BY COLLEEN DISKIN The Record
A chain of group homes that markets itself as a cozy and safe alternative for people with Alzheimer’s and dementia is in hot water again with state regulators — and the situation is reigniting a call for stronger oversight of these facilities.
Memory Care Living, which formerly operated under the name Potomac Homes, has been fined more than $20,000 for violating new staffing requirements — rules its own lawyers had negotiated with state regulators after a series of safety lapses. Inspectors said the company failed to hire more aides to help residents who needed more assistance.
The company is also facing lawsuits from the families of former residents, alleging the group homes failed to provide sufficient care and supervision.
Company officials are contesting the fines, saying the homes are staffed at appropriate levels and that inspectors are improperly enforcing regulations. In a letter to the Department of Community Affairs, the company’s attorney, Lisa D. Taylor, said the state’s enforcement action “constitutes harassment.”
Billed as alternatives to large, institutional long-term-care centers, the 13 suburban-style homes operated by Memory Care Living in New Jersey each have 15 or 16 private bedrooms, with aides on duty to provide mostly personal, not medical, care.
The facilities, eight of which are in Bergen County, are licensed as Class C boarding homes, a distinction that makes them subject to fewer regulations than nursing homes and assisted living residences. The Community Affairs Department is responsible for inspecting the group homes, but those inspectors have expertise in building and safety — not medical — issues.
Assemblywoman Valerie Vainieri-Huttle, D-Englewood, has sponsored a bill that proposes transferring regulatory authority over the 24 licensed dementia-care homes in New Jersey to the state health department, whose inspectors have medical training. It has passed in the Assembly and cleared a Senate committee on June 8 and will be reviewed by another committee today.
Huttle said the recent fines lend more weight to her argument that these homes should be inspected by personnel who are trained in how to read a medical file and evaluate the care a resident needs and receives. “It’s more than just bricks and mortar that needs to be looked at here,” she said. “It’s a question of the safety and well-being and the Department of Health is better suited to evaluate that.”
Huttle began drafting the legislation after a December 2012 article in The Record, which chronicled a series of incidents in which residents at the company’s homes wandered away or were injured. The homes were threatened with fines of more than $100,000 for incidents between 2010 and 2012, including one involving a female resident who broke a hip climbing out of a second-story window and another in which a male resident wandered into the middle of a busy intersection.
Wandering is a common behavior for people with dementia, and the company’s website advertises that its homes are designed to allow for “safe wandering.” But problems with residents getting out unnoticed through unsecured windows or doors date back to 2003, when a 75-year-old man climbed out a window of a Cresskill home on a winter night wearing only a T-shirt and later died, with hypothermia listed as a contributing cause.
The company has had a long-running battle with regulators, which came to a head in 2012, when the Community Affairs Department ordered the homes to discharge more than two dozen residents who were in wheelchairs or incapable of evacuating on their own in an emergency. The homes were not set up or staffed to handle residents with such mobility issues, state inspectors said.
The company argued that the families were intentionally seeking a more home-like setting for their loved ones and knowingly assumed the risks of the less-restrictive environment. It contended that the residents should be allowed to “age in place” instead of being sent to a nursing home.
The regulations governing the homes were rewritten in 2013 to allow the company to retain residents with physical and mobility limitations. Most of the $100,000 in fines were rescinded.
The new rules stipulate, however, that as homes admit more residents with mobility issues, they must hire more aides. The rules also require residents to be assessed upon admission and every three months afterward by a nurse from an independent home health company to determine whether they need help in an evacuation.
Not long after the regulations were finalized, Memory Care Living was cited on state inspection reports for failing to have assessments completed on all residents.
The company paid a $1,500 fine in September 2014 for failing to have evacuation assessments at its Chester Township home and a $1,000 fine in October 2014 for failure to submit documents requested by inspectors at its Paramus home. More fines were levied late last year, when state inspectors found homes in Park Ridge and Cresskill lacking the required staff.
