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Imagine being 80 years old, frail, in need of almost daily care. Imagine you have little money and no family willing to take you in. Chances are you would either end up in one of Miami-Dade County's 600 licensed assisted-living facilities, or in one of countless illegal homes. The sheets on your bed haven't been changed in weeks. There are feces under your fingernails because no one has helped you bathe in days. You feel the pain of inch-deep bedsores that refuse to heal. Out in the hallway, two mentally disturbed residents who also live in your home scream profanities at each other.
Now put yourself in the shoes of a 40-year-old diagnosed as schizophrenic, living in this same facility, dependent on a health care system you can't even fully understand. Your burnt-out relatives rarely visit you, your gray-haired neighbors across the hallway hardly leave their room, and your depressed, mentally ill roommate gave up on life by jumping from a balcony. Sometimes the wrong drugs are given to the wrong people, and sometimes, with chronic understaffing, medications aren't given out at all.
A nightmare indeed, but far from an exaggeration. Such conditions are a reality for many people stuck in some of Miami-Dade's woefully neglected, sometimes unlicensed assisted-living facilities (or ALFs). Although the elderly and the mentally ill have very different needs in terms of care, if they are poor, there's a good chance they'll be thrown together in one of about 160 places that are licensed to house such a diverse population. Even high-end assisted-living facilities that admit only seniors may not always provide the best of care. In this county there is a grand total of one person responsible for training all the administrators who run assisted-living facilities; only three inspectors assigned by the Agency for Health Care Administration (AHCA) make sure codes are enforced and the people in the approximately 9400 licensed beds in the county's ALFs are treated properly. According to Bruce Middlebrooks, who works for AHCA media relations, ALFs are not “required” by law to report how many people are living in each home at any given time. (Compared with other counties in Florida, Miami-Dade has the fewest number of inspectors assigned to assisted-living facilities.)
And these are just the licensed homes.
Unlicensed ALFs, experts and law enforcement say, have proliferated because of the shortage of affordable beds in licensed facilities. The underground network of ALFs is as vast as the number of legitimate homes for seniors and the mentally ill. “There are just as many unlicensed homes as there are licensed ALFs in this county, if not more,” says Det. Mary Walters from the Miami-Dade Police Department's elderly-exploitation unit. Douglas Adkins, chairman of the Florida Center for Assisted Living, a lobbying group that represents assisted-living facilities throughout the state, says dollar signs are driving the rise of unlicensed facilities. “It's more profitable to operate an unlicensed facility than it is to play by the rules,” says Adkins, who also owns an assisted-care home in Hilliard County that houses only mentally ill residents.
Since no agency monitors unlicensed facilities, neglect, abuse, and fraud are commonplace. In September City of Miami police officers charged 73-year-old Eva Avila with running an unlicensed home on SW 23rd Street. While conducting a surprise sweep of Golden House, police discovered eighteen elderly women living in bedrooms the size of walk-in closets. There was no air conditioning, and some rooms had no windows. The house was protected by burglar bars but lacked a fire escape; there were no licensed staff members on the premises. Avila told police she was just an old woman taking care of the people living in her home.
Only when a crisis erupts do residents complain to authorities, or anonymous tipsters report a case to an abuse hotline and make such places fall under authorities' radars.
A closer look at both the licensed and unlicensed ALFs and at AHCA investigations over the past three years reveals the deplorable state of many of those institutions set up to care for those who most need it.
The Pioneer Adult Residential Facility at 2166 SW Fourteenth Terr. is a legally run assisted-care home. It's licensed by AHCA and monitored by other public agencies and volunteer groups such as the Department of Children and Families (DCF) and the Long-Term Care Ombudsman program. Yet records kept by AHCA from as recently as this year show that the Pioneer is plagued with problems.
In December 1999 AHCA inspectors discovered that medicines were kept unlocked in a cardboard box, medical charts were incomplete, and some residents were either taking medicines without prescriptions or not taking medicines they were supposed to. One resident was taking Glipizide to treat diabetes, even though doctors had stopped prescribing it. The same resident was receiving another drug called Zestril every day without a physician's order. There also was no address or telephone number for the resident's health care provider on file at the Pioneer. When AHCA inspectors interviewed the Pioneer's assistant manager, Aida Leyva, she admitted not knowing who the resident's primary physician was. Another resident was prescribed insulin shots, but there was no record of the resident receiving them.