Largely Unregulated : Homes for Elderly Can Care or Kill

“Daily throughout this state, residents of community care facilities are being severely abused, beaten, fed spoiled food, forced to live with toilets that don’t work, generally subjected to a demeaning existence and left unattended. In fact, some residents are actually killed.”

The dramatic words echoed those of turn-of-the-century muckrakers, but in fact they described life in contemporary America. In a 1983 report to Gov. George Deukmejian and the California Legislature, the watchdog Little Hoover Commission was commenting on some of the state’s “board-and-care” homes--refuges for the elderly where the residents are guaranteed three meals a day and some help with the routine tasks of life.

As more people live into their 80s and beyond, board and care is becoming an attractive alternative for elderly persons who do not need the round-the-clock care of nursing homes but can no longer get along at home. Usually more homelike than nursing homes, they are also considerably cheaper.

Types Vary Widely

Hundreds of thousands of the elderly live in the facilities, which range from one-bed “mom-and-pop” operations in private houses to large homes with 100 residents or more. Some homes promise little in the way of care, while others make sure residents take their medicine, help them out of bed and even assist with bathing.

“We are the answer to the population that needs supervision,” declared Charles W. Skoien Jr., vice president of the California Assn. of Residential Care Homes. “I’ll take you through one of our homes and I’ll take you through a nursing home--then you tell me where you want your parents.”

Yet some board-and-care homes operate in the shadows where the law scarcely reaches. Like nursing homes of a generation ago, board and care in many states is largely unregulated. Many of them are unlicensed, and some of them are anything but homelike.

“There are some really good homes, and I’ve been in some excellent ones,” said Bill Benson, a staff member of the U.S. Senate Special Committee on Aging and former long-term-care ombudsman of California’s Department of Aging. “But for the bad ones, you could not fictionalize them, you could not write a horror story to match what goes on there.”

Last October, a man was discovered dead in a South-Central Los Angeles board-and-care home, his body locked in a closet that had been nailed shut. The manager of the Heaven’s Crest home later pleaded guilty to involuntary manslaughter.

Just last month, the California Department of Social Services shut the Hilton Retirement Center in Lynwood and threatened to close Waldorf Manor in Gardena, alleging fire hazards, filth and inadequate supervision of residents. Both are owned by Los Angeles businessman Sam Menlo.

And problems extend far beyond California. Firefighters near New Orleans responded in June to an alarm at the Villa Angela Retirement Center in Metairie, La., and discovered “deplorable and uninhabitable conditions,” including toilets hanging loose from the walls and rooms infested with fleas, according to a report by the governor’s office. Fire inspectors shut down the converted motel, but the home’s operator reportedly loaded 28 of his 45 residents into vans and moved them 120 miles north across the Mississippi state line to a former church camp he owned. One of the relocated residents wandered away and was later found dead.

For every horror story, however, there are homes where the residents live comfortably and get all the care they need. One such is Epworth Manor in Ocean Grove, N.J., walking distance from the boardwalk, where many of the 46 boarders relax on the porch under gray-and-white awnings.

“I’m very grateful for the protection of this home and the very active fellowship here,” said Enola Wragg, 86, who moved there earlier this year after the death of her husband. Crab casserole and ambrosia salad were on the lunch menu that day, and a resident provided piano music for the diners.

Government Helps Pay

Residents pay $720 a month if they can. If they cannot, they can get help from government welfare programs for the elderly and from the United Methodist Church, which operates Epworth and seven other New Jersey board-and-care homes.

Similarly, in Los Angeles, the 100-bed New Garden of Roses home resembles a well-maintained garden apartment building. Saul Bernstein, the home’s owner, said his family eats the same kosher food he serves the residents.

“We have our integrity,” he said, “and we run a pretty good operation here. In general, I think people expect a lot worse than what they see when they get here.”

Nobody knows exactly how many such homes operate nationally because tens of thousands of them are unlicensed. In California, there are 3,523 board-and-care homes for the elderly certified by the Social Services Department, up from 3,150 four years ago.

Nor is board and care only for the elderly. Much of the industry’s expansion occurred in the 1960s and 1970s as state mental hospitals sent many of their residents onto the street. Some homes mix the mentally ill and retarded with the elderly--a blend that can be explosive.

‘They Are a Catchall’

“Board-and-care homes often are the depository for the less desirable people the health care system does not want to take care of,” said Barbara Frank, associate director of the Citizens Coalition for Nursing Home Reform in Washington. “They are a catchall for so many different types of folks: homeless people, discharged mental patients; elderly people who suffered an injury, gone to the hospital and are too weak to return home, and the elderly who simply cannot manage alone and have no one to take care of them.”

