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Part 4: A dysfunctional system
A jumble of state-by-state rules let a chain of horrors grow.
Some consumer groups have urged Congress to consider federal rules for assisted living, and the Senate Special Committee on Aging held a hearing on the subject in April 2001. But Washington has been reluctant to create a new regulatory scheme for an industry that, unlike nursing homes, is not funded with federal dollars.
"The argument was, there is very little federal money going into assisted living, so there's no hook for federal regulation," said Catherine Hawes, professor of health policy studies at Texas A&M University.
One leading state regulator believes some national enforcement scheme is inevitable.
"There's no question that if the federal government doesn't step in, we're going to have states that continue to loosely regulate assisted living, and people are going to get killed or injured as a result," said Rick Harris, Alabama's top regulator and a former head of a national group of state elder-care officials.
Harris was speaking about the industry in general, not Alterra specifically.
Federal regulation is not a panacea, he added. But he believes the status quo isn't working, at a time when the need for senior care is poised to explode in the next few years as Baby Boomers reach retirement age.
"The bottom line is, the pressure is on assisted-living facilities to accept residents that are really beyond their ability to take care of," he said.
A lawyer for the Neff family, though, notes that federal regulations haven't stopped elder abuse in nursing homes.
"Institutional neglect and abuse will end only when the highest level of managerial officials of those corporations face criminal punishment" for allowing it, said attorney Ronald N. Lebovits, who often represents victims of such abuse.
Today's Alterra
Because there is no national database for assisted-living regulatory violations, it is difficult to compare today's Alterra with the past, or with other chains.
Since Brookdale took over, Schulte said, the company's regulatory record has been better than most of its competitors.
These days, he said, the company has preemployment screening and criminal background checks, employee-training programs, an employee-integrity hotline and sophisticated software to track incidents.
"That kind of thing was not being done," years ago, he said.
There have still been violations cited at some Alterra homes.
At Alterra's home in Westampton, Burlington County, regulators in the fall of 2005 found a resident with a broken arm who had suffered repeated falls, some of which had not been recorded, and a resident with skin tears who was not being treated.
Alterra submitted a plan of correction, and the state required the company to hire an independent nurse to monitor compliance.
On Jan. 29, an 80-year-old woman fell and died at Alterra's Wynwood facility in North Wales, Montgomery County. That death is under investigation by Pennsylvania regulators; Schulte declined to comment on the death, or any specific incidents.
Acting Montgomery County Coroner Jeanne Ottinger said the cause of death was heart disease, but that fractures to the woman's elbow and hip had contributed to her death, along with diabetes and emphysema. "She appeared well cared for," said Ottinger.
Last March, a relative or friend of a resident of the North Wales facility wrote a letter of complaint to state regulators. The name of the complainant was blacked out in the copy released by the welfare department.
