for injuries she suffered in an incident April 13, 2006.
That night, Stephan, who suffered from dementia, was handcuffed and restrained by police after becoming confused and accusing a caregiver of taking her car keys.
While Stephan’s injuries were caused by police putting her in handcuffs and keeping her on the floor, the jury arrived at the verdict after testimony showed that nurses and caregivers at The Pearl did nothing to intervene.
Testimony also showed that while Avamere marketed The Pearl as providing top-of-the-line care for dementia patients, workers there did not provide the care or have the training or medication that could have helped Stephan that day and prevented the call to police.
The nurse who called police did so from another wing of the facility, reporting Stephan was “extremely agitated” and “aggressive” and “threatening” without examining her, even though Stephan’s caregivers repeatedly asked for help.
Stephan ultimately suffered bruising to her forehead and wrists and twisted one of her knees, according to a subsequent state investigation. The Oregon Department of Human Services fined The Pearl $300 for failing to appropriately assist Stephan on its own before calling police.
Stephan’s son, James Stephan, now hopes the verdict involving his mother sparks discussion and puts care providers on notice to improve services.
“Avamere isn’t just going to have a $300 fine from DHS filed in a folder at DHS and just keep operating the way they were,” Stephan said. “What I hope is that it just brings some more awareness to our society.”
Probes uncover violations
But lately, for-profit care providers have been under fire nationwide. A Pamplin Media Group investigation found:
• For-profit nursing homes often provide worse care than their nonprofit counterparts, based on regulatory benchmarks and on citations issued by Oregon state regulators.
• For-profit companies often insulate themselves by creating labyrinthine corporate structures that make it more difficult to sue them.
• And, in Oregon, regulators say that some care providers are so profitable that relatively small government fines do nothing to encourage them to comply with government regulations.
Across the nation, a 2007 analysis by The New York Times showed that investor-owned companies provided substantially worse care for seniors than similar nonprofit ventures.
The findings echoed a 2001 study by researchers for the University of California and Harvard Medical School, which found investor-owned facilities showed deficiencies at a rate 46.5 percent higher than nonprofit facilities and 43 percent higher than public nursing homes in surveys.
The Pamplin Media Group’s look at three corporate care companies with facilities in the tri-county area – Avamere, Alterra and Marquis Care – showed similar results. The three are the for-profit companies with a large presence of multiple care services in the tricounty area.
The analysis looked at state citations for care violations and injuries at 59 facilities owned by the corporate care groups, five stand-alone for-profit firms and another seven nonprofit facilities.
On average, the corporate care groups were cited by state investigators more frequently than nonprofit and publicly owned senior care facilities.
Avamere had the highest per-patient citation rates. At 30 of its facilities, Avamere averaged one citation for every nine beds over two years between 2006 and 2008.
That rate was higher than citation rates for Alterra and Marquis Care, which received one citation for every 15 and 23 beds in their facilities, respectively, during the same period.
Nonprofit and publicly owned senior-care facilities, by contrast, were cited once for every 32 beds in their facilities.
Laundry list of problems
At Avamere, incidents that led to citations included:
• A patient at Avamere Rehabilitation of Clackamas developed gangrene for lack of foot care. The state cited the facility and fined it $500.
• Workers at Avamere Rehabilitation of Beaverton, who had not received fire safety training, according to state officials, left the door to the laundry room open while a fire broke out, filling the hallways with smoke.
• A patient lost 11.6 pounds after living less than a month at Avamere Rehabilitation of King City. Employees didn’t review the patient’s medical history and “failed to recognize” the patient’s loss of bowel and bladder control. The facility was cited and fined $1,000.
Avamere founder Rick Miller said long-term care is a tough business and one that often is unfairly criticized because it provides services to people who already are often very ill.
Miller said he and business partner, Rick Dillon, have tried to build a unique senior-care system that allows the elderly to get care where and when they need it. Avamere, a 13-year-old Wilsonville-based company, provides home health care, independent living, assisted living, dementia care, skilled nursing and hospice.
“We’re focused on building a business that we want to have when we need this level of care,” Miller said. “And one thing we know about seniors is they don’t want to be in nursing homes.”
But Miller acknowledges that innovation and growth have caused fluctuations in quality.
“We’re not where we need to be,” Miller said. “But we’ve got to be a company where, if there’s a problem, we’ve got to be transparent about that.”
Avamere starts self-reporting
Company data in 2005 and 2006 showed Avamere was falling behind state averages in periodic reviews of facility care, prompting the company to begin self-reporting quality issues to state regulators, a policy Miller believes may account for Avamere’s higher citation rates.
By the start of 2007, the company completed an aggressive restructuring aimed at improvement by appointing a new CEO, a quality control specialist and a company strategist.
Avamere also assembled a volunteer board of current and retired business executives and health-care experts to tackle problems.
Since then, Avamere’s numbers show the company has improved. In 2007, the company’s state surveys were better than Oregon averages, according to Avamere’s numbers.
But Mary Gear, the state’s licensing and quality care administrator, said the Department of Human Services would not still be issuing citations at Avamere if investigations involving the company – brought about by Avamere’s self-reporting or by others – did not turn up problems.
In July 2007, the same year Avamere officials hit high marks on state surveys, regulators had enough concern about the company to invoke a rarely used authority to initiate an investigation.
Citations still pile up
Following a probe of Avamere’s personnel files, state investigators cited nine of the company’s 30 facilities for failing to conduct criminal background checks on workers.
Avamere’s Oregon facilities received 251 citations in the two years between April 2006 and April 2008.
The citations were for everything from failing to provide essential care to failing to shield clients from rough treatment, financial exploitation, corporal punishment, mental and emotional abuse and unwanted sexual contact.
In 65 of the incidents, senior citizens in Avamere’s care were actually harmed. The state levied fines totaling $26,840 in 63 cases.
The $26,850 Avamere paid was a small fraction of the $250 million in revenue reported in 2007 in an article in American Executive magazine.
Penalties not sufficient
Gear said state-imposed penalties often aren’t sufficient to curb problems at senior care facilities.
She said officials tried unsuccessfully to get the 2008 Legislature to raise licensing fees and will try again.
“They are significantly lower than the national average and certainly lower than our neighboring states,” Gear said.
“We also proposed raising our penalty fines. … and again, those are significantly lower than most of our surrounding states.”