When the state was notified of an incident of neglect, as required by law, it many times failed to adequately investigate.
The explosion that had ravaged Audree Hopkins’ face, burning off both earlobes and the end of her nose, was a mystery.
Seattle police Detective Suzanne Moore had her suspicions. But by the time Moore was called to the West Seattle elder-care home to investigate, five days had passed since the blast and nearly every shred of evidence was gone.
The detective questioned workers who had cared for Hopkins, a stroke- and emphysema-hobbled 68-year-old who had lived in the TLC Adult Family Home for six months at the time of the March 2007 accident. The caregivers’ stories, all seemingly synchronized, shot down Moore’s theory.
No, they said, none of them had handed the partially blind Hopkins a lit cigarette, though she was a smoker and unable to light one herself.
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No, they said, Hopkins was not connected to an oxygen pump at the time, though she used one at night for breathing.
Moore left the adult family home on Southwest Thistle Street determined to get answers. She caught a break when she learned from Fire Department reports that responders saw an oxygen pump on the deck. And then she discovered that Hopkins’ husband, Larry, had retrieved his wife’s melted wheelchair, damaged oxygen pump and burned clothing for safekeeping.
Moore sent the evidence to the federal Bureau of Alcohol, Tobacco, Firearms and Explosives for testing. Experts there traced a trail of fire from Hopkins’ nose down to her sternum — the same path as her oxygen breathing apparatus. The source of ignition: a cigarette.
Moore had been right. She had been deceived by the three caregivers. Further, the TLC owner, Antonia Malla, had failed to contact the state Department of Social and Health Services (DSHS) immediately after the incident occurred, as required by law.
In fact, a Seattle Times investigation has found, such cover-ups by adult family homes are not unusual. The Times found that over the past five years, at least 357 of the adult family homes in this state have concealed cases of abuse or neglect of their residents. Many of those cases involved serious injury or death.
In dozens of these cases, untrained or unlicensed caregivers mishandled residents’ medications, sometimes giving them fatal overdoses. In other cases, residents became ill after being denied basic care and hygiene. A Seattle man died from infection after his catheter was not changed or sterilized for four months.
In many cases, these caregivers tried to conceal abuse or neglect by forging medical records, lying to state investigators or threatening residents with eviction if they provided witness statements.
Worse yet, The Times found, even when DSHS was notified of an incident of abuse or neglect, as required by state law, the agency many times failed to adequately investigate.
Hands-off approach by state officials
Adult family homes are private residences that provide rooms and care for up to six people who can no longer live on their own. They are marketed as lower-cost alternatives to nursing homes, allowing seniors and other frail people to live in cozy settings and familiar neighborhoods, with more freedom and personalized care.
The homes’ owners are given freedom, as well. To encourage this new industry over the past two decades, Washington state imposed few regulations — no requirements for a minimum number of employees or even, for many years, liability insurance.
This laissez-faire approach has succeeded in spawning nearly 3,000 adult family homes across the state. Many are successful businesses, with residents’ fees typically starting at $3,000 a month and rising to $7,000 for the nicer homes.
But the state’s approach also has resulted in dangerous conditions going unchecked in many homes, the Times investigation found. Unqualified caregivers remain at work and substandard homes remain in business, an analysis of DSHS inspection files from 2005 to 2009 revealed.
Washington law requires mandatory reporting of suspected abuse or neglect of vulnerable adults in nursing homes and adult family homes. State legislators passed that requirement in 1984, intending to provide a wide safety net — if one caregiver failed to report abuse or neglect, someone else along the chain of care would be required to do it.
But unlike busy, professionally staffed nursing homes, adult homes often have only one link in that chain — a caregiver, with little training, working alone.
The Times found that many homes routinely violated this law but rarely faced stiff punishments. Even when adult family homes and their workers have been caught trying to hide problems, most have kept their state-issued licenses.
Page Ulrey, a King County senior deputy prosecutor who specializes in elder-abuse cases, said studies have estimated that for every six incidents of elder abuse, only one is reported.
“There is a huge issue in the lack of reporting,” she said.