Los Angeles psychiatrist Paul Logan said some California board-and-care homes have been used for years as convenient places to discharge patients from state mental hospitals. “The people who set up the regulations and set up the monitoring (of board and care) at the very beginning were doing a dumping process,” he charged.

Estimates of the total number of board-and-care residents range as high as 1.5 million, including the young as well as the old. And the elderly board-and-care population is likely to mount in the years ahead as the federal Medicare program forces hospitals to discharge frail elderly patients sooner than ever to cut costs.

Regulation of board-and-care homes falls to the states, and their record is spotty at best. Most states require only bare-bones accommodations, as reflected in the meager welfare benefits received by board-and-care residents who cannot pay their own way.

In California, for example, the maximum payment for the needy elderly is $551 a month under the Supplemental Security Income program combined with a state welfare grant. And many other states are less generous than California. By contrast, California nursing homes get almost three times that amount for their poor residents under the Medi-Cal program.

‘The Law Is Inadequate’

Beyond cost considerations, critics charge that board-and-care homes are too isolated from the health-care system. “The law is inadequate,” said Deanna J. Marquart, a Sacramento consultant who helped write the 1983 study by the Little Hoover Commission (formally, the Commission on California State Government Organization and Economy). “It cannot ensure the safety and well-being of the people it’s intended to serve.”

Although all states require that homes be licensed, some, such as Louisiana, have established no standards for obtaining licenses. Others, including California, have basic standards for nutrition, sanitation and safety, but many of these states have too few inspectors to enforce their standards. “Enforcement is sorely lacking,” said Katrinka Sloan of the American Assn. of Retired Persons.

Strict enforcement sometimes claims board-and-care residents among the victims. Jean Ruecker’s 75-year-old mother-in-law could find herself in that category.

Ruecker said her mother-in-law might have to leave her Ventura County board-and-care home because authorities fear that her Alzheimer’s disease has left her unable to escape a fire--a violation of fire regulations. Ruecker, however, wants her to stay where she is. “We think she’s getting a much better level of care than she would be getting in a convalescent hospital,” Ruecker said.

States Ignored Rule

For similar reasons, the states have resisted the one effort by the federal government to regulate board-and-care homes. Congress decided in 1977 to cut off SSI checks to residents of homes that failed to meet health and safety requirements. It hoped that owners would make improvements for fear of losing their clientele, but the states ignored the rule because the immediate losers would be the vulnerable individuals it was supposed to protect.

Virtually out of reach of all regulators are the thousands of homes that remain unknown to authorities because their owners have not sought licenses. Skoien, of the residential care association, said there could be thousands of unlicensed homes in California, although Marsha Jacobson, an attorney with the state’s Social Services Department, said she doubts that there are that many. Susan Rourke, executive director of Michigan’s Citizens for Better Care, estimated that there were thousands of unlicensed homes in Detroit alone.

Unlicensed homes are typically run out of private residences, boarding houses or shabby hotels. Repeated scandals in Florida, including the suspicious case of a woman who changed her will in her dying days to leave her $250,000 estate to the owner of a board-and-care home, prompted the state Legislature to make it a felony to run an unlicensed facility.

State officials sometimes catch up with unlicensed operators. The California Social Services Department last April closed an unlicensed home in Palm Desert where a woman had taken eight elderly people into her house. “We had heard of her on and off for about four years, and every time we visited she had moved,” Jacobson said.

At Least 18 Died

In Orange County, the state attorney general’s office is trying to close an unlicensed home operated by the Rev. Kenneth Lowe, who previously maintained three other uncertified homes in the county and earlier this year served 16 days in jail for disregarding a judge’s order to close them. At least 18 residents have died in the homes, raising questions of negligence in some cases, according to Deputy Atty. Gen. Richard Spector.

For the elderly residents, however, closing a home is hardly a solution. “If you close down a facility, where are you going to put 100 people?” asked John W. Hagerty, the California Social Service Department’s deputy director for community care licensing. “I don’t think that’s an excuse to keeping a bad facility open, but it certainly is a consideration.”

It may not be enough to save Sam Menlo.

Menlo had been at odds with state authorities before this year. In 1979, a municipal court judge ordered him to surrender his nine nursing home licenses after John Van de Kamp, then Los Angeles County district attorney, cited the homes for more than 2,000 Health Code violations, including cases of residents who lay in their own excrement and who had untreated bedsores.

