DSHS vows to toughen oversight of state's adult homes

In an attempt to overhaul Washington's adult family-home system, the Department of Social and Health Services (DSHS) is seeking new laws to boost the cost of opening new homes, raise training requirements and hike enforcement penalties for violators.

In addition, an adult-home-industry group asked DSHS to stop licensing new homes in three key counties — King, Snohomish and Clark. High vacancy rates are threatening to put dozens of owners out of business while reducing residents' quality of care.

The proposed changes are in response to a continuing investigation by The Seattle Times, Seniors for Sale, which found 236 deaths of vulnerable adults that indicate neglect or abuse but were not reported to the state or investigated.

Washington has licensed nearly 3,000 adult homes to provide board and care for up to six adults. Adult homes are less-regulated, less-expensive elder-care options than nursing homes, and are touted as providing personalized care in cozy, neighborhood settings.

But The Times found that hundreds of seniors have been injured or died prematurely from substandard care, often through neglect by scantly trained caregivers.

The Times also found that adult-home deaths indicating neglect occur at strikingly higher rates than comparable deaths at nursing homes. For example, pressure-sore deaths in adult homes occur at a rate more than 3.5 times higher, according to an analysis of death certificates from 2003 through 2008.

The Times also uncovered scores of cases in which elderly victims were imprisoned in their rooms, roped into their beds at night, strapped to chairs during the day so they wouldn't wander off, drugged into submission or denied medical treatment for weeks.

State Sen. Karen Keiser, D-Kent, chair of the Health and Long Term Care Committee, said: "We have work to do. We're going to have to push forward and take action. We cannot afford to have the kind of awful cases The Times uncovered to continue. We must put a stop to it."

Cindi Laws, executive director of the Washington State Residential Care Council of Adult Family Homes, said the vast majority of adult homes maintain high standards and have never been cited with serious violations.

As for the substandard homes, she called on DSHS to move more quickly to shut them down. Some investigations have languished for a year or more while dangerous caregivers continued to work, Laws said.

Kathy Leitch, DSHS' head of aging and disability services, said, "The adult family-home industry is quickly evolving to a sophisticated business model. We have to ensure that our policies, rules, regulations and oversight keep up with this changing industry."

Many of DSHS' proposals, which require legislative approval, will make it more difficult to enter the adult-home business.

DSHS officials are seeking to raise license fees to about $1,000 from $100. Lawmakers tried to make a similar fee increase earlier this year but failed after fierce opposition from the adult-home industry.

The $100 license fee covers just 4 percent of the state's cost to regulate the homes, state officials said. The state tries to set license fees to cover most of the cost of enforcement.

State officials also hope to tighten oversight of a mandatory 48-hour training program for adult-home owners.

The state created the training program three years ago as a way to fix the problem of unprepared owners going out of business at a rapid rate. As many as 300 homes fail each year, most within two to three years after opening.

However, DSHS-approved private subcontractors, who conduct the training, sometimes doled out completion certificates for cash without conducting even an hour of training, The Times found. Some trainers held classes in pizza parlors and coffee shops.

DSHS wants instructors to adopt standardized curriculums and hold classes in classrooms certified by the state.

Other DSHS proposals include: raising the requirement for owners and caregivers to be proficient in English; and increasing the maximum civil fines for violations to $3,000 from $100.

DSHS' recommendations followed the release Wednesday of a 25-page draft report by a work-study group formed earlier this year in response to The Times' previous findings.

The 41-member group — which includes police, prosecutors, advocates and senior-care providers — called for DSHS to replace its antiquated computer system, which is unable to track enforcement actions among homes.

The study group also called for DSHS to work more closely with law enforcement by referring more neglect cases for possible criminal prosecution.

The adult-home industry's call for a moratorium will likely be ignored. State officials said they want to stabilize the industry by boosting licensing requirements, tightening training standards and working more closely with law enforcement.

Michael J. Berens: mberens@seattletimes.com or 206-464-2288