In Florida, where nearly one of every five nursing homes is on a state "watch list" for poor care, patient advocates say a federally mandated watch-dog program is crumbling — at a time when it's needed most.
"It's really a broken system," said Brian Lee, executive director of Families for Better Care, who led Florida's watch-dog efforts until early 2011. "There's a leadership vacuum in the ombudsman program, and the state needs to open up and be honest about what's going on. … People are dying in these facilities."
In recent months, inspectors have found disturbing problems:
•At one for-profit nursing home in Orlando, federal investigators this spring found an elderly man had repeatedly sexually molested at least four female patients, groped several of the female staff and continued to urinate in the hallways — with little done to stop him.
•At a Melbourne nursing home last year, a woman fell from her wheelchair during an outing and hit her head. The staff didn't call 9-1-1, though the patient developed a bump the size of an orange. By the time she was transported to a hospital nearly two hours later, the woman needed surgery and later died.
•In June, state investigators fined a Winter Haven facility more than $17,000 after workers resuscitated two elderly patients — including a 102-year-old — against their expressed wishes not to be intubated to prolong their lives. State inspectors found the facility "violated these residents' rights to … have a peaceful and dignified death."
In many facilities, volunteer ombudsmen in the watch-dog program are the only regular visitors the residents see.
That ombudsman effort, established by the federal Older Americans Act, was intended to be a safety net for vulnerable residents of nursing homes and assisted-living facilities across the country. In Florida, the program consists of a handful of paid staffers at the top and the volunteers — charged with watching over some 4,000 facilities.
But this summer, the state's leader of the program resigned after being placed on indefinite leave while Florida officials conducted an investigation into unspecified allegations of wrongdoing against him. That official, Jim Crochet, was brought in two years earlier to replace Lee — at the recommendation of the nursing-home industry.
Two weeks after Crochet's departure, a top deputy also abruptly resigned, as has the chairwoman of the ombudsman council, a St. Petersburg college professor.
The departures came just as the state began requiring its long-term-care Medicaid patients to enroll in HMOs, starting with about 9,300 Central Florida residents.
The state Department of Elder Affairs, which oversees the ombudsman program, strongly denies any problems, other than being "bombarded by an onslaught of negative press."
"Increasingly over the past few weeks, attacks have been used to publicly bemoan an imagined decline of Florida's Ombudsman program and to spread gross misrepresentations of program policies and decisions," department officials said in an Aug. 27 statement.
Spokeswoman Ashley Marshall characterized the program as "thriving."
Though the number of volunteers fluctuates, there are now about 370 across the state. They must undergo background screening and training before they start. They must do at least yearly inspections of all the facilities in their assigned area. And they must investigate individual complaints from residents — about 7,600 last year — responding within seven days and following up with a written report.
Don Hering, the program deputy who abruptly resigned, said the volunteers are devoted, but that the program is suffering at the top — plagued by bureaucrats "more concerned about their careers and building their retirement accounts than the residents." Hering spent seven years as a volunteer before accepting the deputy post, where he received stellar job performance reviews.
The AARP and other consumer groups contend that the shift to HMOs makes the ombudsman program all the more vital. The managed-care industry and the nursing-home owners, they worry, may be more concerned about cutting costs and building profit margins than protecting patients' well-being.
In recent years, the nursing home industry has increasingly shifted to the for-profit marketplace, driven by its investment potential. On average, nursing home stocks have risen 415 percent since 2003, more than twice the pace of the Dow Jones Industrial Average for the same period, according to the independent investment research firm Morningstar.
"It's a big responsibility," acknowledged James Croteau, a retired nonprofit Elder Care Services leader and Leon County school official tapped by state leaders to head the ombudsman program while they search for a replacement. "But I've been impressed with the program … and I'm coming in with the assumption that the facilities all want to do a good job and provide a nice, safe, homelike, accommodating environment for the residents."
Lee and other critics are less optimistic.
In Winter Haven, for example, four of the city's seven nursing homes are on the state's watch list, meaning they either have chronic, long-term problems in staffing, patient care, cleanliness or unhealthy conditions or especially egregious short-term ones.
"More than half of the people in these facilities have Alzheimer's disease or some other form of dementia," said Sheldon Kanars, a long-time ombudsman volunteer and retired patent attorney from Port Saint Lucie. "And they're not going to be able to tell you something's wrong in the kitchen.
"You have to go a step further," he said.
In February, Kanars sent a memo to fellow volunteers in his district urging them to take more initiative when it came to inspecting facilities. Two days later he was told by officials he needed to resign.
That, it turned out, was contrary to a Crochet directive to stay narrowly focused on residents' complaints.
The application period for a new state ombudsman leader ends Monday. And spokeswoman Marshall said a hiring decision will be made "as soon as possible."
Lee, for one, hopes they get it right this time.
"I'm really supportive of the ombudsman program," he said. "I'd love to see it expand even — because that's the best chance to protect the residents."
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