How is a Mesa assisted living facility still open after a death and 148 citations?
There’s a lot to be shocked about when you read reporter Caitlin McGlade’s story about the horrors endured by some of our most vulnerable parents and grandparents who had the rotten luck to be living in Heritage Village, an assisted living center in Mesa.
There is the fact that a Heritage Village resident suffering from dementia killed her roommate in 2019 after a caregiver skipped a dose of the medicine she needed to remain calm.There is the fact that Heritage Village since then has racked up nearly 150 citations — two and half times the number of any other assisted living center licensed to serve residents who need the most help and supervision.
There is the fact that despite that, the state Department of Health Services has not threatened to close the place down.
In fact, DHS seems to have difficulty seeing a real problem here — declining even to substantiate some complaints, including one in which a police detective told a grieving woman that it appeared “the entire staff/system at Heritage Village facility failed” her dead mother.
Arizona officials stonewalled answers
There is the fact that other people have been hurt and/or terrorized at Heritage Village and at other assisted living facilities but the public wouldn’t know about it.
The law detailing what needs to be reported is a joke.
Meanwhile, the state’s reporting system makes it ridiculously difficult for someone researching assisted living options to find out what really goes on when you put mom or dad in one of these places. Do a default search of Heritage Village on the state’s website and just one citation pops up.
And the most shocking part of this story?
The state stonewalled McGlade when she went looking for an explanation of what is happening — and as importantly, what state regulators plan to do about it.
DHS, which regulates assisted care facilities, never made an official available to talk to McGlade about her findings.
Gov. Hobbs' office never responded
And Gov. Katie Hobbs? Her office couldn’t be bothered to respond to McGlade’s repeated requests that she address shortcomings in the system that’s supposed to safeguard the state’s most vulnerable residents.
I’m not the only one who is stunned about the state’s apparent disinterest.
Will Humble, a former state health director who now heads the Arizona Public Health Association, said he’s “speechless”.
“This wasn’t a one-day turnaround piece,” he told me via a message. “They (ADHS – Jennie Cunico) had weeks to come up with an explanation and maybe some … goals they could commit to. They could also make the case their civil money penalty authority (in statute) is woefully inadequate to get operators’ attention.”
McGlade spent months analyzing thousands of complaints, citations, inspections, police reports and body camera footage. She interviewed families and former employees.
Though the state apparently is uninterested in what she found, the rest of us should be fairly horrified.
Estalyn's treatment should horrify you
Consider the case of Estalyn Bouchard, 86, who had dementia.
She was moved into Heritage Village during the summer of 2021 and soon thereafter, her daughter says she came to visit, only to find that nobody knew where she was. Maybe, the staff suggested, she left. (Her daughter says she finally found her standing in someone else’s room, with no clue of where she was.)
During Estalyn’s year at Heritage Village, her daughter says her furniture went missing, as did her dentures, her walker (twice), her shoes and even her socks.
She lost 12 pounds in a month and her says she often found her mother dirty and wearing wet socks and stained clothes.
She was injured in a fall but no one took her to a hospital until two days later when her family arrived. This old woman went two days with a broken wrist and none of her “caretakers” noticed?
When the family moved her out in July 2022, McGlade reports she had night terrors about someone on top of her, hurting her.
Heritage Village was fined a mere $250
Her daughter filed complaints both with Adult Protective Services and DHS. Heritage Village was fined $250, though it’s unclear if that fine was related to the Estalyn’s injury.
That fine doesn’t show up if you go the state’s website to research Heritage Village — not unless you know to search “closed” facilities.
Never mind that this one remains, you know, open.
Abuse in care homes won't stop: Until the state gets serious
If you research open facilities, you’ll find just one of the facility’s 150 citations — about not paying a licensing fee.
McGlade discovered Estalyn’s ordeal in a Google review left by her daughter.
What else the records don't reveal
Here are some other things that you likely wouldn’t find by looking at DHS licensing records, unless you happen to be a skilled investigative reporter who does this stuff full time.
That Heritage Village was cited for hiring unqualified caregivers, without checking references or verifying that they aren’t criminals.
That residents in memory care didn’t have call lights or any other way to reach out for help.
That a worker didn’t have a key to a door that locked, which is how one resident inside a locked room came to be crawling out a window and hitchhiking on a nearby freeway overpass.
That one resident didn’t get prescribed asthma medicine for a month and another was given Narcan — a drug used to treat opiod overdoses — for allergies.
I could go on.
OK. I will. One more.
Punishment for rape? A $500 fine
Months after Joyce Dinet was killed by her roommate — the one who wasn’t given her prescribed medication to keep her calm — another 85-year-old resident was raped by a staffer. He was fired and is now in prison.
But the only thing you would know, if you went to the DHS website and were smart enough to look in the “closed” facility file, is that the staffer was “inappropriately touching” a resident.
Heritage Village, by the way, was fined $500 for that incident, which is the highest fine that can be levied for each day that a violation occurred.
I’m sure that was a crusher, given that Heritage Village and places like it charge more than $4,000 a month to provide this “care.”
DHS remains mum, except to blame others
No DHS official was available over the last two months to talk to McGlade, but an agency spokesman did find time to point a finger at Adult Protective Services, insisting DHS doesn’t have the authority to investigate abuse, neglect or exploitation allegations.
“They do, too,” Humble told me, citing the rule that allows the agency to substantiate abuse and neglect in licensed facilities.
For what it’s worth, the director of Madison Realty Companies, which has owned Heritage Village since 2017, said his team fired the previous management company and has transformed the facility over the last year, with more and better trained employees and an on-site medical office.
“Our goal is to provide good care to everybody,” Gary Langendoen told McGlade. “If anybody was injured in any way, that’s certainly not a good thing. We would try to do anything we could to correct that in the future. I would apologize to anybody if there was an injury.”
That’s certainly more — a lot more — than the state’s regulators or governor have to say.
Reach Roberts at laurie.roberts@arizonarepublic.com. Follow her on X (formerly Twitter) at @LaurieRoberts.
Support local journalism: Subscribe to azcentral.com today.
This article originally appeared on Arizona Republic: Why is a Mesa assisted living center with 150 citations still open?
