February 11, 2009 5:45 PM

Assisted Living, Erratic Regulation

By
John Kreiser
President-elect John F. Kennedy in Miami, Nov. 14, 1960, and then-Sen. Barack Obama, Oct. 16, 2006.

President-elect John F. Kennedy in Miami, Nov. 14, 1960, and then-Sen. Barack Obama, Oct. 16, 2006. (AP)

(CBS)  Dennis Camarata lost his father in a way no child could imagine.

At age 83, Mike Camarata was healthy and active — but dementia had turned him almost childlike. So his family placed him in an assisted-living facility in Michigan because it would feel more like home, CBS News chief investigative correspondent Armen Keteyian reports.

"They encouraged you to wander around," says daughter-in-law Mary Camarata. "He would go in the refrigerator and drink orange juice out of the jug."

In April 2004, Mike Camarata drank from a jug he found in an unlocked kitchen cabinet. But he wasn't drinking juice — it was a toxic, industrial dishwashing detergent containing lye.

"The chemical just literally burned his entire mouth and then burned him all the way down," says Dennis.

Four days later, Mike Camarata died what Dennis calls "a horrific death."

So how could a toxic chemical be stored, unlocked, in an Alzheimer's wing? One reason: Unlike nursing homes, the nation's 36,000 assisted living facilities — places designed for seniors who don't need constant medical attention, just a little extra help — are not subject to any kind of federal regulation. A CBS News investigation has found that state laws are literally all over the map.

Read Armen Keteyian's Reporter's Notebook
Elder Abuse Resources
For example, only 32 states require CPR and first aid certification. Just 24 require a nurse on staff, and Alabama is the only state in which the medical director must be a doctor.

"No real policies. No real sanctions. No accountability," says
Jules Olsman, an elder-care attorney.

And no way, say elder-care experts and industry insiders, to track what they say are a growing number of negligence cases.

In Pennsylvania, 69-year-old Angelita Torres was an Alzheimer's patient who wandered away from an assisted living facility. She was found drowned in a nearby canal.

In Georgia, 70-year-old Ann Wideman should have been moved from assisted living to a nursing home after she became bedridden. Instead, the facility kept her; she developed a massive bedsores and died from the infection.

"They knew and they didn't do anything about it," says Toni Godfrey, her daughter. "They let her die."

In Michigan, where Mike Camarata died, facilities outnumber inspectors 100-to-1. There is no requirement that staff members for Alzheimer's residents receive any special training. As for regular caregivers, they must be "awake and fully dressed."

Keteyian asked Marianne Udow, the woman in charge of assisted living in Michigan, who writes the laws that basically say "awake and fully dressed" is enough in some people's mind to provide resident care.

"Those are probably old regulations," she says. When told that they date from March 2006, she adds that the laws "probably been in place for many, many years and have not been updated."

When asked if families know what the quality or lack of quality of some of the care is in the state's assisted living facilities at the moment, she says, "I think they don't."

After Mike Camarata's senseless death, the state's only response was a letter, asking the facility if a "corrective active plan" was implemented.

"So you're father's death boils down to a 'don't do this again' memo?" Keteyian asks.

"Pretty sad, isn't it," says Dennis Camarata.


Correction: This story was updated Nov. 14, 2006, to reflect new information from the state of Minnesota. Minnesota recently implemented laws specific to assisted living that include background checks for all staffers and a nurse on-call at all times; last week the state confirmed to CBS News it had no staff requirements.

Copyright 2009 CBS. All rights reserved.
Add a Comment See all 42 Comments
by mlhunt November 18, 2006 9:39 PM EST
The problem I have with ALFs is that they accept people who need far more help than they are prepared or equipped to provide. Most of the ads and websites for ALFs show people who are able to get around easily by themselves and just need some help with housework and other simple assistance. But many ALFs are now claiming to have "specialized memory care units" designed for people with Alzheimer's. When ALFs start taking in people with advanced dementia and other complicated medical issues, they are dealing with situations that would be better handled in a nursing home. The results are the types of tragedies documented in this story, as well as in articles that have appeared in the Washington Post, USA Today and many other publications. It is not at all unusual for patients to suffer fatalities in ALFs, but the facilities seldom face serious consequences. They need the same regulations as the nursing homes.
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by ap646668 November 17, 2006 4:04 PM EST
The death of the gentleman is inexcusable. Chemicals should always be under lock.

As a nursing home administrator with over 20 yrs of experience, I would pose the following question. Where are the families? The only good I see coming from the lopsided report, is to encourage families to do some research before placing a loved in any tpye of living facility. My wife is the administrator of an ALF. Just last week she was offered 2x the going rate if she would take back a resident (dementia)that she had to discharge because the ALF could not meet her needs nor provide a safe environment.

Having operated 5 LTC centers and filled 10 interim positions, I observed that the best care was always provided by the facilities that had the most interaction with the families. As a former educator, I can make the same observation. In most cases, parental involvement resulted in a better learning environment.

The whole concept of involvement is called teamwork.

Unfortunately we spend more time shopping for a new car than we do for healthcare for a loved one or daycare for our children. Care and safety should take presedence over location and convenience. Thank you. Augie Pepple
Reply to this comment
by hehobson November 17, 2006 10:59 AM EST
As the President and CEO of Plymouth Harbor, CCRC,in Sarasota, FL who has spent the past 26 years at assisted living and nursing homes in Ohio, Virginia and Florida and exposed to over 100 other's nationwide, I found this story to be unbalanced, sensationalisitic, yet sufficient to create further anxiety among not only those who currently reside in assisted living facilities and nursing home; but, those who are planning a move for either themselves or a loved one.

