Reports of Abuse at Unlicensed Homes for Aged Spur Crackdown

Esther Manask knew something was wrong when she saw her husband’s slippers and new sports coat on the male nurse who opened the boarding-home door.

Inside, Joseph Manask wore tattered clothes that were not his. His catheter bag was overflowing, and his elbow kept slipping off the arm of the couch.

Esther Manask already was upset. The smashed window in her 82-year-old husband’s bedroom had not been repaired, as promised. There still were no protective rails on his bed. And, since the day she had arrived at mealtime to find that he was about to be fed peaches in heavy syrup--clearly not a healthy choice for a diabetic--she doubted that even his most basic needs were being properly met.

She eventually turned to the Los Angeles County Department of Health Services, which, after investigating her complaints and others, started criminal proceedings against the home’s operator, Marina Di Pietro.

“It just seemed like they did everything wrong,” Esther Manask said of Di Pietro and her staff.

Eleven days after he was admitted to the unlicensed North Hollywood board-and-care home, Manask died. Doctors attributed his death to cardiac arrest but noted that he was dehydrated when he was taken to Northridge Hospital Medical Center in a coma on Jan. 22, 1986.

“It was negligence,” charged Esther Manask. She said her husband’s stay at Di Pietro’s home “undoubtedly” accelerated his death.

Although distraught relatives’ charges can be the product of grief rather than hard evidence, authorities say impressions of improper care are often accurate. Neglect pervades the perhaps 150 unlicensed board-and-care homes that dot the San Fernando Valley and surrounding areas, they report.

In homes across the Valley, investigators have found confused elderly patients and mentally handicapped residents being robbed by some caretakers and simply ignored by others. Senile patients have been found strapped to their beds. The examiners have voiced suspicions that death has come sooner for some boarders than it might have in other facilities.

The concern has culminated in a stepped-up search for unlicensed homes during the last three or four months. Ephraim Mochson, a community-care licensing supervisor for the state Department of Social Services, said at least 75 homes have been identified and cited in and around the Valley but at least that many remain hidden.

The citations are a first step toward encouraging the homes to become licensed. Some operators haul Skid Row transients to their homes from downtown Los Angeles in return for control of pension checks or Social Security payments. “It’s become a cottage industry there,” Mochson said.

Two Arrested

Di Pietro was one of two women arrested last month on charges linked to operating an unlicensed home. In announcing the arrests, City Atty. James K. Hahn called such facilities “one of the biggest threats to the health and safety of elderly people and the mentally ill.”

Di Pietro, whose trial is set for Monday, is charged with 13 misdemeanors, including endangering the health of dependent adults, failure to maintain medical records, operating an unlicensed board-and-care home and operating an unlicensed nursing home.

But some people--including a few whose relatives were under Di Pietro’s supervision--question whether quality care necessarily hinges on a license.

They encounter long waiting lists at institutions equipped to care for violent, disruptive or disoriented Alzheimer’s disease victims. Most licensed board-and-care homes are not permitted to handle such patients, but relatives wonder if an unlicensed home necessarily need be unloving.

“What difference does it make?” asks Jean Wilde, whose 76-year-old sister, after being refused admission at other facilities because of her severe Alzheimer’s disease, lived at a home run by Di Pietro for three years.

“It’s tough to find a place willing to accept people in that condition,” Wilde said.

“Marina was wonderful,” she said. “She cared about her people. She made them feel a beloved part of the family, just the same as you would want for your own mom or dad. She would do things like take them out to lunch when they went to see the doctor.”

“They always were kept well-dressed and nicely groomed,” Wilde said. “They’d get makeup once in a while. She gave them dignity.”

‘Temptation of Caring’

A few years ago, Di Pietro was denied a license largely because she did not have the money to make capital improvements in her home, said her attorney, Bruce Brown. “But families begged her to take their relatives back,” he said. “She found the temptation of caring for people she loved very much too strong to turn down.”

Brown said Di Pietro’s homes were clean and comfortable. Consulting physicians provided good medical care, and patients with Alzheimer’s disease received close attention, he said.

Brown declined to respond in detail to specific charges about Di Pietro’s operation, saying answers would surface during Di Pietro’s trial.

Relatives often choose small board-and-care facilities because they feel a homelike setting offers better care and greater compassion.

