In the obscure world of personal care homes, the worst abuse of vulnerable adults often happens in unlicensed facilities that state officials often can’t find, don’t inspect and have few resources to shut down, The Atlanta Journal-Constitution has found.
The AJC found cases of residents being beaten with belts and burned with curling irons, kept in basements with buckets for toilets, robbed of their public assistance and pension checks, and shuttled from home to home as operators kept a step ahead of the law.
Unlicensed homes “are what keep me up nights,” said Brian Looby, director of the Division of Healthcare Facility Regulation within the state Department of Community Health. “We just don’t know they’re out there until somebody lets us know.”
In an ongoing examination of personal care homes that aid adults, The Atlanta Journal-Constitution has analyzed thousands of inspection reports as well as interviewing state and local officials, social service providers, advocates for vulnerable adults and residents and their families.
Personal care homes are required to be licensed and regularly inspected by DCH. But advocates say they see a growing number of unlicensed homes — perhaps hundreds around the state — operating outside the law, unregulated by any agency.
Unlicensed homes tend to charge less than licensed facilities, but they are often shabbier and offer fewer services, said Mary Twomey, co-director of the National Center on Elder Abuse.
“This is the underground gray economy,” said Twomey, who said the problem is not unique to Georgia. “These can be some of the most invisible citizens.”
Georgia officials say a new law that takes effect July 1 will finally empower them to crack down on rogue operators.
The law for the first time criminalizes the operation of an unlicensed personal care home, making the first instance a misdemeanor and the second a felony. It also allows the state to immediately impose fines.
Beforehand, when an unlicensed home came to light, the state simply gave the owner a month or two to get a license. The new law also gives the Georgia Bureau of Investigation authority to investigate unlicensed personal care homes.
“We’re not going to allow this practice to continue,” said state Rep. Sharon Cooper, R-Marietta, a nurse who sponsored the law. Under the old law, she said, “there was no punishment.”
However, the GBI has few resources to devote to the task, and no other agency is charged with rooting out illegal homes and shutting them down.
State regulators must get a warrant to enter an unlicensed home without the owner’s permission; they have obtained such warrants only twice in the past 12 months, Looby said. In many of the cases, officials said, the owners allowed regulators to enter without a warrant.
Cover for illicit activity
Unlike nursing homes, personal care homes do not handle medical care. They provide lodging, food, bathing and other grooming services, and can help residents manage their medications.
Many are in individual homes in residential neighborhoods. It can be difficult for residents’ families, neighbors and even regulators to distinguish them from boarding houses or other types of residential facilities.
Some sophisticated but unscrupulous operators have used licensed homes as a cover for illicit activities. State investigators say they have encountered several operators who maintain one or two licensed facilities at the same time they are running several unlicensed ones.
The licensed homes are used as a showcase for prospective clients or family members, said GBI Director Vernon Keenan. But residents are soon shipped to unlicensed homes, where they are given little supervision or care.
Brothers James and Thomas Jones were shuffled between several personal care homes in Gwinnett County. James, 60, is paraplegic, and Thomas, 56, is schizophrenic.
The brothers said they were given only child-sized portions of food. On several occasions, they found roaches infesting their belongings, including the electronic wheelchair where James spends nearly all his waking hours. Sometimes the bugs crawled over him.
“It rattled me,” James said.
Their cousin, Wanda Rogers, said she complained several times to state regulators and the state’s Long-Term Care Ombudsman’s office, with little success. She finally moved her brothers to another home last year.
“They’re just letting these people fall through the cracks,” Rogers said.
Beating the system
Over the years, illegal operators have become adept at beating the system.
When Barrow County police were set to shut down an illegal personal care home in Bethlehem in November, the operators swiftly shuttled four residents to another home, leaving them with just a bag of fast food, Sheriff Jud Smith said. The residents, who were mentally disabled or mentally ill and did not have their medications, were on their own in the home with no heat or running water for about 12 hours before one contacted a relative, who alerted a deputy.
Smith said the operators — Narquitta Street and Priscilla Streete, and Narquitta’s husband, Marlo Kenneth Yarbrough — were part of a metro Atlanta network of unlicensed homes that stretched as far as Villa Rica. Family members of the residents had been led to believe their loved ones were going to legitimate, licensed personal care homes, but instead the residents were sent elsewhere, he said.
“It was 100 percent bait-and-switch,” Smith said. “These people were routed to another location, and their money was being cashed and [the residents] were getting only 5 [percent] to 10 percent of it at the most.”
Taxpayers are often footing the bill because the residents receive Medicaid, Social Security and other government support.
New law enough?
Johnny Ray Hill said he was trapped in the windowless basement of an unlicensed care home in DeKalb County for about five months, ending in March 2010. For breakfast, he got Ramen noodles in Country Crock margarine containers; for dinner, bologna sandwiches. He used a 5-gallon paint bucket for a toilet.
“I’d become a hostage,” he testified last year.
The operator, Chandra Renee Faust, pleaded guilty in September to keeping the disabled man captive in her basement and taking his monthly disability checks. She was sentenced to 10 years in prison.
Bobbie Neil Ward, a former middle school aide, faces 25 criminal charges, including aggravated assault, abuse of a disabled adult, identity fraud, forgery and exploitation of a disabled adult. DeKalb County prosecutors say Ward physically abused disabled adults who lived with her, stole their identities and pocketed their pensions and public assistance money.
Ward is accused of burning one man with a curling iron and beating him with extension cords.
But Ward’s family has disputed the accusations.
“They’re lying on that girl,” Ward’s mother, Magnolia Ward, told the AJC.
Ward’s attorney, Careton Matthews, said “We deny the allegations and plan to present a rigorous defense.”
Advocates and officials praise the new law, but they question whether it will be enough. Lawmakers provided no additional funding to DCH or the GBI to hire more personnel. Keenan said the GBI’s role in enforcement will be limited.
“We don’t have the resources to handle this work for the entire state,” Keenan said. “The whole objective would be to engage law enforcement to handle problems in their communities.”
However, many local law enforcement officers have been unaware of the problem, or been confused as to which state agency to contact, Keenan said.
To fill the gaps, Keenan has convened an At-Risk Adult Working Group that includes some local officials as well as representatives from four state agencies that provide services for vulnerable adults.
A state task force created a year ago by Adult Protective Services is working to educate local police departments.
Despite the challenges that remain, DeKalb County District Attorney Robert James said the new law can make a difference.
“It’s not a magic bullet,” James said. “But it’s something we can use.”
Over the past month, The Atlanta Journal-Constitution has gone behind the headlines to report on systemic weaknesses that imperil vulnerable adults who rely on personal care homes. In this report, we’ve found:
• Advocates say they see a growing number of unlicensed homes operating outside the law, unregulated by any agency.
• Personal care homes can be difficult to distinguish from boarding houses or other types of residential facilities.
• A new law, effective July 1, makes it a criminal offense to operate an unlicensed personal care home.
How to help
To report abuse, neglect or exploitation of elderly, developmentally disabled or mentally ill adults
• In a home or residence: Call Division of Aging Services, Adult Protective Services 1-888-774-0152 or 911
• In a personal care home: Call Healthcare Facility Regulation (HFR) 1-800-878-6442.
About the Author
Credit: Jason Getz / Jason.Getz@ajc.com