My question is what was left on the "editing room floor" as programs such as this one are produced and edited. Witnessing the loving care of a nurse, aide or visitor is also important. Observing the way we preserve the dignity of those who need us most is important and newsworthy.

Katie, et al, you owe it to the public to show the balance that you know exists.

We welcome you to Sarasota to spend not just a few minutes, but perhaps a few days to view our care at Plymouth Harbor which I believe is more representative of long-term care. Send someone in undercover, but if you do a story ("60 min. style") may I have an opportunity to sit in on the editing session to make sure what you show has balance?

Respectfully,

Harry Hobson
Reply to this comment
by tomm9050 November 17, 2006 2:27 AM EST
What "OTHER SIDE OF THE STORY" is there here? The ALF was negligent and lax and a person who was entrusted to their care, died! Or more correctly; was killed.

The fault is entirely with the facility. What would the other side of the story be? Mr. Camarata should have known better? Those here defending and shilling for the ALF industry, should be ashamed.
Reply to this comment
by thkh95 November 17, 2006 12:35 AM EST
Maybe CBS should look beyond one or two states and one or two ALFs. 1000's of ALFs throught all 50 states provide excellent, loving, care to the nation's senior citizens. But I guess CBS would not have a story to air if it was about a 84 year old lady that lived in a house alone, had few visitors, ate one meal a day, mismanaged her medications and then made a life changing decision to move to an ALF where she got loving, nurturing care from mission driven people. She ate three delicious, well-balanced meals a day and took her medications with the help of loving staff. And this lady, turned around and became the social butterfly that started up a bridge club and coffee group in the cafe every morning. This 84 year old lady now has a dignified, social, healthier, dignified, improved quality of life, but I guess that would be a story worth airing on a national news show, now would it?
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by thkh95 November 17, 2006 12:28 AM EST
Okay - let's federally regulate assisted living, because federally regulating nursing homes have improved them greatly, right? I don't believe so, no, the increased regulations, the increased paperwork, the increased liability, the increase fines, the increase requirement, and the decreased reimbursement have left nursing homes in shambles. Now let's run the ALF's down the same road, because we proven oh so well that federal regulation works!
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by cab555-2009 November 16, 2006 9:23 PM EST
I believe the most significant issue here is that CBS news chose to present a story as complete fact, obviously failing to report both sides accurately. This is such a disappointment; much like reading a tabloid. I will have trouble believing CBS news in the future.
Three tragic stories were told, but we know that those are anomalies, not the norm. The assisted living industry is state-regulated, not a bad thing. They are not nursing homes, they do not need physician leadership, nor RN's on duty. If people need daily RN assessment, they should be in skilled nursing facilities, not assisted living. ACF's provide help with dressing, bathing, meals, housekeeping, laundry, medication administration and activities. A safe place to be when they can no longer be safe at home. And living with families is not always optimal. They are sometimes left alone frequently, and family dynamics often prove stressful for everyone.
Every industry has good and bad, in ours it is certainly the good that prevails. Your news story was more like a tabloid story, with sensationalism and catch phrases like, "Assisted living business, risky business?" Oh, dear.
Would you please consider doing the story again, but with a more equal content?
Reply to this comment
by ced15 November 16, 2006 6:22 PM EST
As a employee of the assisted living community in Milwaukee for over 15 years, I have witnessed unfortunate incidents. But, to say that an ALF is not regulated is incorrect. The DHFS in Wisconsin has set rules and regulations which must be followed to ensure proper care and resident safety. Caregivers are screened, have background checks run with the State and must complete several training courses in order to complete resident care and maintain employment. This also includes continuing education on a monthly basis during their employment. Surveyors from the BQA do visit, and they do cite when problems are found.

What CBS has showed is the worst that could happen. To assume that all facilites provide this type of care to their residents is wrong.
I have been employed over the years for several companies and have worked side by side with incredible caregivers, nurses, and other providers who ensure that their residents are given the love, dignity, and respect that they deserve.

How about airing a follow up story showing the other side of the coin? You will without a doubt find thousands of families and residents who are extremely happy with the care that they recieve.
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by griffinj3 November 16, 2006 12:29 PM EST
The story is beyond sad and my heart goes out to the families affected.

However, I do not understand the neglectful way the media presented the story. It almost came across that ALL assisted living facilities were amoral in the care they provide their residents.

In the state of Florida, the state regulations are written for the protection of the residents. I believe that every possibility is covered. Let me assure you when a state survey is performed they do not cut anyone any slack for any infraction and you are not simply slapped on the wrist. Providers know that they are held to high standards and if they cannot live up to those standards they should not enter the assisted living arena and if they do, they won't last long unless their standards meet the state requirements.

There may be states that do not require high standards and that is wrong. But please do homework and give credit to the states that are striving to meet the needs of our true assets - our elderly.

Reply to this comment
by tomm9050 November 16, 2006 1:39 AM EST
Bravo CBS! This is an important story that needs to be told! It mirrors our experience with an ALF precisely. Although there may be a lot of well intentioned and sincere individual caregivers, this has become a corporate business, more concerned with the "bottom line" than the actual well being of the elderly and infirm. A business preying on those least able to defend themselves and on the guilt of family members overwhelmed by the demands of an aging spouse or parent. There was NOTHING in this report that was untrue or one sided, although it was curious that the facility refused to participate. This industry needs to be investigated and more thouroughly regulated! What they do borders on criminality.
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