When trust is betrayed for dependent adults

Washington licenses three types of long-term care facilities: adult family homes, nursing homes and boarding homes (or assisted living centers.)

Adult family homes are residential homes licensed to care for up to six residents. They provide room, board, necessary supervision and assistance with daily living and personal care activities. Some provide occasional nursing care. Some offer specialized care for people with mental health issues, developmental disabilities or dementia.

Nursing homes are the only type of facility required to provide 24-hour supervised nursing care, specialized therapy services and nutrition management. Generally, people needing the highest level of long-term care live in nursing homes.

Boarding homes and assisted living centers are designed for more independent living. They usually provide room, board and varying levels of assistance with care. Some provide nursing care.

The Washington State Department of Health licenses all health care providers in the state. Two common types of providers working in adult family homes are certified nursing assistants and registered nursing assistants.

Here is the state credentialing requirements for both types of nursing assistants:

Registered nursing assistant: No formal training required. However, those working in nursing homes have four months to complete an approved training program and testing for certification.

Registered nursing assistants must also provide a statement detailing their physical and mental health status, lack of impairment due to chemical dependency/substance abuse, history of loss of license/certification/registration, felony convictions, loss or limitations of privileges, disciplinary action and professional liability claims history.

They must also complete a seven-hour HIV/AIDS course.

Certified nursing assistant: A minimum of 85 hours of training must be completed through a state-approved program. Applicants must also pass the competency exam. Verification of placement on a state Omnibus Budget Reconciliation Act registry is required if the applicant is applying for endorsement.

Certified nursing assistants must also provide a statement detailing their physical and mental health status, lack of impairment due to chemical dependency/substance abuse, history of loss of license/certification/registration, felony convictions, loss or limitations of privileges, disciplinary action and professional liability claims history.

They must also complete a seven-hour HIV/AIDS course.

Pam Pratt knew something wasn’t right.

Her mother, Mildred “Mickey” Newman, struggled to communicate after suffering a stroke. But her behavior hinted that something was upsetting her at the Vancouver adult family home where she resided.

Or rather, someone.

Pratt and her sister Debbie Johnson were angry to learn in April 2009 that their mother’s caregiver — registered nursing assistant Susan Meade — was accused of yelling at, cursing and threatening their mother and another resident.

They were horrified to learn two years later, in March 2011, that Meade had been accused of doing more than verbally abusing their 83-year-old mother. She was also accused of rubbing a soiled disposable diaper in Newman’s face.

And they were outraged to learn that despite the allegations and despite ongoing investigations by two state agencies, Meade still had her state-issued credentials and was free to continue working.

Just two weeks ago — more than 28 months after the incidents occurred — the Washington State Department of Health suspended Meade’s license for two years, at which point she can petition to have her privileges reinstated.

“To take two years to investigate and give her two years to respond to this complaint is criminal because she still had time to do things to the most vulnerable people in our society,” Pratt said.

Cindi Laws, executive director of the Washington State Residential Care Council of Adult Family Homes, shared Pratt’s frustration.

“The state took 2[½] years,” Laws said. “We got in and out of the Persian Gulf War in less time than that. Yet the state of Washington will allow people to be subjected to a bad caregiver (in order) to protect that caregiver.”

Dual supervision

Part of the problem, Laws said, is two different state agencies conducted separate investigations of Meade.

In Washington, the Department of Health is responsible for the licensing of health care providers. The Department of Social and Health Services is responsible for identifying abuse and neglect within adult family homes and other long-term care facilities.

The dual supervision means in some cases, like Meade’s, both agencies are conducting investigations involving the same person.

“You have these two really important divisions of the state but there’s not a lot of collaboration,” Laws said.

“DSHS and DOH are notorious for taking years for investigating problems,” she added.

In Meade’s case, the owner of the adult family home fired Meade immediately and reported the allegations of abuse to DSHS on April 16, 2009. DSHS launched an investigation into the claims and issued a preliminary finding April 22, 2010. The finding said Meade was guilty of physically and mentally abusing vulnerable adults.

Meade didn’t appeal the decision so the finding became final May 27, 2010. DSHS prohibited Meade from working in a position that involves the care of vulnerable adults or allows her to have unsupervised access to vulnerable adults. However, she was still licensed to work as a nursing assistant.

Following the DSHS decision, the Department of Health launched its own investigation.

On Feb. 7, 2011, DOH charged Meade with unprofessional conduct. Meade requested to defend herself against the allegations at a hearing, which was scheduled for Aug. 16. However, Meade failed to appear at a scheduled pre-hearing conference on July 22.

On Aug. 9, the department of health suspended Meade’s registered nursing assistant credentials for 24 months.

“I’m very unhappy that there wouldn’t be any other stipulations,” Pratt said. “It’s ridiculous. To me, just biding your time doesn’t solve anything.”

Meade could not be reached by phone for comment and did not respond to The Columbian’s written request for comment.

DSHS investigation

DSHS Residential Care Services receives complaints regarding adult family homes. The complaints are vetted and those that warrant follow-up are passed along to one of seven investigators in the state, said Bob McClintock, Residential Care Services quality assurance administrator.

