[E]SSEX — When Bruce Bottamini was searching for a memory care residence for his wife, he said he felt assured by the many promises and marketing materials promoting age-in-place and end-of-life care.
He settled on Maple Ridge Memory Care in Essex — known as Spring Village at the time — because he felt it would be a comfortable place for his wife Phyllis, who had Alzheimer’s disease, to spend the rest of her life.
After she died in May, Bottamini began hearing of “involuntary discharges.”
Families of residents say the promises made by Spring Village went unkept, and allege that management is now forcing their parent or spouse to leave. The facility claims resident care needs exceed their state operating license.
The discharges began after a management change this year, according to three family members of residents who spoke with VTDigger.
Spring Village Memory Care opened in late 2016 under the ownership of Sentio Investments LLC and managed by Woodbine Senior Living. Sentio’s health care properties were acquired by Florida investment firm Kayne Anderson in August 2017.
The facility is now managed by Massachusetts-based Hallkeen Assisted Living, according to its website, and now operates as Maple Ridge Memory Care. It is currently home to 28 residents, according to management.
Families say they were seeking a place where their loved ones could spend the rest of their lives without being “uprooted.” The promises of “end-of-life care” and “age-in-place” care printed in brochures for Spring Village and emphasized in conversations led them to believe this was true
The organization’s marketing director made those promises clear, according to a relative of one resident who spoke with VTDigger on the condition he not be identified to avoid any possible repercussions for his family member. The sole exceptions to the non-discharge pledge would be if an individual required a feeding tube or became violent toward other residents.
John Hill’s father was one of the first residents to move into the facility. While his father is not currently among those being forced to leave, he said it has been a growing concern as care needs have increased.
“I almost expect that every day,” he said.
Hill said when he originally visited Maple Ridge, the facility was presented as a state-of-the-art complete care option. And with a base price of $5,500 a month, it was the least expensive in the area. The decision was a “no brainer,” he said.
“We were absolutely impressed with the explanation of memory care they could provide my father,” he said. “It was a brand new facility, it was beautiful.”
Hill said he spoke with Carrie Rae Shamell, the director of community relations, who explained to him that Spring Village offered end-of-life care. Many promises were made to him orally about the care the facility could provide.
“It’s a difficult time when you’re looking for your father,” he said. “You have a tendency to believe things period; you want to believe a brand new facility.”
Hill said he began hearing from other resident family members when the “involuntary discharges” began three months ago.
“There is no doubt that they were false promises,” he said.
Bottamini also said he feels misled by the marketing, and that end-of-life care was one of the factors that drove his decision to select Spring Village for his wife. He said staff assured him that they would be able to keep his wife, even as her care needs progressed, including applying for a “waiver” or variance, if necessary.
“With a facility like this, you go in trusting the people,” Bottamini said.
Although his wife’s condition never got to a point where she was told to leave, Bottamini had been concerned that such a day might come. He also has seen the stress on other families of residents who have been targeted for removal.
Earlier promises acknowledged
Bottamini said he has heard of at least four residents who have been issued involuntary discharges.
Maple Ridge Executive Director Katy Lemory declined to respond to questions from VTDigger about the discharges and referred a reporter to the facility’s management company, which disputes that number.
Only two residents have been issued an involuntary discharge since the operating change in April, according to Sharon Ricardi, president of Northbridge Advisory Services. Her company works with Hallkeen Assisted Living on marketing, public relations and other areas.
Out of those two, one is staying under a variance, or exemption received from the state, while the other is in the second round of appealing the discharge with the state.
Ricardi said her firm is working to ensure that all potential clients and current residents receive complete and accurate information.
“We are pleased that people want to stay, they like the care they’re receiving and they’re happy here,” she said.
Ricardi said she is aware of the earlier claims made to families, and stressed that promotion of age-in-place and end-of-life care has not occurred in more than a year.
“There was a marketing director that was misrepresenting, that’s how I would clarify it,” she said.
Ricardi said she doesn’t believe any liability would carry over to current management as a result of the marketing director’s statements. She said Lemory, the current executive director, has been “open and honest” with families for months that those things “shouldn’t have been said.”
“It was done perhaps with good intentions, or perhaps erroneously, but we’re very aware of that,” Ricardi said.
State probes revealed issues
Six investigations conducted by the state while the facility was known as Spring Village reveal an operation that has had its share of problems. Those inquiries resulted in six reports by the Division of Licensing and Protection in Vermont’s Department of Disabilities, Aging and Independent Living.
“We are typically not in residential care homes that frequently” on state investigations, said Pamela Cota, the division’s director.
The state enters residential care facilities for a regular inspection every other year, with additional visits as needed in response to complaints.
A survey conducted on Aug. 30, 2017, shows evidence of potential confusion around the parameters of the facility’s operating license.
The report states that Spring Village “failed to assure” that no individual was accepted or retained who meets a level of care exceeding its operating license, which is for a residential care facility.
“In the month of August, 6 residents were admitted to the facility. At the time of the survey, there is no evidence present that either the Licensed Practical Nurse (LPN) or the RN had done any type of admission screening at the time of admission for R #1, #2, #3 and #4,” the report states. “During the survey visit, and additional 2 residents were admitted without a nurse being involved in any pre screening process.”
The report also notes that the memory care director said she does not screen for level of cognitive impairment.
Sean Londergan, Vermont’s long-term care ombudsman, said that raises some concern.
“In my view, that’s pretty serious as it seems like they were admitting individuals without doing any sort of medical assessment,” he said.
