NC must improve care for vulnerable seniors

Three care staff at Danby House assisted-living and memory-care facility, part of the for-profit Affinity Living Group headquartered in Hickory, were recently arrested and charged with assaulting disabled individuals. Their offenses included encouraging residents with dementia to fight, recording the altercation, and sharing a video of the abuse.

What was particularly chillingly about this episode was the attitude of the caregivers toward the residents. The staff weren’t angry or stressed; they were just workers entertaining themselves. During this crime, the staff weren’t treating the residents like frail older persons deserving assistance and dignity; they were treating them like animals they could entice to do amusing tricks.

How does such a thing occur? The failure of three interrelated systems set the stage for this episode of abuse. First, Affinity and its president and CEO, Charles Trefzger, Jr., failed miserably. Affinity’s personnel practices (vetting, hiring, training), quality assurance, and management procedures did not protect those in their care. Affinity will surely claim this was an isolated incident. However, the casual cruelty of the aides implies that their behavior in this incident was part of a pattern of recurring behavior that should have been clearly apparent to their supervisors.

Second, the North Carolina Department of Health and Human Services (DHHS) is responsible for assuring that assisted living facilities (ALFs) meet regulatory requirements through annual inspections of ALFs. care. Third, each county department of social services has at least one adult care specialist who works with DHHS and inspects ALFs quarterly.

In the case of Danby House, all three of these systems failed, and these three failures largely share a common foundation. The residents in ALFs are some combination of physically frail older persons, persons suffering from some form of dementia, or individuals with intellectual or developmental disabilities. In addition, many ALF residents are so poor that they are Medicaid recipients.

People who are old, sick, and poor have little political power. These characteristics place ALF residents low on any list of legislative priorities. The same can be said for those public agencies assigned to protect them. The budgets provided for ALF oversight by DHHS and counties are inadequate for these entities to properly perform their duties. At the same time, advocates for improved quality in ALFs face a well-organized and financed ALF industry that claims all ALF ills will be cured by higher reimbursement. Yet, the industry balks at any payment increase that requires they demonstrate that the additional funding went to add staff and improve quality, rather than increase profits.

ALF residents are almost always invisible to the general public. It is only when some heartbreaking event is publicized that ALF residents and public policies designed to protect them become the focus of public discourse. As advocates for ALF residents, we can only hope that this is one of those troubling instances that spurs public officials to revisit the way ALFs are reimbursed and regulated with an eye to assuring that vulnerable North Carolinians never again face an incident like that at Danby House.

Charles Phillips is chairman of the board of directors of Friends of Residents in Long-Term Care.