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Carlos says most people living at the Carlyle have no other choice. “An assisted-living facility is supposed to be a happy place,” he observes. “It's supposed to be a social facility. But here nobody really cares about these people.”
Between 1985 and 1999, seven residents killed themselves at Carlyle on the Bay, according to AHCA records. Five people jumped from the windows, balconies, or fire escapes of the condo-style building; the victims included a woman diagnosed with depression who jumped from her window in 1997, and a man diagnosed with chronic paranoid schizophrenia who jumped from the seventh floor of the building in the summer of 1999. Two others hanged themselves.
Carlos says the suicides are a result of carelessness. Indeed, as noted in AHCA records on the Carlyle from 1999, “preventative measures were not initiated in the facility to prevent further jumping from high altitudes.” Finally, in response to the 1999 suicide, AHCA required that wooden blocks be added to each window frame in the facility so the windows wouldn't open more than four inches, and that all fire-escape landings be completely enclosed in wire mesh.
Carlos criticizes the Carlyle for other reasons, too. He condemns the unpleasant aesthetics of the place, from the old faded furniture to the shag carpets he says should have been ripped out and replaced long ago. Water from a sprinkler recently seeped through cracks in the walls, flooding four floors of the building. He also challenges the way the Carlyle's administrator, Rose Wilson, runs the facility. He accuses her of not knowing how to “handle” mentally ill residents and claims she is careless about drug supervision.
AHCA reports from August 1998 and witnesses of a more recent incident that occurred at the Carlyle substantiate Carlos's claims. That summer a new resident revealed to AHCA investigators that she had not been taking her medicines since being admitted to the facility. The Carlyle chart AHCA investigators reviewed also stated that when the resident had asked for her medications, the nurse responded that she had run out of drugs, and therefore the resident would have to wait 30 days until her health care provider was in place.
This past July a 41-year-old mental-health patient was admitted to the Carlyle from the psychiatric ward of Jackson Memorial Hospital. (Mental-health patients who are on Medicaid and can't care for themselves are transferred to assisted-living facilities. Medicaid pays the bill for medicines prescribed by psychiatrists to mental-health patients living in ALFs; assisted-care facilities also receive government money for the care of each mentally disabled person living there.) The resident asked for her medicine on a Friday afternoon, says another Carlyle employee who asked not to be identified. “When no one responded, she asked me for help,” the Carlyle worker says. “I called a nurse, and the nurse said she didn't have any medication for the resident. The nurse took the woman to Rose. [At this point, say other witnesses, the woman began screaming for her medicine.] Rose just said, “Don't pay her any attention; that's what I do.'”
“Next thing you know, she walked outside and set her blouse on fire with a lighter,” says a 65-year-old wheelchair-bound resident who witnessed the incident. “A lot of crazy things have happened here,” he adds.
The resident suffered first-degree burns and remained in Jackson's intensive care unit for about a month. From there she was transferred back to the hospital's psychiatric ward, where she had initially come from. “I don't know how it happened,” she said in a phone interview. “I feel a lot of discomfort from the burns.” The resident's father would not comment further, though he believes there was no neglect on the part of Carlyle staff members. Former Carlyle employee Carlos, however, insists she had not been receiving medication for at least three days and had reached a state of desperation when she set herself ablaze. Administrator Rose Wilson would not comment.
In December 1999, according to City of Miami police reports, Adolf Parker, a Carlyle resident, set fire to his mattress. Upon returning to the Carlyle from a night of drinking and before entering his room, he argued with Wilson, Carlos says. “She gave him a 30-day notice to get out.” On the following morning, the sprinkler system in Parker's room started spraying water as flames and smoke filled his tiny living quarters. No one was hurt but the water from the sprinkler flooded four floors. Carlos says that although Carlyle owners received insurance money for new carpeting, the old, mildewed rugs remain to this day. Again Wilson declined comment.
Assisted-living facilities provide housing, meals, and support services. Staff members help residents bathe and dress and remind them to take their medications. ALFs are alternatives for people who don't need 24-hour nursing supervision but do require basic assistance in caring for themselves. ALFs intending to house both seniors and people with psychiatric disorders who receive a state supplement must obtain a limited mental-health license.
In Florida many assisted-living facilities started out in the 1960s as boarding homes for senior retirees. Back then they were known as adult congregate-living facilities and were not regulated until 1975. The admission of mentally ill people into assisted-living facilities dates back to the deinstitutionalization movement of the 1970s, when many mental hospitals discharged patients and shut their doors. “It's not, for the most part, a threat to the residents,” says Larry Polivka, director of the Florida Policy Center on Aging at the University of South Florida, of the living arrangements. “Of course it only takes one episode for it to become a problem,” he adds wearily. The issue of mixed-living homes has been debated for years, but it has prompted little action. Very few residential programs cater exclusively to poor mentally ill patients.