Londergan’s office works to protect residents in long-term care facilities, through educating people about their rights and helping to file complaints. The project, operated under Vermont Legal Aid, also assists residents in appealing an involuntary discharge.
Additional findings in the state’s investigation determined the admission of several residents with medical conditions that exceeded what Spring Village was able, and licensed, to care for. Multiple issues include nursing oversight, which would require a higher level of care.
Ricardi said the first thing Halkeen did upon taking over was to contact Cota and the state about addressing problems from the previous management.
“We worked with the state and said ‘who do you think is beyond the ability of our license to care for under your guidelines and regulations,’” Ricardi said.
She said Maple Ridge is in the process of applying for an assisted living license, which would slightly expand the care capabilities of the facility.
“Basically we’re doing everything we can to keep our residents as we legally can and ethically can,” Ricardi said.
State investigators found red flags in other areas under prior management.
The Division of Licensing and Protection noted that medications were being administered to patients without a written order from a physician.
Staffing issues included high turnover and insufficient personnel at night. One patient went without a shower for seven days, according to an interview conducted as part of the survey.
“Based on observations, record review, and interviews the facility failed to assure that a sufficient number of qualified personnel are available at all times to provide necessary care, to maintain a safe and healthy environment, and assure prompt, appropriate action in cases of injury, illness, fire or other emergencies,” the report states.
Hill said his father’s care initially was excellent but that it declined to a point where staff struggled to get the right medical equipment. One time his father’s meal was served on top of a heater rather than a bed table, which resulted in his food “blowing all over the place.”
“I was quickly learning that the directors were new, they didn’t have the training and the experience to be advertising this memory care facility,” Hill said.
Another report from October found that the staff shortage was resulting in inadequate supervision of residents. Police had to respond to multiple calls, especially on weekends and evening shifts, to help with resident behaviors and residents leaving the facility. In one situation, a resident was found a few miles away at a busy intersection, according to the report.
Documents obtained by VTDigger show the state placed a ban on admissions in September 2017 and lifted the restriction in April. The state ordered Maple Ridge to pay $70,590 in fines for that period.
Forced and voluntary departures
Maple Ridge is licensed as a residential care facility and has special designation as a memory care unit. The next level up would be nursing home care.
Cota, of the Division of Licensing and Protection, said nursing home facilities are for people who need around-the-clock care, and assistance for such tasks as bathing and daily grooming. Residential care homes are supposed to provide care for people who can live almost entirely independently.
“There are far less protections and regulations for residential care, because those residents are still expected to be able to speak for themselves and advocate for themselves,” Cota said.
Facilities, such as Maple Ridge, can apply for a “variance,” which allows them to keep a resident exceeding their license, if they can adequately prove their ability to take care of that resident.
“It’s pretty serious when they’re send a variance, it says they can definitely meet the needs,” Cota said.
Families say at least one resident is staying on a variance, and others are in the process of appealing an “involuntary discharge.”
Hill said that primarily for financial reasons he plans to remove his father from Maple Ridge, but he also has concerns about personal care, safety and the climate around “pending evictions.”
He said staff has forgotten to give his father meals and frequently feeds him late. He said he believes his father could also be forced to leave if he were to stay.
“I am absolutely scared everytime the phone rings from this facility,” Hill said.
“This facility is absolutely not trained, and not prepared for end-of-life care.”
Adverse health effects
For residents who ultimately have to leave Maple Ridge, the health implications of that move could be detrimental. Experts say changing the environment of an individual living with Alzheimer’s disease or dementia can have a significant impact.
Pamela Beidler, the director of programs and outreach at the Alzheimer’s Association Vermont Chapter, has worked in care communities in a variety of roles, including activity assistant and dementia program director.
Beidler has worked with many individuals who have had to move family members because of financial difficulties or limitations of care.
“This is definitely not a stand-alone issue that many care communities are challenged with across Vermont,” she said.
For an individual living with the disease, one of the most important things for them is stability and routine. Relationships with staff are important, according to Beidler.
“Removing them from that comfort zone can be really disruptive for their health and well-being,” she said.
Beidler said a move can cause anger, agitation and withdrawal from activities. But things can be done, including setting up a new apartment to look like the old one, or hiring familiar care staff, to ease the situation.
“It really varies by individual the impact of living with the disease,” she said, adding that some are successful with support.
What can be done?
Cota said in an interview her organization has been reviewing complaints and examining the admission contracts of residents. Nothing in the contracts aligns with the promises made in the brochure or in person.
There’s nothing in the official agreement that guarantees age-in-place care.
“We don’t have any regulations that govern how they provide customer service, how they advertise, how they present information,” Cota said.
The Department of Disabilities, Aging and Independent Living has no control over how facilities talk to families during marketing efforts, she said.
“It’s unfortunate, but there’s nothing we basically can do about past behavior of the facility if they’re doing things that are in line with their regulations and license,” Cota said.
“It’s just not in our role. We have no jurisdiction over what they tell families.”
Bottamini has contacted Cota’s department and legal aid agencies in attempts to stop discharges from occurring for the residents remaining at Maple Ridge. He has compiled a hefty binder of collected documentation and has page after page of notes from his efforts.
It’s an experience that Bottamini describes as “extremely frustrating.”
“I simply feel my mission at this point in time is to try to find a solution or answer to what has occurred,” he said, “and hopefully find a way for the individuals who are still living there to stay and live out their life.”
“These are real people, and it saddens me greatly to see what’s happening.”
