Maryland health officials are investigating the recent death of a mentally ill man who was residing in an unlicensed assisted living facility in Northeast Baltimore, one of "dozens" suspected of operating around the state without adequate staff or training to care for residents.
The 14-room house on Halcyon Avenue in Lauraville had been home for up to seven unrelated people with mental disabilities and other health problems for nearly two years. All the residents required the care of a medical professional or certified nursing assistant, officials said, but the facility was run by two people without proper training, including a man with a criminal record.
Investigators who visited the house in March said conditions presented "a threat to the health, safety and welfare of the residents." Donald F. Matthews, 50, who suffered from diabetes, seizures and bipolar disorder, died May 1. The resident manager said he called for help after finding Matthews, who had gone to bed, had stopped breathing and had blood around his mouth. State health officials said they're awaiting results of an autopsy and are investigating to see whether inadequate care might have contributed to his death.
State adult protective services officials said they have removed all the other residents of the house.
The state oversees more than 1,300 licensed assisted living facilities, but it has difficulty identifying and shutting down unlicensed operators. In the past two years, at least 30 such homes have been fined for not having licenses, but officials say they believe many more exist.
On Tuesday, the health department sent a notice of possible sanctions to an unlicensed assisted living program in Eldersburg that had been housing at least four residents with severe mental disabilities, including schizophrenia.
"I suspect there are, conservatively, dozens" of unlicensed facilities, said Wendy Kronmiller, director of the health department's Office of Health Care Quality, which licenses and certifies most types of health care facilities. "We only find out about them if there's a concern from someone in the community."
State health officials said there are not enough licensed assisted living facilities that will take low-income people with significant health problems. As a result, an underground cottage industry has sprung up in Maryland and other states, according to experts.
"You see cases where people are victimized by people who are not licensed - I have called it 'treating people like chattel or boxes' - and the reported caregivers take their [Social Security] checks and thus control the future of the person," Kronmiller said. "On the other hand, if you look at the records, you see that the people in these homes were receiving $400 a month, $600 a month. It's very difficult to find housing, period, for those kinds of sums, let alone housing plus medical care and provisions. There are not a lot of options for these people, and there are some that would argue that some of these providers keep people off the street."
Assisted living facilities provide "housing and supportive services, supervision, personalized assistance, health-related services ... in a way that promotes optimum dignity and independence for the residents," according to state regulations.
Not all group homes are subject to regulation by the state, Kronmiller said.
"Many sites that people might think are a group home that needs to be licensed, in fact, can be people who live independently, people who are in boarding houses or transitional housing," she said. "We only get involved when people have health care needs."
Since last September, the Office of Health Care Quality has issued two $10,000 fines to two different operators for running an unlicensed facility at the Halcyon Avenue house. At one point, officials said, they believed the facility had shut down, but in March, investigators - responding to a tip from neighbors - reported "serious findings about the quality of care" for seven new residents living in the house.
One 81-year-old man, for example, suffered from diabetes, blindness and congestive heart failure and required assistance with at least six medications. Another man, a 38-year-old with schizophrenia and diabetes, was said to be "very confused and/or psychotic. He has audio hallucinations and ... aggressive and hostile" behavior. Others required adult diapers, daily dressing for wounds or regular insulin shots.
Because of privacy, state officials cannot detail Matthews' medical history. Although they have not made any connection between the care Matthews received at the Halcyon house and his death, "He certainly wasn't in a situation where all the safeguards were in place," Kronmiller said.
On April 30, Matthews was taken from Raven's Medical Adult Care Center in West Baltimore, where he spent some of his days, to Maryland General Hospital for breathing problems, said Sadie Mae Handy. She was the operator of the Halcyon Avenue house and an employee at the day care center. She said she picked up Matthews at the hospital that evening and took him home. He went to bed about 8 p.m.
Shortly after midnight on May 1, Karl Williams Sr., the self-described manager of the Halcyon Avenue house, said he found Matthews not breathing and called 911. It is unclear whether he was pronounced dead at the house or at a hospital. A cause of death has not been determined.
Handy said that she believes Matthews should have been kept overnight at Maryland General Hospital, and that she and the Raven's facility did everything they could for him.
She said she provided good care at an affordable price for all the residents. If she hadn't taken them in, many would have been homeless. "No one would take them and I took them all," said Handy, who was licensed as a medication technician until November 2006, according to the Maryland Board of Nursing website.
Some residents were referred to Handy by Maryland General Hospital after they came in as patients. "There are no places to put mentally ill people," said Celeste Bland, a social worker at the hospital. "It's very sad."
Bland praised Handy's willingness to work with people with mental illnesses. Bland did not refer Matthews, but others who knew him said the formerly homeless man enjoyed living at the house. He had been there since December, Handy said.
Handy became emotional when asked about the former residents of the home. Wiping tears from her face, she said she "just wanted to help people."
"I'm from the Eastern Shore," said Handy, who is 50. "We pull weeds, we pluck chickens and we help people."
She said she didn't get a license because initially she didn't know it was required. Later, she said, she learned that to be licensed, operators and staff cannot have criminal backgrounds.
Williams said he didn't know Handy lacked a license. He said he has a background in home improvement and acknowledged he was not trained to care for the residents, but did it "out of the goodness of [his] heart."
He said Handy paid him $500 a month to feed, supervise, clean up after and occasionally change adult diapers for the residents. "I did everything but give them their medicine," Williams said, adding that Handy would "come in and give them their medicine and then leave."
Williams, 48, has a criminal record that includes convictions for second-degree assault and drug possession, according to court records.
The Office of Health Care Quality found that Handy collected $400 to $500 monthly from each of the residents, totaling $3,900. Handy rented the house from Peter Omonlumen Okojie, a pharmacist who in 2006 applied to open a group home for boys at the Halcyon house but was rejected by the city's zoning office. Handy paid $1,600 in rent to Okojie, who now says that he did not know there was a group home operating in his property and that he is evicting Handy.
Handy took over the Halcyon facility from Edna Evans, who also was unlicensed. The health department shut it down last December after finding four men and women with severe mental and medical problems living there and paying Evans for care.
Evans, who runs the Raven's adult care center, settled with the state for $5,000 and is paying the fine in installments, Kronmiller said. Evans could not be reached for comment.
"We routinely settle the money in return for them saying they won't get involved in these kinds of things anymore," she said. "What we're most concerned about is that people safely move the residents and they don't do this again."