“We’d visited a convalescent hospital, and there were people wandering through the hallways,” Esther Manask said. “It was institutional,” she said, adding that she could not think of putting her husband “in a place like that.”

Instead, she chose Di Pietro’s home, which had been recommended to her by a hospital social worker. Seven residents lived in the house, which has four bedrooms and a converted garage. Rates were as high as $1,500 a month. Manask said it did not occur to her to ask if the home were licensed.

“It was a lovely Spanish-style house,” she recalled. “It just seemed a lot more humane.”

But social-services investigators who responded to complaints from Manask and others disagree. According to court records:

One resident told of a Di Pietro employee giving disoriented residents hot chili peppers as candy. He also said the employee struck residents.

A 79-year-old Alzheimer’s victim suffered serious leg and foot burns either from a hot shower or a hot liquid he might have spilled. “Delay in obtaining medical care greatly increased the risk of infection for this patient,” wrote Dr. Mindel Spiegel, a Department of Health Services medical consultant.

A bedridden 90-year-old man with Alzheimer’s was hospitalized with a severely infected foot. Spiegel concluded that the ulcer stemmed from the failure of employees to shift the man’s position in bed. Spiegel also observed that the man was allowed to administer his own sleeping medication.

Mike McSkane, a registered nurse who was the chief investigator on the case for the Department of Health Services, said the home included a “solitary confinement” area--a bedroom with a wire grille over a hole cut in the door, and a chain and lock outside.

After the inspection of the North Hollywood home Feb. 2, Di Pietro allegedly moved her operation to a rented house in Granada Hills. When investigators tracked her there, she moved to Newhall, and then to Kern County, investigators say.

“She led us on a chase,” said McSkane. “She had the ability to move really fast.”

Debatable Point

If Di Pietro’s operations were deficient, whether licensing could have improved them is debatable. Abuses have long been chronicled at licensed facilities, authorities acknowledge, but operations hidden from public scrutiny pose a greater potential threat of abuse.

Katharine H. MacKenzie, the prosecutor in the Di Pietro case, said he thinks that unannounced inspections are a good start. Under the law, licensed homes receive such an inspection once a year.

But “there’s nobody out there checking up” on the unlicensed homes, MacKenzie said. “Who knows how many people have been hurt or malnourished or mistreated or neglected?”

To be licensed, a board-and-care home must have appropriate fire exits and other physical improvements, its operator must have a clean criminal record and “some kind of minimal experience,” said Mochson of the state Social Services Department.

“Compared to nursing-home regulations, they’re not terribly stringent,” he said. Nursing homes must provide skilled medical care, and the facilities must meet extensive physical requirements.

More should be required of the board-and-care homes, say some industry observers.

Martin Rist, executive director of the California Registry, a Los Angeles-based service that provides referrals to licensed convalescent hospitals and board-and-care homes, said: “The licensing regulations are so easy to abide by that I can’t understand why anyone would operate without one.

‘Nominal Changes’

“Only nominal changes have to be made to turn a single-family home into a licensed board-and-care,” he said. “In most cases, it would cost less than $1,500. You can’t be a felon, you can’t be tubercular, you have to read and write. There are no professional requirements at all.”

That can lead to inadvertent abuse, no matter how compassionate an operator might be, he said.

“When they wrote the law,” he said, “they had in mind pensioners living in a boarding house situation, but not people with multiple problems of all ranges of severity. You really need knowledge, you really need experience to do that job right.”

Many homes do, said Nancy Seibert, a Sacramento-based community-care licensing official for the state Department of Social Services.

“You can tell the good ones when you walk in,” she said. “They smell fresh. There are activities going on. There are flowers on the table and brightly painted walls; the residents are happy, and there’s some plan for them to be doing something, going shopping or on an outing.”

Licensing provides “another set of eyes” for the consumer, she said. “If a person doesn’t want to be licensed, it means they don’t feel comfortable being checked upon.”

Attorney Brown acknowledges that Di Pietro had no license, but contends--despite the assertions of state officials such as Seibert to the contrary--that state licensing laws do not necessarily apply to homes as small as the ones she ran.

“It’s kind of like forcing someone earning minimum wage to keep the same kind of records as Armand Hammer,” he said.