In the case of Audree Hopkins, nobody immediately reported the tragedy — not the owner of TLC, not her employees, not the seven firefighters and paramedics called to the scene, not the doctors and nurses at the hospital.
The owner finally did contact DSHS three days after the incident, leaving a message on an answering machine at night. The agency then took two days to contact Seattle police.
Once Detective Moore nailed down the cause, she referred the case to the King County Prosecuting Attorney’s Office. Ulrey filed felony criminal mistreatment charges against a TLC caregiver and owner Malla, as well as a misdemeanor charge of failure to report neglect against Malla.
The caregiver, Milagros Mendoza, was convicted in 2009 of reckless endangerment and received 30 days in jail. After the judge dismissed Malla’s felony charge, she pleaded guilty to failure to report, and received probation and 240 hours of community service.
She continues to assert her innocence, however, insisting: “I didn’t do anything wrong. My caregivers didn’t do anything. The resident caused it. There was no oxygen in use.”
Malla was the first adult home owner in Washington history to be criminally charged — let alone be convicted — of failure to report.
DSHS, which is required to inspect each of the state’s homes once every 18 months, finds on average about 20 failure-to-report violations each month, mostly by reviewing residents’ files and taking note of any reportable injuries.
Even so, officials acknowledge, the agency rarely passes on the evidence to law enforcement for further action.
DSHS’ tepid response highlights an inherent conflict within the agency: While it polices adult family homes, it also seeks to foster the industry as a less-expensive, more-appropriate housing option for seniors.
The TLC case illustrates the conflict in stark terms.
After Seattle police began investigating the flash explosion, DSHS revoked owner Malla’s license to operate TLC. She appealed. DSHS rescinded its revocation “in order to control the expense and uncertainty of litigation.” Malla was allowed to do a “voluntary surrender” of her license and then reapply in two years instead of the customary 20.
But losing the license for TLC did not put Malla out of business. DSHS allowed her to keep licenses on two other Seattle homes. When TLC closed, all but one of its residents went into Malla’s other two homes.
DSHS shelving evidence of crimes
DSHS officials acknowledge that adult-home caregivers have routinely failed to report neglect. In the past 22 months, DSHS investigators have uncovered 425 instances of failure to report, each of which resulted in administrative, noncriminal fines and other sanctions, said Kathy Leitch, assistant secretary for aging and disability services.
However, in analyzing state files for 2007-09, The Times found at least 53 cases in which DSHS officials had failed to adequately investigate reports of neglect or to forward evidence of criminal acts to police or prosecutors.
Among cases that DSHS knew about but did not refer to police:
• A witness inside a Bellevue adult home described how two residents were neglected and had developed life-threatening pressure sores.
• A health-care worker who visited a Renton adult home provided evidence of a resident who was “soaked in urine,” with blood draining from two open wounds.
• A health-care provider revealed that a resident from a Shoreline adult home had lapsed into a coma after untrained caregivers failed to swiftly provide cardiopulmonary resuscitation.
DSHS officials say many complaints were difficult to pursue because the tipsters were anonymous or the alleged violations occurred weeks or months earlier.
But the agency also failed to notify police even after its investigations found evidence of crimes.
For instance, DSHS officials never notified police about the 2006 death of Nadra McSherry, 80, who died from untreated pressure sores, which developed at a Tacoma adult home.
Caregivers at Narrows View Manor, owned by Arlie Leno, were aware for weeks of the advanced wounds, which were open to the bone, but failed to notify family members or seek emergency help, DSHS found. The Times profiled McSherry’s case earlier this year but only recently learned that her death was not reported to police.
In another case this year, DSHS found that a Seattle adult home had failed to provide proper care to a resident who had suffered a broken arm, allowing him to suffer for nearly two weeks. DSHS levied a $1,200 civil fine against the home in June. But it wasn’t until The Times inquired about the case that the agency reported the violation to Seattle police.
