Behind Closed Doors: Lockdowns Leave Homes Unchecked And Residents Vulnerable
The focus on COVID-19 last year didn't mean that the typical problems in Vermont's eldercare facilities went away.At one home, a resident was rushed to the hospital because of a medication error. At another, a med tech with a drug addiction stole a resident's pills. One caregiver is accused of grabbing her elderly charge in the groin and leaving him bleeding on the floor. Another resident had to be hospitalized because a home didn't train aides on how to manage bowel problems.
This is the second in a series of three stories co-reported by VPR and Seven Days. Listen to VPRand follow Seven Days this week and next for more stories from this series. Find past reporting from Worse for Care, here.
Pandemic-related shortcomings occurred, as well: In at least two homes, managers made no effort to keep residents distanced at mealtimes or to screen visitors for coronavirus-like symptoms.
That's just a sample of what's been documented during a year of relatively few inspections.
As state officials went into overdrive to keep the virus out of long-term care homes, they paid less attention to monitoring how well residents' daily care needs were being met. The same steps taken to reduce the risk of outbreaks also locked out critical watchdogs for residents' well-being. Most inspections were canceled.
Nobody really knows how well, on the whole, people in residential care and assisted living have been cared for. State regulators believe these homes largely rose to the unprecedented challenge posed by the pandemic. Advocates are less sure.
"Everyone is focused on COVID. But other things are still happening. The focus on COVID does trickle down, and it impacts quality of care." - Sean Londergan, Vermont long-term care ombudsman
"Everyone is focused on COVID," the state's long-term care ombudsman, Sean Londergan, told state lawmakers in January. "But other things are still happening. The focus on COVID does trickle down, and it impacts quality of care."
The pandemic exacerbated the chronic understaffing that was widely acknowledged as a crisis before the virus hit.
The past year also put financial strain on homes as occupancy rates dropped and operating costs increased. New safety precautions that were less familiar to workers slowed the pace of care, and the common practice of caregivers working jobs at multiple homes became less tenable.
"It was just trying to keep our heads above water," said Barbara Spear, the nurse administrator for Historic Homes of Runnemede in Windsor. A resident there was hospitalized last May with withdrawal from a medication that a nurse forgot to reorder. The residential care home was short-staffed in the pandemic's early months, which Spear said led to "not as much oversight."
Yet this seemingly perfect storm did not lead to a spike in complaints to the array of state offices and advocacy groups that watch out for residents. Instead, those made to an independently run ombudsman program for eldercare homes dropped by nearly 50 percent. Complaints from all sources to the state's Adult Protective Services office dropped by 13 percent. They remained flat overall to the Department of Disabilities, Aging and Independent Living's licensing office.
That's likely because families were unable to visit and residents had less access to resources such as ombudsmen, who haven't been inside homes since the state of emergency began in March 2020.
In addition, fewer of the complaints submitted have been investigated. Adult Protective Services' casework dropped by nearly one-third, while DAIL's licensing arm visited eldercare homes just 29 times in 2020, compared to nearly 140 visits in a typical year.
When COVID-19 struck, the agency worried that eldercare homes wouldn't be able to cope. While not as densely packed as nursing homes, the residential care and assisted living industry includes a wide spectrum of professionalism and facility types, from large, corporate-run facilities to tiny mom-and-pop homes where managers don't have clinical — or sometimes any — credentials.
"The biggest risks were in those smaller facilities that didn't have the requirements for a medical director," then-DAIL commissioner Monica Hutt told lawmakers in January. Gov. Phil Scott has since promoted her to a new addiction prevention position.
Early in the pandemic, Scott used his executive authority to explicitly shield long-term care homes from any civil liability stemming from their COVID-19 response, making it harder for families to sue homes that may have failed to protect residents.
DAIL likewise focused more on helping homes stem outbreaks than holding them accountable. The agency offered technical support and resources, eventually funding a pool of emergency workers who could respond in crisis situations. The state applied federal guidance for nursing homes to its state-licensed eldercare homes and halted all but the most urgent inspections. Licensing surveyors instead took to reviewing each home's COVID-19 precautions with its manager.
"They really need a lot of help to understand how to keep their residents safe," licensing chief Pam Cota said. "So instead of coming in afterwards and just telling them what they did wrong, we just took a very proactive approach."
