Part 4: A dysfunctional system

In July 2002, a resident wandered away from an Alterra facility near Orlando, Fla., and drowned in a pond. Although a door alarm sounded, staff ordered no head counts of the patients, and did not call police, records show.

Also in 2002, an 84-year-old woman wandered into the outside courtyard of a home in Tulsa and froze to death. It was at least the third incident since 1999 where an Alterra resident wandered into a courtyard and died, according to public records and news reports.

Safety hazards

In May 2000, an Alterra facility was fined $10,000 by Kansas regulators after a resident suffocated while stuck in the guardrails of a bed.

In 1998, an Alterra resident died in Florida after she was found "hanging upside down from the footboard area of her bed, with her head swollen, and her leg caught in the bed rail or footboard of the bed, a position she had been left in for six to eight hours," according to a lawsuit.

There were dozens of other incidents, records show. An internal Alterra document dated April 2000, and covering 1998 to 2000, listed 159 open claims, including 11 marked by Alterra as resulting in "death," four cases of "abuse," nine "assaults" and nine "elopements," the industry term for people who wander away from the home.

In the case of Mildred Garner, the elderly woman assaulted in North Carolina, the family's lawsuit says Alterra's records show that they had for weeks observed dangerous behavior by her attacker, an 84-year-old Alzheimer's patient.

Twice, he tried to hit staff members, and he was quoted as telling a resident he "might have to kill someone."

After the attack, Alterra employees put her to bed instead of taking her to the hospital, and she was later found in a pool of her own urine, records show. The next day, she was diagnosed with a fractured hip. She never fully recovered, and died two years later, her daughter said.

Because of the bankruptcy, Kathryn Garner, who paid $6,000 a month to Alterra, has little chance of recovering anything from her lawsuit, her lawyer said.

"They kind of treat this as, 'Oh well, it's the price of doing business,' " Kathryn Garner said. "Well, my mother was a human being who suffered, who had feelings and couldn't communicate. She couldn't even yell for help."

Some state regulators and local prosecutors sought to change Alterra's conduct, but their reach was limited.

In February 2002, the district attorney in Centre County charged Alterra as a corporation with criminal neglect in the deaths of three residents with severe bedsores. The company denied wrongdoing and the charges were thrown out in a preliminary hearing.

New Jersey banned admissions at all 12 Alterra facilities in the state in June 2001, citing "widespread deficiencies" that were "placing residents at risk for serious harm." It was the first and only time the state had taken that action against a chain, officials said. A few months later, New Jersey lifted the ban after the facilities promised to improve.

In March 2000, the Minnesota attorney general won a settlement after leveling civil consumer-fraud charges against an Alterra facility near Minneapolis where both employees and relatives of residents reported understaffing and neglect.

Alterra promised to improve care, to change its advertising, and to hire an independent monitor. But the agreement only applied to one Alterra facility in Minnesota.

Then as now, there was no government agency that had the power to force company-wide changes in national assisted-living chains.

State regulators have inconsistent standards and no way of coordinating enforcement beyond their borders.