This story by Chris Mays was published by the Brattleboro Reformer on July 25.
[B]RATTLEBORO — A state licensing agency has accepted a Brattleboro senior residential facility’s “plan of correction,” making clear that its employees may not solicit for gifts from residents or their families, including gifts benefiting the facility.
That followed Vermont Division of Licensing and Protection findings that residents’ family members donated money to a staff appreciation fund after being solicited through letter campaigns in 2015 and 2016.
A single resident contributed more than $35,000 over a five-year period to Holton Home; the gifts were not solicited. That resident’s gifts ranged from $150 for piano tuning to more than $10,000 for dining room chairs.
Some concerns at Holton Home were brought to light in a survey by the DLP, the state agency charged with overseeing senior residential facilities, after an unannounced site visit in April 2017 to investigate an unspecified complaint. A plan of correction was then submitted and accepted by the state two months later.
Holton Home had failed to obtain a written request from one resident to assist or manage their finances, according to the survey.
Cindy Jerome, executive director of residential facilities at the Bradley House and Holton Home in Brattleboro, told investigators the resident would present her with bills twice a month that needed to be paid — she would make out the check, then the resident would sign it. She said the resident had difficulties balancing their checkbook, so they would do it together.
“Gifts to family members, donations to various organizations and all resident[‘s] bills were managed by [Jerome],” the survey states. “A General Power of Attorney was legally obtained on Jan. 22, 2016. [Jerome] confirms that a written request for assistance was never acquired.”
According to the survey, Holton Home failed to meet a requirement that says residents should “not be solicited for gifts or other consideration by persons connected with the home in any way.”
The facility has solicited annual donations from residents and their family members for contributions to the staff appreciation fund.
Jerome, who stepped down from the position in May to run for state representative, told investigators the letters were sent to families and they could contribute what they wanted. Donations ranged between $25 and $1,000, according to the survey.
Investigators found the resident — the same one who received help with balancing their checkbook — provided $1,000 to the fund annually from 2013 to 2016. The same resident contributed $35,474 in donations from 2011 to 2016, according to the survey.
The donations included $6,000 in November 2011 and $2,000 in December 2011 for updating the facility’s call-bell system; a $3,000 “gift to the house” in December 2012; $1,500 for a “celebration walkway” in August 2013; $150 for piano tuning in February 2014; $8,000 for a capital campaign in September 2014; an additional $100 for the staff appreciation fund in September 2014; and $10,244 for dining room chairs in October 2015. Jerome told investigators the resident wanted to donate to the facility. She said the resident did not want to wait for funds to be acquired for updating the call-bell system and wanted the dining room chairs replaced quickly because they had not been comfortable. (In their report, state investigators did not identify the resident by name.) Jerome “confirms that it was never suggested to resident … to purchase a chair that s/he would be comfortable sitting in,” investigators wrote.
Asked if it was troublesome to accept such large sums of money from the resident, Jerome told investigators she knew the resident had money and “it would not create a hardship” for the person.
An employee handbook says “no collections of money from residents are to be taken for the benefit of residents, staff or any other organization or fundraiser without the approval of the site director or executive director.” And no licensee, staff or employee is allowed to solicit, offer or receive a gift including money or gratuities from a resident.
Residents’ Rights
Investigators also found Holton Home had not been providing residents with a complete list of their rights and responsibilities during admission.
The plan of correction says staff were given an updated policy, and that residents will be given a list of their rights upon admission. A box is included on an admissions checklist document to ensure each resident receives an explanation of their rights.
All residents will now sign a written agreement if they want to be involved with “the petty cash system,” with records and receipts of all transactions being kept by the site director and executive assistant. All employees have been given a policy about “handling resident money” saying employees should not manage residents’ money without obtaining a written request from the resident.
“If a resident provides a written request to an employee asking for them to manage their money, the employee will communicate with the site director/manager immediately,” the correction plan states. “The site director/ manager will review the request with the Resident Care Administrator to discuss the residents’ level of cognition prior to making a decision. The request will be discussed with the residents’ [power of attorney] or guardian if applicable.”
Letters soliciting money for the Staff Appreciation Fund will no longer be given to residents. Wording in future letters “will not be written in a way that could be interpreted as a solicitation by family members,” according to the correction plan.
“If an employee is suspected of soliciting residents, disciplinary actions will begin immediately,” the plan states.
Legislative Race
Jerome, who is running as a Democrat, served on the Select Board in Dummerston. She is seeking to fill the Windham-4 seat being vacated by Rep. David Deen, who is retiring after 30 years in the Legislature. Jerome is facing off in the Aug. 14 Democratic primary against Vermont State Trooper Nader Hashim, of Dummerston, and incumbent State Rep. Mike Mrowicki, of Putney, for the two Windham seats.
