Home Is Where the Hurt Is

Bedsores. Medical neglect. Depression. Welcome to the bleak underworld of Miami-Dade's assisted-living facilities.

During a 1998 visit, inspectors discovered that nurses had not been regularly administering drugs such as Zoloft to mental-health patients. While part of an ALF's function is to help patients properly take their medications, at the Pioneer an announcement is simply made that drugs will be dispensed from an office. Those who are lucid or mobile enough to show up get them; those who are not often don't.

In October 1999 inspectors from AHCA flipped over a resident's mattress, and urine dripped from it. As they examined other beds in the facility, the inspectors realized that most mattresses were stained and had holes in them. In March 1998 AHCA cited the Pioneer for health violations when inspectors discovered the air-conditioning vents in the kitchen were filthy. Around the same time, the state agency received complaints that elderly residents had been raped at the facility; AHCA referred the allegations to DCF's abuse hotline. (DCF says the allegations were not substantiated.)

This past May inspectors from the Long-Term Care Ombudsman program observed that toilets needed cleaning, residents did not have access to private places to make, for instance, phone calls, and that there were no planned activities for residents as required by state law. (Florida mandates that residents at ALFs be engaged in appropriate activities for at least two hours per day or a minimum of ten hours per week.)

There's not much to do at the Pioneer despite a law requiring ALFs to engage residents in activities
Steve Satterwhite
There's not much to do at the Pioneer despite a law requiring ALFs to engage residents in activities
There's not much to do at the Pioneer despite a law requiring ALFs to engage residents in activities
Steve Satterwhite
There's not much to do at the Pioneer despite a law requiring ALFs to engage residents in activities

On a hot afternoon in September, mentally ill residents sat and smoked on the steps leading to the entrances of the Pioneer's two buildings in Little Havana. An elflike senior with blue eyes, pointy ears, a flamingo-pink button-down shirt, and a wisp of hair on his head greeted a New Times reporter at the gate. As he rubbed his skinny hands together, his long fingernails, which clearly had not been trimmed in a while, pointed to the cloudless sky. He walked about with spry steps. “I don't know how long I've been here,” he said in a high-pitched voice. Once inside the building he added, “But I really like it here,” while swaying back and forth like a child.

Residents hovered near the main office. Some begged for their mail while others inquired about their government checks. Others filled the stairs leading to the second floor. A female resident who looked to be in her forties stood on a step with a blank stare. Her face was so caked in layers of makeup, it appeared as though she were wearing a white mask. Two other mentally ill men argued. A tall, lean black man barged into the room of a white, shirtless resident and began repeatedly screaming, “I'm gonna break your motherfuckin' neck.” Each time the other man responded, “Your mother!” A few seniors were milling around the hallway as the shouting match ensued.

The Pioneer's walls are bare, the mattresses inside the rooms are thin and worn out, there is little furniture, and the tables and chairs in the dining area are small and flimsy. Next to the white plastic lawn chairs chained together in the television room is a brown broken-down piano, which no one plays. The only thing heard up and down the hallways on this day were the rants and raves of dysfunctional people. Seniors who wet their beds are grouped together and are called meones by staff, a derogatory Spanish term used to describe people who urinate often. Those who don't have the energy or will to get out of bed are just left there.

“The floors are collapsing, the tubs are slanted, and all the young mentals smoke in their rooms,” Detective Walters says, referring to a recent visit to the Pioneer. “The place is a real dump.”

While the Pioneer rightfully has earned a bad rep, even many of the more respectable homes would be grim places to spend your long days. The Carlyle on the Bay, at 1900 N. Bayshore Dr., is a legitimate home that also mixes psychiatric patients with seniors. In July 1999 AHCA cited it for not having enough staff to “ensure proper supervision of the residents and for not providing a safe environment.” In 1998 inspectors cited the Carlyle for not keeping accurate up-to-date medication administration records on residents. One resident was receiving Ativan, an anti-anxiety drug, without a physician's order. That year AHCA inspectors found that a door leading to the building's roof did not lock, after residents had reported seeing a man diagnosed with acute psychosis leaning over the roof of the building.

“We're currently deficiency-clear,” says Rose Wilson, administrator of the Carlyle on the Bay, in rather convoluted bureaucratese. But Carlos, a former Carlyle employee (he was working there when he spoke with New Times) who uses a false name because he wants to continue to work at ALFs, doesn't think the Carlyle has a clean record. “Everything is covered up,” he asserts. “Nobody wants to make any waves.” On a Sunday in September, while he was still employed at the bayside facility, Carlos stood at the entrance to the activities room where a few seniors, almost devoid of all facial expressions, sat in front of a blaring television set. Nearby on a hallway wall, a list of planned diversions for residents was posted. Biweekly Bible studies as well as weekly outings to Publix and Walgreens were offered. Other options included playing bingo and watching television.

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