A Dysfunctional System

A Failure to Care. A jumble of state-by-state rules let a chain of horrors grow.
By Ken Dilanian and Nancy Phillips Inquirer Staff Writers

Daniel S. Paglione lived through gun battles with the Japanese navy as a young sailor in World War II. He died, at age 80, after two miserable years at a Bucks County assisted-living facility where he was sometimes left to lie in his own feces, his family says.

Paglione, a diabetic who had Alzheimer's disease, suffered head wounds from repeated falls that his caregivers at Alterra Healthcare Corp. took few if any steps to prevent, the family's lawsuit alleges. Blackened ulcers developed on his heels.

Critics call Alterra a case study of how a hodgepodge of state-by-state assisted-living regulations failed to protect people from the perils of an ailing national chain.

"Unfortunately, the Alterra debacle hasn't raised awareness and insight to any national level, so that this same situation couldn't reoccur," said Karen Love, a former assisted-living manager who helped form the Washington-based Consumer Consortium on Assisted Living.

Residents were beaten and raped by employees or other residents. They were given the wrong medication or left to lie in their own excrement. Some died of neglect, court and regulatory records show, while others, suffering from dementia, died of cold or heat after Alterra failed to prevent them from wandering off the premises.

Unlike nursing homes, assisted-living facilities are not subject to federal oversight. Licensing standards vary from state to state, and the rules are generally less stringent than those governing skilled-nursing facilities.

Then as now, there was no government agency that had the power to force company-wide changes in national assisted-living chains. Washington has been reluctant to create a new regulatory scheme for an industry that, unlike nursing homes, is not funded with federal dollars.

....the need for senior care is poised to explode in the next few years as Baby Boomers reach retirement age.