After months of review, a new operations guide helps state, locals manage response to abrupt adult group home closures.
By Brenda Porter-Rockwell
Just over a year ago, Amy and Larry Patton, owners of three adult care homes in the central Piedmont walked into their facility in the Montgomery County town of Mt. Gilead and ferreted away all the valuables, including ice makers and fax machines, while residents of the home slept.
The next day, residents and staff were left in a state of confusion.
State and county workers swept in to secure new homes for the combined 75 residents. Within less than two days, they had scrambled to find placement for all of the Pattons’ residents.
The state of North Carolina suspended the couple’s license to operate an adult care facility for a year. No criminal charges were filed.
Now a year later, after the Pattons abandoned their facilities, the state has developed a new plan called “Operational Guide For a Coordinated Response to the Sudden Closure of an Adult Residential Care Facility” to allow for a more strategic and coordinated response if faced with the sudden closure of a facility.
Little warning
Although rules were in place in 2013 to prevent sudden, unorganized closures – such as a 30-day notice of closure requirement – state and local officials across two counties had no coordinated plan or process to guide them through quick and decisive actions.
The Pattons had followed the letter of state rules when in late January they told authorities they planned to close their three facilities – one in Mt Gilead and two in Greensboro – within 30 days.
They were in financial difficulty, including a defaulted $2.6 million loan a court had ordered them to pay, along with back taxes.
Only one week elapsed before they emptied out the Mt. Gilead residence.
The same scene played out at their other two adult care homes, known as Serenity Care and Serenity Gardens, in Greensboro.
Acknowledging that local workers managed to resolve the problem well, Department of Health and Human Services Secretary Aldona Wos said last January that she wanted to ensure a more orderly response should this happen again. Wos immediately tapped Dennis Streets, director of DHHS’s Division of Aging and Adult Services, to chair an inter-departmental task force.
According to a press release at the time, Wos said the plan would, “Strengthen our preparedness and response to adverse situations that could jeopardize the health and safety of vulnerable adults living in residential facilities.”
No crime and no punishment
While the Pattons’ actions might have been unethical, they did not break any laws. To the frustration of many, state or local officials were powerless to take legal action to hold the couple responsible.
Even with the operational guide in place, Streets said DHHS continues to examine additional measures to prevent sudden closures and, just as important, hold accountable those who disregard the rules.
“Are there things that can be done, administratively or through legislative action, that would be a deterrent to someone doing a sudden closure of this nature and putting people at potential risk?,” asked Streets.
Among the actionable measures being considered against negligent owners is an immediate revocation of a license. The state is also considering forbidding negligent owners from ever receiving future public funding.
Further, Streets said there is a possibility that in the future the Pattons’ actions could be considered criminal, but that would be a matter for the state legislators, who would need to amend the law.
Montgomery County Lead Assistant District Attorney Darren Allen said no laws currently exist that would’ve allowed arrest and prosecution. However, he said he hopes the legislature considers taking a harder stance.
“I would be in favor of making it a crime. It would be nice if the legislature would provide some sort of deterrent to that happening again,” said Allen.
Streets is also looking at how adult care homes have prepared emergency response plans that are associated with a natural-disaster closure as a model for the need for a sudden closure. Facilities are expected to have natural-disaster emergency plans in place.
“What we would like to do is think about it in the most practical, effective way to avoid this in the future and, if something does happen, hold the party responsible,” said Streets.
“What that exactly is, I’m not sure yet,” he said.
Response hubs
After months of planning and meeting, Streets, a 30-year veteran in the industry, said state and local officials now have the tools needed to work cooperatively when faced with a sudden closing.
“We are now in a position where we can ensure an effective sharing of information and communication among those of us at the state level when we need to support those at the local level in the event of a re-occurrence of something of this nature,” he said.
One of the most important and immediate steps taken was to create ad hoc inter-agency response hubs for both adult care homes and mental health group homes.
The response hubs, said Streets, activated only in case of an emergency, outline each agency’s respective roles as divisions – such as the Division of Health Services, Health Services Regulations, Medicaid or Medical Assistance, Mental Health, Substance Abuse and Aging and Adult Services – in the event of another occurrence.
The operational guide also includes the creation of tools like discharge tracking logs to document residents and track their discharge status. A daily situation report, another part of the plan, provides a uniform set of questions to help assess and track the status of the facility and residents and to identify any need from DHHS.
A post-event debriefing has been added to the task list to ensure continuity of care for affected residents and to identify any issues that may affect the state’s response now and in the future.
The state unexpectedly had to put their operational guide to test with another unplanned closing in New Hanover County, which occurred shortly after the closures in Montgomery and Guilford counties.
“We had a little more experience with that situation by then,” Streets said. “While not a full-blown emergency closure, we could draw on our experience and provide our local partners with the outline of this operational guide.
“We’re finding that what we’ve developed and outlined makes good sense and is working well,” he said.
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