After collecting information, the investigator assesses the information and decides whether to move forward. The burden of proof is 51 percent or “more probable than not” that abuse occurred, McClintock said.

Preliminary findings are drafted if the investigator believes abuse, neglect or financial exploitation of a vulnerable adult occurred. The accused has 30 days to appeal the decision and request a hearing.

If the person does not appeal, or appeals and is found to have committed the abuse, the findings become final and the person is placed on a statewide registry.

State law prohibits long-term care facilities from employing individuals on that registry.

Providers are able to check if employees are on the registry by providing a Social Security number and birth date, but the database is not readily available to the public.

Until findings are final, they are kept confidential in order to protect caregivers in the case of unfounded allegations, McClintock said.

“You have to remember that caregivers are people too,” he said. “It isn’t like you want to cause them to lose their livelihood for a period of time and hire an attorney to defend themselves (against unfounded allegations). There’s a sense of fairness there too.”

The length of the complaint investigation process varies from case to case and can take anywhere from six to seven months to a couple of years to complete, McClintock said.

In 2010, DSHS received 543 complaints related to adult family homes. Of those, 15 cases resulted in final findings, two of which were in Clark County.

Despite the DSHS findings, Meade may have continued to work with vulnerable adults. Another caregiver recognized Meade’s name from the March 2011 Columbian article about the investigations and claimed Meade was employed by Addus HealthCare in Vancouver.

A woman who answered the phone at Addus two weeks ago said Meade had been an employee of the company but is no longer employed there.

“She hasn’t been with us for a couple months,” the woman said.

A call to the Addus HealthCare headquarters in Palatine, Ill., was not returned.

But DSHS’s enforcement of the findings is somewhat limited.

DSHS doesn’t discipline caregivers; it can only cite long-term care facilities for violating state law and putting vulnerable adults at risk by hiring caregivers with findings, McClintock said.

Addus places caregivers in homes to provide various medical, personal care and companionship services and is not certified by DSHS. In some cases, though, Addus would have to adhere to DSHS restrictions. For example, Meade would not be eligible to provide Medicaid funded in-home care because those contracts prohibit the use of caregivers with DSHS findings, McClintock said.

“With adult family homes, and all licensed and certified facilities, the provider is responsible for the safety and care of the individuals,” he said. “It’s not the state.”

DOH investigation

The Washington State Department of Health follows a similar investigatory process.

DOH receives complaints against health care professionals. Investigators conduct interviews, review any existing medical documents and legal action against the provider.

If the evidence supports the allegations, the state will file charges against the caregiver, said Gordon MacCracken, DOH spokesman.

The accused is given the opportunity to appeal the charges and request a hearing. If the accused doesn’t respond, or a hearing finds him or her guilty of the charges, sanctions are imposed. Disciplinary action can include requirements of additional training, suspending privileges or revoking licenses.

The state may also elect to settle with the provider prior to a hearing, MacCracken said.

The length of time it takes to conduct an investigation and impose sanctions varies from case to case, he said.

“It’s a serious issue to take someone’s credentials from them,” MacCracken said. “It takes time to conduct that investigation, to hear people out.

“In cases where there appears to be an immediate risk of harm, there will be an immediate suspension,” MacCracken said.

In most cases, there is not an immediate risk of harm and the provider maintains their credentials and is allowed to continue working during the investigation, MacCracken said.

Questioning the system

In September 2010, despite being under investigation by DOH, Meade’s credentials were renewed for another year — a decision Laws found unfathomable.

“We’ve got some wonderful providers that are working hard to protect their residents, and it’s sometimes appalling how the state doesn’t seem to take the same interest,” Laws said.

Pratt and Laws also question why caregivers aren’t immediately suspended pending investigation, like teachers and police officers who are accused of serious wrongdoing.

“With teachers when something looks seriously inappropriate, they aren’t allowed to stay in the classroom,” Laws said.

The practice puts the workers’ right of due process above the well-being of people seeking long-term care, she said.

“There is no conceivable way that someone can convince me, as head of this organization, that vulnerable people are being protected from bad caregivers,” Laws said.

In addition to swifter action, Laws said she wants providers to have more access to information.

In the past, the state operated a public database with the names of workers under investigation by the state. The state eventually stopped making the information public on the grounds that it should protect wrongfully accused caregivers.

Laws would like to see that list made available to providers who want to know whether current or potential employees are being investigated.

Others dismissed

After Meade was fired from the adult family home, two other women working there were fired for verbally and physically abusing Newman, according to Newman’s daughters.

“I think one of the reasons mom was targeted was because of her inability to communicate,” Johnson said. “They treated her that way because she couldn’t tell on them.”

The thought of Newman being abused at a time when she couldn’t stand up for herself keeps Pratt up at night.

Newman suffered a second stroke in December 2010. She died Jan. 3.

Tears roll down Pratt’s cheeks as she talks about her mother’s final years.

“Mom fought so hard for eight years after (the first stroke),” Pratt said. “She shouldn’t have had to fight the people that were hired to make her life better.”

Marissa Harshman: http://twitter.com/col_health; http://facebook.com/reporterharshman; marissa.harshman@columbian.com; 360-735-4546.