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.
The resident was hospitalized with severe hypoglycemia and other problems, including respiratory failure, according to regulators. "His condition continued to deteriorate," and he died days later, inspectors reported.
Inspectors also said that staff at Briery Creek had administered insulin to the resident for more than a year but were not properly trained to do so.
Regulators fined the home $500. The facility administrator did not return repeated telephone calls, and the owner declined to comment.
In Springfield, a resident of Greenspring Village who suffered "serious cognitive impairments" wandered undetected from the home last Christmas, inspectors said. She was found by a motorist a mile away "lying in the emergency lane of Fairfax County Parkway." Workers later told inspectors that an alarm system used to monitor residents had gone off several times that day but they had failed to conduct head counts because they were busy with a holiday luncheon. The facility was fined $500 for the incident.
Pamela Clark, the Greenspring Village administrator, noted that the resident was able to return to her apartment within hours, that staff reported the incident to regulators and that "comprehensive actions . . . have been implemented."
At Faith and Victory Home for Adults in Newport News, inspectors found in December that a resident had been living in the attic for about a month, records show. This and other problems, including dirty conditions and a period when the electricity was cut off for unpaid bills, led state officials to inform the home in April they were not going to renew its license. The facility has appealed.
The home first refused to allow an inspector into the attic, records show. After entering, the inspector found two mattresses, clothing and a "small Polaroid picture of the resident." The attic had holes in the wall, "which allowed the inspector to view the outside framing of the house," records show. Coretta Evans, the administrator, declined to comment.
At Warm Hearth Village's Showalter Center in Blacksburg, where a resident was given an overdose of insulin, an employee had failed to document the dosage, according to records. When the resident was "found unresponsive and in insulin shock," another employee had to contact the worker at home to verify how much insulin had been administered.
The facility was fined $500.
Tambra Stone, director of marketing for the facility, acknowledged the mistake but said the resident was new to insulin and that "a variety of health conditions contributed to her needing to go to the hospital."
Staff researcher Bobbye Pratt contributed to this report.