Oversight questions raised on Elder Affairs

Agency does little with incident reports

The state’s Elder Affairs office, which is charged with regulating some 200 assisted living facilities that care for more than 12,000 senior citizens, some of them suffering from dementia, appears to be asleep at the switch.

The agency receives about 6,500 reports a year of abuse, neglect, falls, and other incidents, but does very little with the information. Only recently did the agency start assembling the data electronically, which would allow for easier scrutiny. Even so, there is little evidence the agency is using the information to look for patterns, either in general or at specific facilities.

The agency has rebuffed repeated efforts by CommonWealth to review the incident reports and the agency’s process for handling them. The agency has also resisted entreaties from an advisory board for access to the reports.

Peter Antonellis, a compliance officer at elder affairs, said the agency does almost no analysis of the data it is gathering. He says the agency cannot say how many people have fallen down, wandered off, been abused, or exploited. He said there are no procedures in place on how to handle incident reports as they come in.

Antonellis contacted CommonWealth after noticing emails between agency officials and the magazine. He said the emails raised many of the same issues he had brought up a year ago in a memo sent to top officials at the elder affairs agency as well as John Polanowicz, the governor’s secretary of health and human services.

In his memo, Antonellis said he believed poor management at elder affairs was endangering the safety of residents living in assistant living facilities. He said the agency’s incident reporting program is “nothing more than a hollow and dangerous façade.”

Officials at elder affairs, who declined to be identified by name, said their regulation of assisted living facilities is rigorous and appropriate. They also noted that the residents of assisted living facilities negotiate their own service plans with the facilities and are capable of moving to a different residence if they are dissatisfied with the facility in which they are living.

Elder Affairs employs two ombudsmen to investigate and resolve grievances from residents at the state’s 224 assisted living facilities. Regulations governing elder affairs require the agency to operate a statewide network of ombudsmen who would visit at least one facility once a month.

Antonellis said two ombudsmen in Boston are not enough. “This is clearly not sufficient to tend to the needs of all the people who are living in assisted living residences spread throughout out the state,” he said.

Officials at elder affairs say the two ombudsmen are sufficient. One official said residents of assisted living facilities “have access to an ombudsman whenever they need it, and it provides the support that people need.”

Assisted living facilities offer apartment-style housing, meals, assistance with personal care needs, help with taking medication, and socializing activities to seniors who can no longer safely live by themselves, but who do not need the intensive, 24/7 medical care available in nursing homes.

David Hoey, an attorney specializing in nursing home and assisted living law, said he believes many incidents never get investigated because Elder Affairs is stretched too thin.

“Elder Affairs just doesn’t have the resources, the manpower, the time to properly inspect and investigate all the assisted living facilities in the state,” he said. “There’s so many more serious problems out there that just don’t get reported.”

One of Hoey’s current clients, William Myerson, is suing his former assisted living residence, Emeritus at Farm Pond in Framingham. Myerson, who suffers from Alzheimer’s disease, alleges he was physically harassed by a staff member at the facility on March 30. The incident was caught on videotape.

Antonellis said that Elder Affairs has taken no action against Emeritus at Farm Pond.

Robert Shuman, a medical malpractice attorney who represents assisted living residents, says that the operators of the facilities are allowed to put “profits over safety” and often do not have the trained staff and other resources necessary to insure resident safety.

Shuman contends that the companies’ emphasis on occupancy rates — what some have called “putting heads in beds,” a reference that originated in the hotel industry — leads to people being accepted who should not be because they require a higher level of care or being kept on even after their medical needs have grown beyond what the facility can provide.

Tom Grape, the CEO of Benchmark Assisted Living, with 24 locations in Massachusetts, says that the accusation that assisted living facilities accept or keep residents who do not belong there is mostly unfounded.

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“Does it happen from time to time that a resident stays too long due to some extenuating circumstances? Yes, I’m sure it does,” Grape said. “Look, we’re dealing with frail, elderly folks whose needs change. But sometimes families don’t want to admit mom’s condition has deteriorated further and she might not move out as quickly as a provider might suggest.”

Emily Meyer, the president of the Massachusetts affiliate of the Assisted Living Federation of America (Mass-ALFA), a trade organization, said the care provided by facilities is good. “I think in Massachusetts we have a very successful model,” she said.