53 deaths in five years tied to adult-care violations in rest homes

Residents wander into traffic, get wrong medication, choke to death; yet state fines are minimal

More than 50 people living in adult-care homes in North Carolina died recently after preventable mistakes. State records say that inattentive care, medication errors and poor maintenance of the homes contributed to the deaths over a five-year period.

Residents of these assisted-living facilities, rest homes and family-care homes have choked to death, frozen, been scalded and wandered into traffic, according to reports on file with the state Division of Facility Services. One suffered a fatal stabbing by a fellow resident. Another received the blood thinner Coumadin for five days instead of Claritin, an allergy medicine.

In each case, the deaths arose out of "something the facility did or failed to do," said Jeff Horton, the division's chief operating officer.

For about 27,000 North Carolinians living in adult-care homes, the death rate after these preventable incidents is more than six times that of state residents over age 65 who die from health-care complications such as surgery gone wrong.

Just this month, a 59-year-old Alzheimer's patient in Charlotte was found dead almost a week after walking away from a Cleveland County rest home. And last month, Winston Prince, 64, walked away from Parkway Retirement Home in Cary -- while a county inspector was conducting a review there. Prince was found alive nine hours later, after apparently hitchhiking to Fuquay-Varina.

"The folks who are in long-term care, they are a frail elderly population, and you expect some deaths," said Bill Lamb of the UNC-Chapel Hill Institute on Aging. "You don't expect deaths where the staff of the facility is culpable."

These cases, in which people died after the staff or home committed serious violations, are just the ones reported to the state. Advocates for residents say more occur without notice. Outside of family and government, the deaths rarely get attention. A change in state law last year resulted in reduced public access to investigations and information about penalties in the cases.

Jerry Cooper, executive director of the N.C. Assisted Living Association, a trade group, called the deaths tragic.

"We need to kind of step back and look at the big picture and see what system could have been in place," he said.

Under the law, county and state investigators propose fines for violations that include negligence, medication errors and improperly maintained buildings. But these fines are lowered or dismissed in about 38 percent of the cases, an analysis by The News & Observer has found. The average fine paid in these cases was about $2,615.

Since 2000, the state has dealt with 67 cases of preventable deaths in adult-care centers. The N&O analyzed 53 cases for which complete data were available and the most serious level of violation occurred, according to state records.

Industry representatives and advocates for older people point out that many adult-care homes do a good job caring for residents. Horton said that problems can often be traced to poor staff training, high turnover and the placement of residents in homes that aren't equipped to care for them. Industry representatives say state Medicaid reimbursement rates should be raised to better cover the increasingly complicated care that patients require.

Clearly, the growing industry is in flux, and state regulations often struggle to keep up. Changes to state law in 2005 increased some fines to as much as $20,000 and added inspectors for the adult-care industry; each facility will be inspected annually beginning next year.

In the same session, though, a provision quietly added to the state budget bill at the last minute cut the monthly meetings of the Penalty Review Committee to twice a year. This state-appointed advisory committee is seen by advocates for older people as a key means of opening the regulatory process to families and the public.