The informal infection control reviews, conducted remotely, took months to complete. Only three resulted in formal regulatory violations, which serve as black marks on a home's record and require that they submit a written plan of correction. Cota said the few problems uncovered showed that the overwhelming majority of homes were taking their responsibilities seriously.
One of those cases, however, suggests that the state's reliance on homes to self-report their precautions was sometimes misplaced.
Following a consultation last August, the state deemed Lakeview Community Care Home, a Howard Center-run residential care home for people with mental illnesses in Burlington, "low risk" for a COVID-19 outbreak.
A residential counselor working alone on the overnight shift discovered a copy of the state's assessment while tidying up a back office. The report, he noticed, was based on a long list of precautions the home's managers had said they were taking.
"I started reading it, and I was outraged," the counselor, Justin, told Seven Days and VPR. "They were lying about how protected we were."
Justin, who requested that the news outlets withhold his last name so prospective employers would not recognize him as a whistleblower, filed a complaint to the DAIL surveyor listed on the report.
"The biggest risks were in those smaller facilities that didn't have the requirements for a medical director," - Monica Hutt, former DAIL commissioner
By mid-August, a state surveyor inspected Lakeview in person and cited the facility for unsafe practices. Managers had told the state that any resident who stayed at the hospital quarantined at an off-site location before returning to the home. It wasn't true. Five days earlier, a resident had refused a COVID-19 test at the hospital and been allowed to return without quarantining, the surveyor found. That resident wasn't the first to do so, Justin said.
The home also had initially told DAIL that residents weren't allowed to leave the property. In fact, "they go into stores, go to the beach, and walk around the city at will," the surveyor learned when following up. They also ate around the same dining table for every meal.
The lapses were especially risky at a home such as Lakeview, which housed 16 or so residents with severe mental illness in a converted building. Its narrow corridors, tiny bedrooms and shared living quarters would make a COVID-19 infection harder to contain.
The Howard Center agreed to change some practices as a result of the investigation. Justin quit in October. When surveyors returned to the home in November to follow up on another complaint, they didn't cite any violations.
In an interview, the Howard Center's director of long-term supports and services, Delaina Norton, attributed the cited violations to a "communication" issue and said they clarified their procedures as a result. "I'm really proud of the work that's happened in our community and within our residential programs," she said, "and Lakeview is included in that."
The virus struck Lakeview on January 21 — just after the home had held its first vaccination clinic. Thirteen people got infected, but no one died, according to the Vermont Department of Health.
At two other residential care homes, surveyors encountered managers who were seemingly oblivious to the state's COVID-19 guidelines.
At Washington Elms, a 24-bed home in Bennington, the manager claimed to be unaware of state rules for how and when facilities could relax their lockdown measures. Contrary to state guidelines, the home was found to be allowing visitors outside and not screening them for illness. Further, residents continued group activities and meals — unmasked. Staff, too, didn't always wear mandated masks in the home, and managers weren't taking employees' temperatures each day as required, according to an August 12 inspection report. Neither Washington Elms' owner nor its manager returned requests for comment, but the state report indicates that the home agreed to change its practices.
Securing compliance at Owen House, in Fair Haven, proved more difficult.
Leanne Towle Ledo was glad to be able to visit with her mother, Flora Jane Towle, before she passed away at the home last September. Beginning in the summer, Towle's family was initially able to visit with her outside on a veranda, socially distanced and with masks, then inside her room once she was placed in hospice. Ledo said the caregivers seemed diligent about COVID-19 precautions, from her admittedly limited vantage point.
"I don't know what they were doing when I wasn't there," she said.
The state had a different impression when a surveyor visited the home last October to follow up on its remote infection review — one of the few in-person visits of the year. The surveyor found some maskless staff and residents, no symptom screenings, and no supply of surgical masks or gowns. Employees hadn't received any structured COVID-19 safety training, according to the state's report. The home's owner and manager, Catherine Rooney, claimed she wasn't aware of state guidelines because, she told Seven Days in an interview, the home doesn't have internet access.
Regulators were well acquainted with Rooney. Owen House has the worst inspection record of any Vermont eldercare home, the 2019 investigation by Seven Days and VPR found. Her other residential care home, Harvey House, had thesecond-worst track record, according to the analysis, before she converted it into unlicensed rental housing. The news outlets' investigation scrutinized the most egregious violations at Rooney's homes and found that, other than one $5,200 fine, she hadn't faced any professional consequences.
