One of Arkansas' nursing-home alternative programs -- adult family homes -- finally took hold four years after its 2011 introduction, but it was short-lived.
By 2015, five individuals had opened their homes to disabled or aging adults dependent upon Medicaid, but each home has lost its certification in the past year, documents show. Some expired; others were cut off by the state for noncompliance.
Today, the program has only one certified home -- located in Earle, an east Arkansas city of about 2,400 -- but it is vacant.
While decertified, the homes didn't necessarily stop operating. Instead, some have remained functional on the fringes without oversight, creating an environment that puts some of Arkansas' most vulnerable residents at risk of abuse, officials and advocates said.
As long as a facility houses fewer than three residents and doesn't accept Medicaid dollars, the state Department of Human Services doesn't have the power to monitor it unless the agency receives a complaint about it.
This vacuum has the agency re-evaluating its approach to adult family homes, said Craig Cloud, the director of the Division of Aging and Adult Services.
"We want to make sure we know where these facilities are, how they're being operated," Cloud said. "And we want to be able to certify them and require that they have an annual inspection and meet a minimum standard and criteria."
As the division considers the group-home program, the number of abuse cases statewide is increasing, said Shannon Halijan, interim assistant director of the Division of Aging and Adult Services. Halijan said that's part of a national trend as people continue to live longer.
The state began cultivating adult family home providers in 2010 to help address the need for long-term care facilities in rural areas. The program grew slowly, adding usually one home each year. But even at the program's peak in 2015, none of the facilities were in rural areas -- four were around Little Rock and one was in Hot Springs.
Group homes give families alternatives to traditional nursing homes for functionally impaired individuals who are disabled or over the age of 65.
A state-certified home, which may house up to three residents, can receive daily reimbursements from Medicaid ranging from $48.22 to $56.25 per resident, depending on the level of required care. Medicaid reimbursements only cover the costs of "daily living care" and don't include other costs, such as room and board, which beneficiaries pay for separately.
Providers are expected to help those in their care with medication reminders, supervision, bathing, cooking, toilet use and transportation.
Licensed homes are put through an extensive approval process and at least one annual inspection; providers undergo drug tests and criminal background checks.
Martha Deaver, president of Arkansas Advocates for Nursing Home Residents, said her organization is very supportive of the adult family home concept because it gives beneficiaries a less institutionalized, community-based option, but she said outside supervision is key. She supports the oversight increases that Cloud mentioned.
"Too many of these group homes have popped up everywhere with no oversight, and the problems can be just as severe as the violations I find in nursing homes," Deaver said.
Short stints
Records obtained through an Arkansas Freedom of Information Act request show that most adult family homes leave the program after about two years.
Elijah Pricop of Hot Springs joined the program with his wife in 2012. They were state-certified until last year, when their certification wasn't renewed.
Pricop said in a Wednesday phone interview that state regulations make it difficult for family homes to remain solvent. Now that they're no longer certified by the state to receive Medicaid dollars, the Pricops operate two family homes in Hot Springs, which wouldn't be allowed under the state's program.
"The math does not make sense," Pricop said. "That's the sad part. It's tough. That's why I had to do two. If you do one, you just go under. It's only a matter of time."
Pricop called it a "great program," but he said he would like to see the state raise the maximum occupancy to six beneficiaries per home.
Other providers who were formerly certified didn't respond to interview requests last week. However, Hope Fitchpatrick, who operates the sole remaining home in Earle, said she, too, would like to see the maximum capacity increased.
Before moving to Arkansas, she worked in an adult foster home in Georgia. There, she said, homes can have up to five residents.
Fitchpatrick is finishing her bachelor's degree in business. Then, she said, she'll start advertising her home more aggressively.
She was advised to set up shop near Little Rock because of the larger population, but she wanted to fill the long-term care void that exists around Earle.
"That's what I'm really looking forward to," she said.
Risks of abuse
Recent events have underscored the risks of abuse and neglect that are present even in state-certified homes.
Last month, investigators removed three residents who showed "obvious signs of neglect" from a certified home in Little Rock.
Wilson's Adult Foster Care Home, at 5 Sunny Circle in Little Rock, became the first state-approved home in 2011. But when inspectors arrived Feb. 6 for a re-certification inspection, they found a host of compliance problems, according to a report obtained through a Freedom of Information request.
Inspectors found that Shavita Wilson, 45, the owner, wasn't properly storing residents' medications, which were in unlabeled, open containers resembling "plastic laundry detergent caps" on the kitchen counter. Two bottles of her own medicine were said to have been unsecured in the living room.
Inspectors also discovered that outer doors were being locked, and Wilson misplaced the keys while inspectors were on site.
She couldn't provide documentation showing that extra workers she had hired received background checks or training to administer CPR or first aid, telling inspectors, "I train them myself," according to the report.
She also couldn't provide monthly progress notes for the residents or proof that the fire extinguishers were in working order.
Despite those infractions and several others, the state Department of Human Services extended her certification, which was set to expire March 31, for a month to give her time to comply with regulations.
After several attempts by Wilson, the agency accepted a corrective action plan pending a surprise inspection. When inspectors visited the home April 7, Wilson peered out a window but refused to open the door, according to a police report.
After waiting outside for several hours, inspectors were able to enter when one of the residents arrived and opened the garage door, the report said.
Inside, inspectors found numerous violations, and the home's three underfed residents were taken by ambulances to a hospital, the report said.
The state closed the home shortly after, and the Arkansas attorney general's office is investigating the home.
Deaver, the nursing-home residents advocate, said the state overlooked too many "red flags" when it inspected the Wilson home in February.
"When you find that many infractions, and you're caring for the most frail and vulnerable citizens, you can't wait two months to go to that facility to make sure the environment is safe and the residents are getting the care required," Deaver said. "The final outcome speaks for itself."
Brandi Hinkle, a Department of Human Services spokesman, said the initial infractions weren't severe enough to warrant decertification and that the agency hoped Wilson would fix the problems.
Two days after authorities removed residents from Wilson's home, Davette Montgomery, a group home operator in North Little Rock, surrendered her certification in an email to the Human Services Department.
Montgomery had used Wilson as a reference when she applied for the program in 2014, records show.
Attorney general's investigators visited Montgomery's home April 25, but a man at the home said there were no elderly residents at the house and refused to let investigators look inside, according to a search warrant affidavit.
However, while investigators were still there, the man pushed an elderly, wheelchair-using woman from the home to put her on a bus.
Moments later, a second bus arrived to drop off an older man with Alzheimer's disease, the affidavit stated. Human Services employees were then called to take custody of the elderly residents.
An investigation is ongoing.
Hinkle stressed that the department deals with some excellent providers who take great care of residents.
"It's unfortunate that there are other people who do take advantage and besmirch the reputations of good providers," she said.
A Section on 05/08/2017