Opinion: Showing need for senior-care reforms

The AJC’s disturbing findings on problems, and allegations of neglect and abuse of the elderly here should prompt improvements.
A screenshot of an AJC searchable database at ajc.com/unprotected of information on assisted living and large personal care homes.

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A screenshot of an AJC searchable database at ajc.com/unprotected of information on assisted living and large personal care homes.

In a state that forcefully proclaims its value of human life, it’s sad that Georgia has failed to protect some of its most vulnerable citizens, those along the path toward life’s end.

That's the inescapable conclusion from The Atlanta Journal-Constitution's investigation into substandard care at some Georgia assisted living and personal care homes. The project, "Unprotected," uncovered an unacceptable status quo that has allowed the neglect or abuse of too many Georgians who relied on institutions to provide humane, decent care.

Yes, many homes and their workers offer safe and sufficient care. But one in five assisted living or large personal care homes here since 2015 have a history of violations indicating serious shortcomings, our investigation shows.

That is too many. In these cases, even though residents or their families paid thousands of dollars a month for care, it was not adequately provided when it was needed the most.

The problems uncovered by this newspaper seemingly result from a range of causes – from dereliction of duty or deliberate abuse to bureaucratic misfeasance and ineptitude. Mixed in, too, seem to be honest mistakes and lapses coming in part because there is so much difficult work to do and not enough employees to do it.

A statewide shortage of caregivers has made things harder. This, even as many workers are dedicated to giving the best care possible, often under arduous circumstances such as low pay, heavy workload or inadequate training.

And, given these homes are largely for-profit enterprises, it’s reasonable to question how a natural incentive to run lean might have at times compromised resident care to the point of risking harm. An example is that it can be in a home’s financial interest to keep a resident beyond the point at which they should be moved to a higher level of care. Our work shows that one-third of studied facilities have been cited for housing people whose conditions were too serious for them to manage.

Government, we found, has fallen far short of an acceptable standard by failing to provide a minimally effective safety net for Georgia’s most vulnerable people and their families.

No other reasonable implication can be derived. Not when considering that our investigation brought together related pieces of information about suspected – or proven – abuse and neglect in a way that government here routinely does not.

Our conclusion? The left hand often lacks knowledge of what the right is – or is not – doing. That must change. If it does not, more Georgians will suffer or die in ways that might well have been avoided if a comprehensive and consistent system of oversight was in place.

The numbers speak for themselves.

Our reporters analyzed Georgia Department of Community Health inspection reports for every assisted living site and personal care home with 25 or more beds from 2015 through 2018.

They examined the state’s records of fines and other enforcement actions against these facilities. They pored over hundreds of other records, including regulatory appeal documents and applications for new care facilities. They reviewed dozens of lawsuits and criminal case files and sat in courtrooms documenting criminal proceedings.

And our journalists spent many hours on old-fashioned, thorough reporting – interviewing dozens of family members, home operators, trade groups and policy experts.

The statistics we compiled should shock us all: Our investigation identified 600 allegations involving neglect and 90 allegations of abuse in assisted living and large personal care facilities across the state.

It gets worse.

The numbers include 20 deaths and more than 100 injuries in instances where these homes appear to have failed to provide adequate care.

Given incompleteness of records in Georgia, the count of those harmed could be higher.

The statistics, while stunning, can camouflage human suffering that’s occurred too frequently in residents’ rooms.

There’s the diabetic, hypertensive resident, for example, who used an emergency call button to seek help in March 2016. A facility’s own logs show it took 26 minutes for an aide to respond. By then, the man was unconscious, state records show. Another 19 minutes passed before someone called 911. He was dead when the ambulance arrived.

“Imagine his terror for all that time, hoping someone and expecting someone to come and help him, and nobody showed,” Georgia’s Long-Term Care Ombudsman told the AJC.

There were other cases, too. Medications weren’t distributed properly. A plague of biting ants attacked a 92-year-old in her bed. A 97-year-old man from Savannah was found on a sun deck outside an assisted living facility on a near-100-degree day, unresponsive and wearing heavy winter clothing. Four days later, he was dead.

Imagine paying thousands of dollars a month for that level of neglect.

Shock and dismay over this kind of human suffering should be surpassed by anger at the lack of checks and balances that has allowed it to persist. It adds up to a dereliction of responsibility that must surely change. No decent state can allow such a ragtag way of governance to continue.

Georgia’s love of limited government has failed our elders in these facilities and their families too many times and for too long.

In particular, the Georgia Department of Community Health appears unable to help safeguard vulnerable Georgians in assisted living or personal care homes.

Suspicious deaths and allegations of mistreatment, we found, may go unreported to law enforcement. In more than 25 percent of abuse cases detailed in DCH inspection reports, the AJC could not find corresponding police reports. They were even less likely to be alerted to suspected neglect, another legal category of mistreatment.

In other instances, DCH has been slow to conduct investigations. Not surprising, given there is no required timeframe for looking into even serious allegations. Operating with a “we’ll get around to it, eventually and maybe” model can no longer suffice. Nor can the $601 fine we saw for many serious institutional violations.

Worse, the current system relies heavily on self-reporting by care home operators. The results are about what you would expect – inadequate and unacceptable.

We found that an online state database of information about inspection reports was incomplete and haphazard, leaving families with knowledge gaps as they seek care for loved ones.

By contrast, the federal government rates nursing homes, which provide skilled care above that offered in assisted living or personal care homes.

Officials with the DCH refused to be interviewed by our reporters for this project, choosing to answer questions only in writing. That is outrageous for a public agency, and it owes an explanation to Georgians.

Our reporting on this societal problem has just begun. The second installment appears today and continues through Tuesday. Additional stories will appear through the remainder of 2019.

The early findings of our investigation clearly show the need for comprehensive change to protect the state’s most vulnerable people. The problems and shortcomings we’ve discovered demand solutions. Making things better will require hard work and diligence on the part of lawmakers, regulators, law enforcement and others.

But that hard work will be worth it.

The Editorial Board.

At ajc.com/unprotected, you will find a searchable database that includes robust information about assisted living communities and large personal care homes in Georgia, and a consumer guide from our investigative journalists who spent months studying the industry.


» EDITORIAL: A personal view of Ga.'s eldercare

» OPINION: Some specific steps to make senior facilities safer

» OPINION: A path toward fixing Georgia's assisted living system

» OPINION: My family's assisted living experience

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