Home Is Where the Hurt Is

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

Between social security and state subsidies such as the optional state supplement, federal and state governments can provide up to $740 per month for someone needing assisted-living care. Of that monthly stipend, $697 goes to the facility for the cost of care, and $43 goes to the resident for personal expenses. Beginning in January 2001, assisted-living facilities that care for low-income residents will receive $818 per month per resident, and certain residents in the low-income bracket also will see a monthly stipend increase to $54 per month. The rise, however, will come at a cost to some people. Under a provision of the new rules, the income eligibility for receiving the optional state supplement will decrease from $697 to $590 per month; as many as one-fifth of the current recipients of optional state supplements who live in ALFs will be squeezed out. That translates into several hundred indigent elderly and mentally disabled people who will be cut off. Statewide 11,782 Floridians receive the state funds; among them 3125 currently live in Miami-Dade County ALFs.

By law mental-health patients who receive government aid, who can't live on their own, and who have no family willing to care for them must be referred to assisted-living facilities after hospital visits. Hospital social workers, says Douglas Adkins, chairman of the Florida Center for Assisted Living, must then discharge patients quickly -- usually they have two days to find a place for them -- so that the hospital doesn't run up costs.

But sometimes efficiency comes at a price. Social workers may not always have the time to research just where the hospitals are referring patients, Adkins says, and mental-health patients often run the risk of being discharged to homeless shelters or unlicensed facilities. According to Polivka the problem is augmented by the fact that even legal homes catering to low-income people often turn away mentally ill persons because they have no space.

After this illegal ALF was busted, police found residents with bedsores and other signs of serious neglect
photos courtesy Miami-Dade Police Department
After this illegal ALF was busted, police found residents with bedsores and other signs of serious neglect
Out of sight, out of mind: Some doors in homes can be locked only from the outside
courtesy Miami-Dade Police Department
Out of sight, out of mind: Some doors in homes can be locked only from the outside

Hospitals and government agencies that send people to assisted-care homes are faced daily with the dilemma of where to place patients who no longer need medical attention but can't afford even the cheapest of legal ALFs. The ultimate problem, says Adkins and other industry experts, is that the state does not spend enough money to make sure that people who need adequate care get it at legitimate assisted-living housing. Taking up the slack are hundreds of underground homes, often found tucked away in suburban neighborhoods.

Sometimes it is family members who place their relatives in unregulated homes, many not knowing a license is needed to run such a place. And often in Miami-Dade it's Latin families, say law-enforcement detectives investigating the abuse and neglect of the elderly and disabled. The places come highly recommended “from a friend of a friend or an uncle's cousin's aunt who knew someone in Cuba who was some kind of medical something,” says Det. Mary Walters from the Miami-Dade Police Department's elderly- exploitation unit. But, “just because you're a good housekeeper doesn't mean you're trained to run such a place.” Mary Jo LaMont, Walters's partner, says they've investigated more unlicensed assisted-living facilities in Westchester, which has a large Cuban population, than any other place in unincorporated Miami-Dade. “For a while it seemed like we were always on José Canseco Boulevard.” LaMont says.

Detectives Walters and LaMont are the only two members who make up the police department's elderly-exploitation unit. Each city police department in the county has its own equivalent. The two Marys, as they are known in the field and in state monitoring agencies, investigate and bust unlicensed homes. Since 1997 they've made 38 arrests. The people who run these homes, they say, often are elderly themselves. Operating an unlicensed home is a third-degree felony punishable by up to five years in prison. But since most defendants are first-time offenders with no criminal histories, say the Marys, they are sent to diversion programs and usually get no prison time.

Last year, however, the state legislature passed a bill that in effect established local task forces in every county. The State Attorney's Office, the local Human Rights Advocacy Committee, local law enforcement, and other social agencies must identify, develop, and implement a plan to enforce current state law. The task force must report to Tallahassee twice a year. Now the SAO has no choice but to crack down on hard-core scammers, the ALF equivalent of slumlords who prey on the elderly for their government checks.

Most of the people arrested by the Marys are Hispanic women. Walters cites as an example the arrest of a 60-year old woman who was caring for about a dozen elderly people in Southwest Miami-Dade. “She had been trying to lift an 80-year-old resident and dropped her on the floor,” Walters recalls. “The resident broke her ankle and laid in bed for days.” When the Marys arrived on the scene after receiving an anonymous tip, they discovered the bed-bound woman had bruises on her right arm; her left leg was so contorted it wouldn't straighten out.

“The victim's son was outraged that we were pulling his mother from this woman's care,” recounts Walters. “He claimed his mother was receiving wonderful care and said that a friend from Hialeah would come in a pickup truck to transport his mother to his home. I told him: “Over my dead body.' We sent that poor woman to the hospital to get checked out. The woman running the place told us she could care for these people just fine because she was strong as a bull. Well, that wasn't the case.”

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