Va. Records Show More Problems In Assisted Living

A 52-year-old diabetic man died after staff at his Farmville, Va., assisted living facility failed to follow doctor's orders when he fell ill. A resident wandered away from her Springfield facility and was found two hours later lying in the emergency lane of the Fairfax County Parkway. And at a home in Blacksburg, a resident was hospitalized in December after she was given too much insulin.

The incidents are among the latest failures in care found by regulators at licensed Virginia assisted living facilities, disclosed in the past week by the Department of Social Services. The agency, which licenses more than 627 facilities across the state, detailed the problems in records on its enforcement actions since March 1.

The homes, licensed to care for more than 34,000 people, have been the subject of debate among state officials and advocates after a recent series of reports in The Washington Post that found thousands of incidents of harm since 1995. Records documented avoidable injuries and deaths at the homes and a system of state oversight that often failed to identify or correct problems.

Department of Social Services Commissioner Maurice A. Jones has called for major changes in regulation, including increased fines, more inspectors and more stringent caregiver training and staffing requirements for facilities. Sen. Jeannemarie A. Devolites (R-Fairfax) said she and Del. Vivian E. Watts (D-Fairfax) had recently met with Jones and discussed introducing comprehensive legislation to tackle a broad range of problems in assisted living.

A subcommittee of the General Assembly's Joint Commission on Health Care is meeting Tuesday in Richmond to hear from regulators, advocates and industry groups on assisted living. Some are expected to propose broad changes in Virginia.

Jeff Hairston, president of the Virginia Adult Home Association, said that most of the homes provide good care but that many struggle with insufficient resources. Next year, he said, his group will push the legislature for increased state reimbursements for homes that take in low-income residents.

"We don't mind regulatory changes . . . but [they] can have a profound cost impact," Hairston said, adding that the state rate of $28 per resident per day is inadequate.

Assisted living facilities in Virginia range from small, mom and pop businesses in rural areas to sprawling, upscale chains that charge more than $5,000 a month. Residents generally are in need of supervision and care but are not sick enough to qualify for a nursing home.

Many of the residents are mental patients moved out of state institutions, a practice described as dangerous by Val Marsh, executive director of the state affiliate of the National Alliance for the Mentally Ill. She said the practice should be scrapped in favor of developing more appropriate housing for those who suffer from mental illness.

The latest round of records disclosed by regulators details a wide range of problems at 18 facilities that led to stepped-up enforcement actions.

At Briery Creek Adult Home in Farmville, about 50 miles east of Lynchburg, a 52-year-old resident with severe diabetes, heart disease and other medical problems had suffered incidents of low blood sugar twice in early April 2003, but staff members at the home failed each time to administer his prescribed emergency medication, according to records. In one instance, they instead fed the resident "four waffles and sugar-free syrup," regulators wrote.

A third incident occurred April 11, 2003, when a worker heard groaning noises coming from the man's room. Inside, the staff member found him "foaming at the mouth, eyes rolling back and unconscious." The employee called 911 and put a damp cloth on his face while waiting for the ambulance, which he told inspectors took 30 to 45 minutes to arrive.

Once again, they did not administer emergency medication, regulators said.

"The physician's orders were not followed. There was not any blood sugar level taken," inspectors noted, adding that the caretaker involved "was unable to distinguish" low blood sugar from high blood sugar.