Last month, owners of two adult care home abandoned their facilities. The incident reveals weaknesses in North Carolina’s ability to regulate troubled homes. Part one of a two-part story.
By Rose Hoban
In late January, workers at the TIllery Chase Adult Care Home in Mt. Gilead arrived for their morning shifts to find that the place had been cleaned out – computers, televisions and even an ice-maker were gone.
Also missing were the owners, Amy and Larry Patton, who had swept through the facility the night before as their 45 residents slept and taken anything that could be pawned.
The incidents occurred as state lawmakers continue to wrestle with problems funding adult care homes that house people with mental health problems and those with Alzheimer’s disease.
The head of the North Carolina Association, Long Term Care Facilities, Janet Schanzenbach, said she had heard from the Pattons earlier that week that they were facing insolvency, because, as she said they told her, “They were having trouble getting paid in a timely manner.”
But it turns out that the failure of the Pattons’ business had little to do with state funding problems. Instead, it had everything to do with a long record of facility violations for neglect and mismanagement, problems ranging from allowing a sexual predator to roam the halls of the facility exposing himself to female residents and attempting to sexually assault one of them, to sewage problems, roaches and too little food.
Those problems netted the Pattons tens of thousands of dollars in state fines, deepening the couple’s longstanding financial problems.
But the state has few tools at its disposal to shut down facilities such as the Pattons’, and is reluctant to use those it has.
In November, the state’s Division of Health Services Regulation notified the Pattons that they could no longer admit new residents. On Jan. 17, their license to operate Tillery Chase was suspended. On Jan. 22 , the Pattons notified Department of Social Services officials at the state and county levels they were going to close their doors.
State law requires 30 days notice to residents if facility managers plan to close a home; the intent is to give social service agencies, residents and their families time to find alternate placements.
But only two days later, the Pattons disappeared.
“Some of these residents were living there for more than 10 years,” said Richard Evers of the Montgomery County Department of Social Services. “They had a lot of stuff; they’re upset and crying. The staff were upset and crying.”
“We had workers over there who hadn’t been paid in three weeks, and they stayed right there with us to get those people packed up and placed,” Evers said. “I don’t think a single one of them missed their assigned shifts.”
Evers was familiar with the facility; he had visited many times to investigate numerous complaints made by residents and families.
A North Carolina Health News examination of the facility’s file at the Division of Health Services Regulation revealed a facility that had been operating with a pattern of violations and complaints since at least 2010. And Evers’ name was on the many complaint investigation reports in that file.
In 2011, 57 people lived in Tillery Chase, which had capacity for 60 residents. Rates were $1,700 a month for a semi-private room and $3,200 a month for a private room. At that time, all of the residents’ accommodations were paid for by Medicaid, and all were receiving additional Medicaid payments to pay for personal care services, such as help with bathing, dressing, feeding and managing medications.
And many of the residents were not elderly; instead, they had primary diagnoses of mental illness (see box, left).
“There are not people who were trained to work with people with mental health disabilities in these facilities,” said Vicki Smith, head of Disability Rights North Carolina. “And there is no licensing requirement that they have trained staff.”
Trail of troubles
That lack of training is evident in the litany of complaints found during NCHN’s review of Tillery Chase’s state files:
Jan. 18, 2011: A staff member gave a resident a dose of morphine that was 10 times the prescribed dose, resulting in the resident being sent to the hospital.
January 2011: During the investigation of the medication incident, reviewers also found that the heating system in the building had failed several times, leaving the residents in the cold during December.
The investigation also found residents were not being given enough to eat and often complained of hunger, and seven residents had lost weight. The cook at the facility revealed there were several times when she would have to go to the store to buy groceries for meals because there was not enough food to serve the residents.
April 2011: A complaint investigation found one resident with a history of mental illness had been “threatening other residents.” The man repeatedly exposed himself to females and attempted to sexually assault a female resident before being discovered by staff. The incidents stretched over several weeks, until state investigators were finally called.
June 2011: Interviews with staff revealed they did not do anything about, or know how to cope with, residents with psychiatric problems who were combative, including incidents where residents yelled at one another, smoked in the facility, threw furniture and cursed or hit staff.
Sept. 2011: The sewage pipes in one part of the building backed up, flooding about half the building, contaminating it with sewage. Twenty-seven residents were unable to stay in their rooms. Without an evacuation plan, staff had the residents sleep in chairs in the lobby.
June 2012: Another investigation found problems controlling the behavior of residents with psychiatric problems, after several were allowed to terrorize other people living in the facility.
August 2012: County DSS inspectors found roaches in the kitchen and unsanitary food-preparation procedures.
Also in August, Katrina Tatum, Mt. Gilead town manager, wrote to state regulators to complain about the behavior of residents who were roaming the neighborhood around the facility.
More than half the residents had a primary diagnosis of a mental health disorder, making Tillery Chase subject to falling under the jurisdiction of a U.S. Department of Justice settlement with North Carolina (see box, left).
These violations and others netted the owners tens of thousands of dollars in penalties, and, from 2011 until late 2012, their star rating dropped from three of a possible four stars to zero. The state restricted Tillery Chase’s ability to admit new residents.
But the facility closed only after the owners abandoned it, not because the state closed it down.
“These places can really be hellholes; that’s why it was a problem to have people with mental health problems living in them,” Smith said.
“We’ve seen these kinds of conditions in other facilities,” she said. “We didn’t go into this one, but based on a review of files, this is one of those places that doesn’t deserve to be open regardless of whether they’re [institutions for mental disease] or not. They’re just bad places to live.”
Tomorrow: How the state is limited in regulating problematic adult care homes.