The Windham-4 District represents Dummerston, Putney and Westminster.
“I’m really excited I’m running for office and I’m really happy I can oversee the Bradley House revitalization project,” Jerome told the Reformer, adding that the renovations will lead to a “safe and comfortable home” for residents. “It’s going to be amazing and it’s going to serve the town of Brattleboro and the elders and families for generations to come. And that’s great.”
Jerome started working at Holton Home in 1999.
The Garden Path Elder Living board of directors credits her with helping to oversee capital improvements and making the organization into “a successful and sustainable business.”
The decision to step down follows an evaluation of her performance by an outside party that came at the request of staff at both facilities in a petition submitted to the board of directors in November, according to three staff members who questioned whether the board of directors had asked her to step down. Kree Rinfret, executive assistant at Holton Home, wrote a letter to the editor claiming Jerome resigned after an assessment by a neutral third party was conducted.
Ted Vogt, president of the board of directors, told the Reformer that he does not “get into internal type things.”
“We have been aware for some time that Cindy was interested in running for the Legislature,” he said in a prepared statement. “When Rep. Deen decided to step down, it gave Cindy a perfect opportunity to run. Despite her value to our organization, we did not want to stand in her way. We are grateful that Cindy has agreed to stay on as a consultant in order to assure completion of the Bradley House Revival and other projects.”
Routine Monitoring
Vogt told the Reformer the state routinely monitors organizations as a normal process.
“And if and when they find something that can be done better, we immediately work to do it better,” he said. “We’re always trying to make things work better. That’s the goal.”
Pamela Cota, DLP licensing chief, told the Reformer her group conducted a separate relicensing survey and complaint investigation at Bradley House in April. Her group accepted plans of correction from the facility in June.
A resident who was hospitalized for two nights to be treated for pneumonia had left the facility without supervision in January, February and March 2018, according to the survey.
“After the March elopement, the resident was hospitalized for hypothermia,” the survey says, adding that “the resident is eligible for a nursing home admission or has care needs that exceed that of which the residential care home is licensed to provide.”
That resident has since moved into a facility offering a higher level of care, according to a plan of correction. Bradley House plans to have more staff dedicated to preventing residents from wandering off. Those deemed “a high elopement risk” will no longer be kept at the facility.
Another resident had fallen and refused to go to the emergency room, according to the survey.
“The Bradley House did not properly assess the resident at that time but chose to issue an inappropriate emergency discharge notice,” the survey says. The incident “added undue stress on the resident and his/her significant other; visitation was nonexistent due to transportation issues and telephone communication was the pair’s only support to each other during this time.”
A state regulation requires residents be given a 30-day discharge notice that would allow them the right to stay in the facility after making an appeal until a decision is made. These notices will be given to any resident exceeding care that can be offered at Bradley House and residents’ needs will be reassessed on a quarterly basis, according to a plan of correction.
The survey says Bradley House had “failed to obtain a physician’s order for the use of oxygen for one of six sampled residents.” A plan of correction addresses this via an order from a local doctor, a new storage system and “double checking” to see whether additional tanks will be needed when new residents are being admitted.
A plan of correction addresses concerns in the survey saying Bradley House had “failed to have sufficient staff available at all times to assure a safe and healthy environment, [and] assure prompt and appropriate action in cases of injury, illness, fire and/or other emergencies.”
Nurses will notify one another of any change in a resident’s needs and increased staffing will be given on a case-by-case basis, according to the plan. Staff-to-resident ratio, the plan says, “is adequate at this time.”
Nine cans of outdated soup had been found during the investigation, prompting Bradley House to say kitchen staff will monitor all food stock on a monthly basis and move all goods coming close to their expiration date to the front of the shelves. The facility also plans to monitor possible safety hazards after a door leading to a construction zone had been found unlocked.
Jerome told the Reformer a lot of policy changes have been made to manuals and procedures since the two homes merged in December 2015.
“One of the biggest motives for doing that is we want to sync things up between Bradley House and Holton Home,” Jerome said. “We have good site directors at both homes who want to sync up and make things more clear.”
Jerome said officials from the homes are always learning from those who provide licensing.
“They’re radically changing the regulations,” she said. “They haven’t been revised since the year 2000.”
Jerome said she learns something new from every DLP visit.
“We’re constantly changing things,” she added. “We can always be better.”
Clarification: According to Cindy Jerome, Holton Home has not solicited any residents for contributions of any kind since 1999. Nor at no time since 1999 did Holton Home hold money for a resident without their written permission.
