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Vt. regulators fail to regularly inspect, quickly address issues at elder care facilities, audit finds

A photo of a person using a walker while another person in scrubs assists.
miodrag ignjatovic
A new report from the State Auditor’s Office found that regulators who oversee Vermont’s elder care facilities don’t conduct enough inspections, or follow up on serious problems in a timely manner.

State regulators tasked with overseeing Vermont’s elder care facilities don’t conduct enough inspections, or follow up on serious deficiencies in a timely manner, according to a new report issued Wednesday by the State Auditor’s Office.

The auditor’s office reviewed 691 inspections of assisted living facilities and residential care homes, which are overseen by the Department of Disabilities, Aging and Independent Living. The inspections occurred between the start of 2016 and June 2022. Assisted living facilities and residential care homes — unlike nursing homes which follow federal guidelines — are governed solely by state regulations. There are 114 residential care homes and assisted living facilities, with 3,283 beds in Vermont.

The findings of the audit mirror the findings of a 2019 investigation by Vermont Public andSeven Days. The news outlets found patterns of inadequate staffing and care that have led to indignities, injuries and deaths, as well as a system of oversight with light regulation and limited enforcement.

More from Vermont Public andSeven Days: When Elder Homes Stumble, Frail Vermonters Get Hurt

The auditor’s office found that 53% of DAIL’s inspections documented substantial noncompliance, and that the department failed to inspect facilities annually, which is required by law. As of earlier this month, 11 facilities hadn’t been inspected since 2018, the report says.

Federal guidelines for nursing homes require DAIL to follow up on potentially life-threatening problems within 23 days. But the audit found regulators don’t follow up on similar problems at residential care homes and assisted living facilities as quickly.

For the most serious deficiencies, ones that could cause injury or death, DAIL revisited facilities to make sure the problems were fixed, but the report said it took regulators between 54 and 125 days to conduct follow up inspections. For the next most severe problems, DAIL didn’t follow up more than half the time, and when inspectors did return, it took between 35 and 148 days, according to the report.

“I have no reason to question the intentions — the good intentions, no doubt — and the skill of the people running these efforts within DAIL,” said State Auditor Doug Hoffer in a phone interview. “But you know, what we found really needs attention soon.”

“I have no reason to question the intentions — the good intentions, no doubt — and the skill of the people running these efforts within DAIL. But you know, what we found really needs attention soon.”
State Auditor Doug Hoffer

The report also found that DAIL doesn’t have a formal process to track if a facility repeatedly violates the same regulations, which the auditor’s office said limits the department's effectiveness at enforcing compliance.

The audit also found that DAIL rarely takes enforcement action against elder care facilities. The department has levied five fines ranging from $600 to $70,000 since 2017. DAIL hasn’t issued any fines since 2019, according to the report.

“They're concerned about using all their enforcement powers, because it might put somebody out of business,” Hoffer said. “But if it is determined that a facility is incapable of ensuring the safety and well-being of patients, then why should they deserve to stay in business?”

The department has put troubled facilities under control of outside management. Most recently in 2021, DAIL petitioned to have four Rutland-area elder care homes placed in receivership after regulators documented a spate of problems, including a resident who died from a head injury after getting into a fight with a staffer at one of the facilities. The Attorney General’s office reached a settlement with that group of elder care homes last year.

More from Vermont Public andSeven Days: Lockdowns Leave Homes Unchecked And Residents Vulnerable

The auditor’s report included a dozen recommendations for DAIL, including:

  • Conduct licensure inspections annually.
  • Immediately inspect facilities that have gone without inspection for four years.
  • Create a system to track facilities that have repeated violations.
  • Establish stronger procedures for following up on serious violations.

DAIL Commissioner Monica White, in a written response to the auditor’s report, said that the department has “been aware and have acknowledged the need for increased regulatory oversight of state licensed long term care facilities.”
White pushed back on some of the findings in the report, including that DAIL is required to conduct annual inspections. White said that the department determined that the law requires an initial inspection for a new facility, and subsequent inspections for re-licensures could be conducted every two years.

DAIL also halted re-licensure inspections during the pandemic, and is still working through the backlog of inspections, White added.

But she said that a new unit tasked with overseeing state regulated health care facilities would “generally align” with the recommendations made by the auditor’s office.

The Legislature approved funding for five new positions at DAIL to create a state licensed regulatory unit, White said, adding that increase in staffing would allow for “more timely follow-up” when serious issues are found.

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Liam is Vermont Public’s public safety reporter, focusing on law enforcement, courts and the prison system.
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