On Jan. 15, inspectors issued a $5,000 fine against the Woodcliff Lake home for having 10 physically impaired residents, but only two staff members on some shifts instead of the required five. Two more $5,000 fines were issued in May for staffing shortages at homes in Hillsdale and in Middlesex County.
“Potomac appears to have no intention to comply with the … new dementia home rules,” an enforcement bureau official noted in a report.
In a letter to the Community Affairs Department in March, Taylor, Memory Care Living’s attorney, argued that the new rules do “not explicitly require” additional staffing
Amber Williams, senior vice president of operations, said in an interview that “it kind of comes down to a different definition of terms in the regulations.” She said state inspectors are failing to count other staff, such as activities directors and house managers, in calculating staff-to-resident ratios. All staff members are trained in emergency evacuation procedures and can assist if needed, she said.
The fine issued at the Hillsdale home came after a joint investigation this spring by community affairs and the New Jersey Office of the Ombudsman for the Institutionalized Elderly into a complaint from a former employee at the facility, Christine Mulligan.
Mulligan, who worked for a year as a part-time activities director, sent an email to Huttle in April alleging that she had witnessed several examples of lax care. In an interview, Mulligan said she arrived one morning to find that night shift aides had moved the furniture in the living room against the sliding glass doors to keep residents inside, which she considered a fire safety violation. She provided inspectors with a photograph.
Huttle forwarded Mulligan’s complaint to state inspectors. State documents show the inspection did not “support the allegations of neglect in the quality of care by the facility.”
Williams said managers would “absolutely not” permit staff to block doors with furniture. “Our whole philosophy is to allow our elders access to the outdoors,” she said. If a resident wanted to go outside at a time that wasn’t considered safe or when a staff member wasn’t available to supervise, aides are trained to “redirect” the resident to another activity, she said.
Meanwhile, the company has been contending with lawsuits alleging lax care of former residents.
The family of Mildred Ilchisin filed a lawsuit in state Superior Court in Hackensack in April claiming negligence and seeking unspecified damages. Ilchisin lived in a Memory Care group home in Mahwah, from Oct. 15 until Jan. 10, when a staff member found her that morning on her bedroom floor with a broken hip.
They didn’t know how she got there or how long she had been there,” said the family’s attorney, Marc Winograd of Leonia. Ilchisin, whose family has since had her transferred to a nursing home, had also suffered bruises prior to Jan. 10, which family members were never able to get a definitive explanation for, he said.
The lawsuit argues that the home didn’t deliver on promises made in advertisements that “there was round-the-clock attention in a safe environment with homes fully equipped to handle the concerns of dementia.”
A similar complaint was lodged in a suit filed in Mercer County court last summer. That claim alleges that, in the one week that Pietro Iaia stayed in a Princeton home, he suffered a fall and a fracture the lawsuit blames on “a wanton disregard” for his safety and well being. After a result of injuries, Iaia “suffered a painful and untimely death,” the lawsuit alleges
The family attorney, Michael Brusca of Princeton, said Iaia never should have been admitted to the group home because his condition required more supervision than Memory Care staff could provide. “They basically have nursing home-like patients in their home,” Brusca said. “They advertise for that population.”
Brusca’s law firm, Stark & Stark, also represented the family of another resident of the same home. The suit, filed in 2013 by the estate of Bertha Krainski, alleges she received improper treatment of bedsores and eventually required hospitalization. It alleges she died prematurely because of the negligent care. That suit was settled confidentially in December, and the attorney handling it, David Cohen, said he was prohibited from commenting.
Williams described these complaints as “one-offs,” saying “lawsuits get filed all the time.” She said the company has many satisfied families.
But Huttle thinks the health department can do a better job of deciding whether residents are suitably placed.
“This legislation is in no way intended to shut down these homes,” she said. “What we need to do is regulate them and keep them safe.”
Memory Care Living has not opposed Huttle’s legislation, said Williams, who said the company is just seeking “clarity” about the rules.