Part 4: A dysfunctional system

And in Pennsylvania, an Alterra employee was convicted of murdering William Neff, 83, a World War II combat veteran, who was stomped to death in 2000 after he soiled himself at the Alterra Clare Bridge facility in Lower Makefield Township, the same home where Paglione lived.

In the Neff case, an investigative grand jury publicly criticized Alterra for what it called a failure to screen and monitor its employees. (Neither the corporation nor senior executives were charged.)

That case aside, much of the history of alleged abuse and neglect at Alterra homes has gone unpublicized - buried in state bureaucracy and civil court archives, often shielded by confidentiality agreements that the company required relatives to sign as a condition of settlements.

Paglione's daughter, for example, said she was barred by such an agreement from discussing her case.

The Inquirer was able to review most of the suits only because Alterra filed for bankruptcy protection, and the lawsuits were consolidated into a single case at Wilmington's federal bankruptcy court.

In November, The Inquirer's lawyers won a judge's ruling forcing Alterra to disclose death and injury settlements that were filed under seal there.

According to those records, Alterra reached settlements totaling $15.9 million in 53 residents' injuries or deaths between 1999 and 2003, and set aside another $4.3 million for possible settlement in 20 other cases.

The assisted industry in general - and Alterra in particular - has improved since that period, Schulte said.

"That era of assisted living, there were a lot of incidents," he said. "It wasn't just Alterra. A lot of people got into the assisted-living field very quickly.... They really didn't know what they were doing.... We've learned a lot from that."

Schulte acknowledged, however, that resident harm and regulatory violations continue to be a fact of life at his company and in the industry.

"With a high-risk population like the kind we serve, you have the potential for bad things to happen," he said.

Feverish growth

Founded in 1981 by a Wisconsin nursing-home manager, Alterra went public in 1996, during a time of feverish optimism in the assisted-living industry.

With the senior population surging, investors were betting that demand for elder care also would skyrocket.

Like other assisted-living chains, Alterra pitched its facilities as less institutional alternatives to nursing homes, which are intended to house sicker people.

Alterra charged between $3,000 and $6,000 per month. Family members, who liked the clean, well-furnished look of Alterra's newly-built residences, say they believed they were getting something superior to a nursing home.

In fact, while most states require nursing homes to have nurses on staff, there are no such requirements in most states for assisted living. Some Alterra facilities were run by high school graduates with few formal qualifications.

For example, Ann McClintock, who ran the facility where Paglione lived, was a high school dropout who later earned her GED and began with Alterra as a housekeeper. McClintock, who pleaded guilty to neglect, told a Bucks County grand jury she was thrown into her job without proper training.

From 1997 to 2000, Alterra doubled its capacity by buying other chains and building new facilities. In 1998, the company was opening an average of one facility every three days.