Despite City Law, Few Assisted Living Centers Licensed

By Jackie Spinner
Washington Post Staff Writer
Monday, March 3, 2008

Most assisted living centers in the District have not been licensed or inspected eight years after the D.C. Council mandated government oversight of the facilities and set standards for such matters as dispensing medication, training staff and providing adequate bathrooms.

As a result, consumer advocates say, some of the District's most vulnerable residents have been left at greater potential risk for abuse and neglect as an industry that offers housing and daily care for the elderly has taken root in the city.

The city has sought to rectify the problem in the past year under the stewardship of a new mayor and in response to a court order. But as of last month, only the Knollwood military retirement home and the Lisner-Louise-Dickson-Hurt Home, both in Northwest Washington, had obtained a license. The Health Department estimates that seven others will apply by an April 1 deadline.

Technically, the 2000 D.C. law prohibits assisted living centers from operating without a license. Such licenses are standard in most states, including Maryland and Virginia. The centers cater mainly to elderly people who cannot live on their own but do not need the specialized medical care provided in nursing homes.

"D.C. is far behind the ball," said Lydia Williams, who works for the D.C. Long-Term Care Ombudsman Office, a federally mandated advocate for the elderly. "As long as the government doesn't have it together, the bad providers will take advantage of it."

The ombudsman's office, which over the years has fielded complaints about assisted living centers including alleged thefts from residents and questionable discharges, has no power to enforce regulations. The D.C. Health Department does have such authority but has only recently exercised it.

"It simply was not a priority of the previous administration" of Anthony A. Williams, said D.C. Council member David A. Catania (I-At Large), chairman of the Health Committee.

The council did not intervene because it had larger public health issues on its agenda, he said, adding that his committee is now focused on long-term care.

LaShon Seastrunk, a Health Department spokeswoman, said the department began to implement the assisted living regulations a year ago, after Mayor Adrian M. Fenty (D) appointed Feseha Woldu as senior deputy director of the Health Regulation and Licensing Administration. Woldu formerly oversaw the District's licensing of physicians and other health-care professionals.

She said Woldu revived a dormant advisory committee and looked at national best practices in outlining how the regulations would be enforced. "It was his task to get the District compliant," she said.

A D.C. Superior Court judge gave a further push in September, ordering the government to carry out the regulations in response to a lawsuit from the ombudsman.

Assisted living centers are designed for people who are fairly active but may have difficulty bathing, remembering which pills to take or preparing nutritious meals. Under the law, residents have the right to stay in the facility if they are paying their bills, if their level of care has remained relatively stable and if they are not a threat to themselves or other residents. But the ombudsman's office has investigated several reports of questionable discharges, including the case of Margery Arrowood.

The 83-year-old was living at Sunrise at Thomas Circle on Massachusetts Avenue NW when she was discharged two years ago to a nearby homeless shelter without her family's knowledge. "They just dumped her," said Jerry Kasunic, the D.C. long-term care ombudsman.

The D.C. Office of Administrative Hearings ordered Sunrise to readmit Arrowood in 2006, according to court documents. She still lives there. The Health Department did not follow up with an inspection or investigation, Kasunic said.

Arrowood's niece, Martha Gilbertson of Northern California, said her aunt had expressed interest in staying at Luther Place Memorial Church without fully realizing she was being sent to a homeless shelter. "It was a horrible mistake," Gilbertson said. Sunrise, she said, left her aunt at a shelter that was "completely unsuitable for [an elderly woman] who had not taken care of her own personal needs for many, many years."

Daniel Schwartz, senior vice president of North American operations for Sunrise Senior Living of McLean, which owns the facility that discharged Arrowood, said she had been living in a nursing care section of the center at one point but then no longer needed the higher level of skilled care. He said patient confidentiality rules limited what he could say about the case but acknowledged: "We could have done, and should have done, a better job of keeping the ombudsman more involved."

Nationwide, there are more than 36,000 assisted living centers, according to the National Center for Assisted Living. There is no federal oversight of the centers, and the industry does not have uniform standards, although the centers generally provide 24-hour supervised care and access to licensed medical staff.

Maryland's Department of Health inspects centers annually, and the state regulates how much training managers must have, how many residents can share a room and the numbers of meals that must be served daily. Virginia's Department of Social Services inspects centers at least once a year.

The D.C. law requires yearly inspections and stipulates that residents have a right to live in an environment that "is creatively designed to counter loneliness, depression, dependence, boredom, and designed to manage difficult behavior." To date, the District has not tracked centers with records of poor care or fined any that might have violated the law. Nor is there a precise count of assisted living centers in the city; officials say there are about nine.

Consumer advocates criticized the delay in government action.

"Eight years is a long time. . . . I'm just puzzled," said Susan Reinhard, director of the AARP Public Policy Institute. "It's important to have regulations. That should be a consumer protection, a consumer right."

Monthly charges for assisted living centers in the District range from about $3,000 to more than $14,000 for a penthouse at Grand Oaks Assisted Living in Northwest.

Medicare does not cover such charges, and most centers do not accept Medicaid for low-income people. That means most older D.C. residents never see facilities that sometimes feel like upscale hotels, with colorful cloth napkins in dining rooms and special molding, instead of metal handrails, for residents to brace themselves.

Grand Oaks, with 142 residents, offers bridge games, afternoon walks, crafts and movie screenings.

Although the center is not licensed by the District, a group known as the Grand Oaks Family Council has emerged as an advocate for residents. Nancy W. Newkirk, whose 88-year-old mother has lived at the center for more than two years, is a co-chairman of the council.

Newkirk said she knew the center was operating without a license but was reassured when managers told her that Grand Oaks followed the same regulations as those in Maryland, which she considered to be "the most stringent in the country."

Paul M. Kelley, executive director of Grand Oaks, which is managed by Sunrise Senior Living, said the center will not have to make any changes to obtain a license because it has followed D.C. regulations voluntarily since opening in 2000.

"It's a process of understanding the regulations and being in compliance with the regulations, but that's the minimum," he said. "Regulations can't account for every case. It's focus on detail that's very important. Really, I think you owe that to your residents."

Staff researcher Meg Smith contributed to this report.