SUFFERING IN SILENCE: HAWAI'I ELDERLY VICTIMS
States get creative in efforts to protect elderly

By Mike Gordon
Advertiser Staff Writer

From Washington, where law enforcement authorities were forced to share ideas, to New Mexico, where care-home inspectors work undercover, protecting the nation's frailest citizens has challenged officials to be creative.

Carol Scott, the Missouri ombudsman and president of the National Association of State Long-Term Care Ombudsman Programs, said there is no single best answer. States that have good multiagency efforts, strong long-term care ombudsmen programs and laws that allow government to step in to correct a problem often do well, Scott said.

Part of the problem is in spotting something that doesn't immediately look like a problem or crime. And even when they are noticed, there are no guarantees.

In Scott's state, four elderly women died after temperatures on the third floor of their residential care home reached 98 degrees in April 2001. But an investigation began only after a state hot line call from an alert paramedic, who had been to the home several times over two days, Scott said.

A lack of laws addressing elder neglect prevented anyone from being prosecuted, however. This year, the Missouri Legislature will consider mandatory autopsies for care-home deaths, she said.

"The problem of abuse and neglect is it can be happening in even a nice, pretty facility where the staff has nice uniforms," Scott said. "You have to be watching to see if the residents are staying as healthy as they can, is there water for them and are they eating good food."

Four times a year, Scott said, the Missouri ombudsman meets with a diverse group of officials to discuss problems and potential legal cases — state and federal law enforcement, prosecutors, licensing agencies, doctors, nurses.

The goal is simple: share information and advice. Scott called it "a real eye-opening" experience.

The Missouri Department of Health and Human Services also keeps a "blacklist" of care-home staffers — about 800 at last count —Êwho were found to have abused or neglected residents. Depending on the severity of the charge, those staffers may be prevented from working in a care home again, Scott said.

Washington also tracks offenders from care homes and, like 38 other states, requires a criminal background check for anyone who will have unsupervised access to a care-home resident. (In Hawai'i, bills mandating criminal background checks for similar workers have died four times since 1999.)

But probably the most effective change came three years ago when the Washington attorney general brought the state's association of sheriffs and police chiefs together to discuss elder abuse and neglect investigations, said Assistant Attorney General Jennifer Boharski, chief of the office's resident-abuse section.

The group produced the Vulnerable Adult Contact Network that went out to 400 law enforcement agencies. It gives officers and supervisors information about how to respond to cases and who to call for advice, Boharski said.

"If you are responding to a nursing home as a crime scene, you have different considerations," she said. "The victims are more vulnerable and may have physical limitations you are not used to."

Boharski said hundreds of books have been distributed and they are forcing people to do something very simple and very effective: Talk to each other.

Officials in King County, Wash., recognizing that criminal neglect was difficult to prove, took the network one step further, she said. They created a task force with doctors and nurses volunteering to review deaths for prosecution.

One of the solutions that most states take as a given is the practice of unannounced inspections. At least 25 states allow it, but it is not allowed in Hawai'i, where 545 licensed adult residential care homes provide most of the adult care.

"You can't have a system that has any integrity if you announce inspections," said Meredith Cote, the Oregon long-term care ombudsman. Substantiated abuse or neglect become public record in Oregon and that has proven far more effective than fines, which max out at $6,000.

"The prospect of being stigmatized by abuse on their records is worse for the facility than the fines we assess," Cote said.

Officials in Washington began unannounced inspections in 1998, said the state's ombudsman, Kary Hyre. The change was made after a string of deaths and a fire that killed eight people.

"We documented incredible failures to protect residents," he said.

Improvements were almost immediate, he said.

"Right away the department began to catch bad things," he said. "They closed several facilities that were endangering people."

But only New Mexico sends investigators into care homes undercover.

The practice, which became part of state law in 1995, has not been well-received by care-home operators and even the national ombudsman association says it's too much.

"Most of us think they shouldn't do that," said Scott, the Missouri ombudsman and association president. "Our role is to make sure that licensing or some other agency goes out and finds something."

New Mexico ombudsman Katrina Hotrum said these types of investigations are needed to know exactly what residents experience on a daily basis.

"We found out how a resident really feels," she said. "They are really lost in the system. Sometimes residents aren't fed for days because they are new and people don't even know they are in their rooms."

Care homes are chosen based on the number of complaints, although the New Mexico ombudsman can legally enter any of the state's 400 care homes at any time, Hotrum said.

The undercover investigations, however, are not done annually. The last round was in 1999 when Hotrum dyed her boss's hair white, burning his scalp in the process.

His was one of four undercover investigations. Minimum standards of care and cleanliness were not met at three of them.

When her boss arrived at the six-resident home in Albuquerque, he was given the bed of a resident who had died the previous day, Hotrum said.

"There was still blood and stains on the sheets," she said.

He stayed for a week in the home, where hallways reeked of urine and rooms of soiled linen. He was fed Spam for every meal.

These types of investigations have created a tense relationship between care providers and state officials, Hotrum said.

"The industry doesn't like it," she said. "It's a scary thought for them. What we found really puts them on guard. You never know when we are going to be there."

Reach Mike Gordon at mgordon@honoluluadvertiser.com or 525-8012.