While the agency has referred all cases of physical abuse, it has been inconsistent in passing along cases involving neglect. Assistant Secretary Leitch acknowledged that neglect cases represent a “gray area” in which DSHS investigators make subjective judgments. “We’re looking at whether we should send more referrals to law enforcement and not make subjective decisions as to whether a crime has been committed,” she said.
Elder abuse easier to ignore
Abuse of elders is often ignored, or swept under the rug in the manner that domestic violence was decades ago, as a private affair that does not require public intervention, says Ulrey, the King County prosecutor who specializes in such cases. She said few people are advocating for elderly victims.
“We don’t have a body or population of victims who are banging on people’s doors or angry or furious about what’s happened to them, because most of our victims are dead,” she said.
Law-enforcement agencies have been reluctant to investigate because elderly victims who do survive abuse are usually incapacitated with dementia or other maladies and are often difficult witnesses. Juries are reluctant to convict, often sympathizing with caregivers who perform tedious, difficult tasks that few want to do.
At the core, Ulrey said, “there is a tremendous amount of denial in this country that elder abuse exists and occurs. I think many people, and I’m certainly guilty sometimes of this, too, don’t want to believe it’s as bad a problem as it is.
“And they don’t want to think of themselves as getting old. They don’t want to think of themselves as dying. They don’t want to think of their parents as ever being in a situation where they could be neglected or exploited. So we’ve kind of tended to box it away and not deal with it. The same way we tend to box away much of our elderly population in nursing homes and adult family homes.”
In November, Ulrey and Seattle police, including Moore, will conduct training classes on mandatory reporting of elder crimes, funded by a two-year, $400,000 grant provided by the U.S. Justice Department.
Meanwhile, Moore has started training Seattle officers on the topic at morning roll call. Police cruisers will display window stickers that advertise an abuse hotline telephone number.
Ulrey says she believes the training will result in better reporting of abuse, and more convictions. “We see a lot of cases being overlooked,” she said.
After explosion, a difficult recovery
Audree Hopkins was taking classes to be a travel agent when she suffered a stroke in 1990, which paralyzed her left side. Her health went downhill. By the end of the decade, she had emphysema, heart disease and was blind in one eye. After stints in long-term care facilities, including a nursing home, she moved to the TLC home in 2006. After the explosion, she spent three months at Harborview Medical Center. She underwent numerous surgeries to save her life and, later, to reconstruct her face.
Now 71, she lives in a West Seattle nursing home, Park Place West. She is unable to walk. She lacks the muscle control to hold a cup of water to her lips. She cannot even drink water without a thickener; otherwise, she might choke.
But when she recently had a visitor, she preened over a new hairdo and asked how she looked.
When a young physical therapist urged Audree to bend her legs on a cycling machine, she quipped, “Easy for you to say.”
She maintains a love-hate relationship with cigarettes. She doesn’t remember the explosion.
Her husband, Larry, 73, a retired Boeing engineer, visits at least five days a week, sometimes twice a day. “Somebody has to be here for her,” he said.
They take frequent strolls outside the nursing home, she in her wheelchair and always accompanied by an oxygen pump or canister. They often relive past times, such as when she was a student at Holy Rosary High School and starred as Anna in a production of “The King and I.”
After the explosion, Audree’s medical bills skyrocketed. Larry talked to a lawyer about suing Malla, but DSHS revealed that it had granted Malla a waiver from the state-mandated liability insurance. She didn’t have any.
Finding no one with deep pockets to pursue, the lawyer declined to take the case.
Hopkins faced a financial dilemma. Even with Medicare and pension benefits, he quickly would spend himself down to bankruptcy and lose his home. Or he could qualify his wife for Medicaid, the government health-insurance program for the poor, but to do so he would have to divorce her. His Boeing pension payments exceed Medicaid’s limit for allowable income.
He made a painful choice: divorce.
Larry will have enough money to stay in his home, and Audree will receive medical care.
“I guess you could say that I loved her so much that I had to divorce her,” Larry said.
Audree responded: “He’s my one and only.”
Michael J. Berens: firstname.lastname@example.org or 206-464-2288
Seattle Times researchers David Turim and Gene Balk contributed to this report.