Menlo’s board-and-care homes, unaffected by the 1979 order, also began to come to the attention of state inspectors. In an extraordinary action, the Social Services Department dispatched task forces of investigators, nurses, licensing inspectors and local fire marshals to his eight Los Angeles-area homes at 6 a.m. Aug. 19.

15 Frail Residents Moved

What they observed led to the closing of Hilton--which could be temporary--and the threat to shut down Waldorf Manor in Gardena. Waldorf was allowed to remain open after some 15 frail residents, who inspectors maintained would have trouble escaping a blaze, were transferred elsewhere.

At Hilton, which is situated in Lynwood, Social Services officials said boarders stole food from each other, often got drunk, were allowed to wear soiled clothing and were not given medication or dental care. On Aug. 18, they said, Hilton staff failed to notify the fire department after a resident set fire to his mattress. And they found other fire code violations: an unsatisfactory fire drill and rooms with dead-bolt locks for which the staff had no master key.

Although Hilton was called a retirement home, many of its approximately 78 boarders were younger persons with mental problems, and their presence generated substantial neighborhood controversy. The Rev. Paul L. Hackett, whose Carlin Avenue Foursquare Church is next door to Hilton, said residents littered the neighborhood and church property with bottles, that one boarder threw a bottle at him and that another spat in the face of a churchgoer. When residents were moved to other institutions in the area, Hackett said, there was a marked improvement in the neighborhood around the church.

“I’m not questioning his (Menlo’s) right to run a facility,” Hackett said. “I’m questioning his right to run a facility that is detrimental to my well-being and the well-being of the church and church property.”

Age Compatibility Required

And while the state requires “compatibility” between older and young residents, several younger boarders with psychiatric problems at Menlo’s Barrington Villa home in Long Beach last February seemed to be an unsettling influence, said Lee Agnello, a representative of the Department of Aging’s ombudsman program.

“The other residents seemed to be afraid of them,” Agnello said in an interview. One of the younger residents, with large white scabs in her hair, moved from table to table eating off plates, Agnello reported to the Social Services Department.

Moreover, Agnello said she saw an aging woman with “half-dollar size open dark red oozing sores on lower arms, hands, ankles and lower legs.” A female resident had bruises on her face that she said resulted from a beating by another boarder.

Although Menlo declined to speak on the record, he released a written statement through his attorney, Peter Aronson. The statement said the recent state actions against Menlo’s homes, coupled with Menlo’s own conversations with state inspectors, “strongly suggest that Mr. Menlo has been singled out for an effort to put him out of business. Mr. Menlo considers that his facilities are comparable, if not superior, to any other community-care facilities in the state.”

Concentration Camp Survivor

In the statement, Menlo, a 58-year-old native of Czechoslovakia and a concentration camp survivor, described the closing of Hilton and forcible removal of its residents as a “Gestapo raid.” He maintained that he had not been informed that it had failed to meet fire-safety standards and that Social Services used the deficiency to shut Hilton on a technicality. “The fire chief notified the Department of Social Services of certain minor deficiencies common to almost all facilities of this type which are easily and quickly corrected,” he said.

But in an interview, Lynwood Fire Chief Ronald Lathrope said he agreed only that the problems were easily corrected. “They were not minor deficiencies--they are serious deficiencies,” he said. “I don’t know of any other facility in this jurisdiction where we’ve located dead-bolt locks on doors and the non-reporting of fire incidents.”

Referring to his other homes, Menlo said that certain charges--such as those involving the Barrington Villa woman grabbing food from other residents’ plates--had never been brought to his attention, if the incidents had indeed occurred.

While still declining a detailed interview, Menlo offered a Times reporter tours of his facilities, “because I wanted to show you I don’t run dumps.” Indeed, a casual walk through Waldorf--the subject of the recent shutdown threat--revealed what seemed to be a clean environment with no obvious deficiencies.

Status Under Review

Social Services officials declined to elaborate on the Menlo case, noting that the status of his homes was under review in light of the August inspections.

No one knows how prevalent conditions are in board-and-care homes that the public would find unacceptable. And what seems scandalous to one observer might be perfectly acceptable to another.

Bill Keating, a special investigator for the Social Services Department, said he has run across other cases of filth, violence, neglect and sexual abuse. But Keating, noting that investigators invariably are steered toward problem cases, declined to generalize about the industry.