The backlog of investigations and general inspections will take years to clear
More than two months after the state discovered lax precautions, Rooney still hadn't submitted a written plan of correction. So a surveyor drove to the home in early December and hand-delivered the form. By late January, Rooney still hadn't submitted it. But surveyors were back at Owen House on January 26, thanks to a new complaint.
The problems uncovered during the more thorough January visit ran deep.
In the middle of the night on October 23, one of Owen House's four residents, who had schizophrenia, got into a physical fight with a caregiver, according to a licensing survey and report by Fair Haven police. The caregiver was taken to the hospital by ambulance after, as Rooney later told surveyors, the resident "beat the shit out of" her employee.
The injured caregiver was alleged to have accepted money from the resident to cover her medical costs, which state regulations forbid in order to protect residents' interests. "I mean, I don't think I should have to pay for it," the employee told the inspector. "Do you?"
She shouldn't. But Rooney had let her state-mandated workers' compensation insurance expire months earlier, claiming that she couldn't afford the premiums. By January, Rooney told the state, she was still scrounging for money to cover the employee's ambulance bill.
Rooney had not reported the financial exploitation allegation to the state, nor had she investigated it. "What am I gonna investigate?" she explained in an interview for this story. The employee still works at Owen House, though DAIL cited the home for failing to ensure that the resident was free from exploitation.
"It has not been fun for anybody ... It's like, you don't see the pot of gold at the end of the rainbow. And all I've ever tried to do was make a nice place for people to be happy, healthy and safe." - Catherine Rooney, Owen House owner and manager
When DAIL investigated in January, the state's surveyor found a slew of unrelated problems. Owen House's contracted supervising nurse hadn't entered the home since February 2020. A majority of the residents hadn't had their required annual care assessments completed in years. Employees still hadn't undergone formal COVID-19 training.
All of this occurred while Owen House operated under an expired residential care home license. The license lapsed on September 30, 2019, but the state didn't compel Rooney to renew it until December 2020, when she failed to follow through on the COVID-19 plan of correction. DAIL denied her application on March 5 on technical grounds, because she didn't have workers' compensation insurance.
Rooney claimed that she recently acquired insurance but has decided to close the home anyway. She's fed up with, as she put it, "the whole COVID thing."
"It has not been fun for anybody. And whatever. I'm tired. I'm frustrated," Rooney said. "It's like, you don't see the pot of gold at the end of the rainbow. And all I've ever tried to do was make a nice place for people to be happy, healthy and safe."
Asked why the state didn't intervene sooner at Owen House, Cota said she has to consider how enforcement affects elderly residents. "For me to shut down someone's home is a really big decision. I don't take it lightly," she said. DAIL has yet to receive a formal shutdown plan from Rooney. Homes must submit a plan and inform residents at least 90 days before they are discharged.
Now that eldercare home residents are vaccinated, Cota's office has begun following up on less urgent complaints that it received over the past year. The medication error at Historic Homes of Runnemede occurred in May 2020, but DAIL only followed up to inspect in February.
The backlog of investigations and general inspections will take years to clear. Advocates worry that it's not always possible to get to the bottom of allegations so long after the events occurred. Meanwhile, a rewrite of 20-year-old industry regulations that was nearly drafted before COVID-19 hit remains on indefinite hold. Cota said it would be unfair to saddle homes with new mandates while they're still reeling from the virus.
A case at Our House Too, in Rutland, encapsulates the present state of affairs. The small home for people with dementia is currently defending a civil lawsuit brought by the family of Marilyn Kelly, who died in 2016 following a physical assault by a caregiver. Last August, five months into the pandemic, a similar incident took place at the home: A frustrated caregiver allegedly struck a resident who was leafing through paperwork in the kitchen, and a struggle ensued, according to an affidavit filed in Rutland Superior Court. The 83-year-old man was bleeding when a second caregiver found him.
The home reported the alleged assault to authorities and regulators. The caregiver surrendered her nursing assistant license, faces misdemeanor criminal charges and was substantiated for abuse by Adult Protective Services.
As of early March, DAIL's inspectors still hadn't gone to Our House Too to review the home's processes or document the abuse violation. Because the employee accused of harming the resident was fired, Cota said, the situation didn't meet the threshold for immediate follow-up.
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