Rushing To Turn Family Homes Into Rest Homes It Can Be A Good Living For Owners, And A Good Life For Their Residents

Christian Daugherty serves breakfast for nine in his kitchen and dining nook, but he eats standing at the stove.

He owns a roomy house on Spokane’s South Hill. But he sleeps in the basement.

The retail salesman and his wife, Patrice, a high school teacher, gave up their careers and much of their home last year when they entered the booming business of caring for the elderly at home.

Scores of Spokane County residents have left their jobs - day care, nursing, waitressing, construction, teaching and more - to turn their houses into so-called “adult-family homes.”

They advertise aggressively for elderly and disabled clients who otherwise might land in nursing homes. State health officials enthusiastically funnel business and money their way, intent on slashing 1,600 people within two years from the state’s nursing home population of about 26,000.

Federal and state money pumped into adult-family homes nearly doubled in two years, from $6.4 million in 1993 to $12 million in 1995, according to state records.

Word is spreading fast: The money can be lucrative. Adult-family homeowners can stay home with their kids, be their own bosses, and still earn solid incomes.

Some caregivers leap in with a big-business approach, opening several homes and charging each resident $800 to $3,000 per month. It adds up, especially in a county such as Spokane where a family’s median income is $33,577 - about $7,000 less than the state average.

For nearly 30 years, adult-family homes existed as “mom and pop operations,” said Carla Burke, a supervisor with the state Department of Social and Health Services, which oversees adult-family homes.

“It’s evolved into a pretty big business - a pretty good money-making business, too.”

The public is demanding more access to home-like alternatives, say state health officials. They expect that demand to mushroom. Census analysts predict one in six Washington residents will be 65 or older by 2020.

About 50 new adult family home beds open each month statewide. There’s such a stampede to get licenses, state officials just slapped a 90-day moratorium to prevent runaway growth.

The state saves big when people choose adult-family homes instead of nursing homes. The government pays $1,000 per month for the average resident. That number jumps to $2,500 for people in nursing homes.

The number of Medicaid clients placed in homes rose from 1,257 in 1993 to 2,028 in 1995, according to state records.

Facing more safety rules

Yet sharp growing pains mar the expansion. The Daughertys and other caretakers feel ambushed by more paperwork and state officials who want to monitor them more like nursing homes.

Homeowners are flocking to classes to keep up with all the new rules.

In just a year, however, stricter inspections revealed a slew of problems in Spokane County homes alone, from alleged sexual abuse to neglect to a caretaker convicted of negligent homicide.

The state shuts down one or two homes a month in Eastern Washington, compared to one or two a year in the past.

“There was greater potential for abuse and neglect,” said Burke. “We didn’t have the eyes and ears out there like we do now.”

All those eyes and ears come as a shock to new adult-family homeowners, like Christian Daugherty.

Daugherty’s mother ran an adult-family home, so he expected hard work when he and his wife opened theirs.

He didn’t expect privacy, and he didn’t flinch at buying mayonnaise by the gallon. He also knew the shower rarely would be empty long enough to dry.

What caught him off guard was the recent barrage of legislation.

“They’re supposed to be downsizing government?” said Daugherty. “Well, they’re not.”

Daugherty keeps in close touch with a lobbyist hired by a coalition of adult-family homes formed to curb government control.

Many homeowners approve of the new regulations but worry state officials will go too far, said Dan Simnioniw, the coalition’s chairman.

“A lot of people feel they’re giving up their constitutional rights, and that that’s really overstepping the line because they’re private homes.”

Extended family for residents

Proponents tout Spokane County’s 264 homes as friendly, comfortable alternatives to more sterile and impersonalized nursing homes. People get home-cooked meals and bedrooms decorated with their own belongings. Ideally, they develop close bonds with the people who care for them.

For the Daughertys, opening their home meant an instant extended family for their daughters. Women pat 3-year-old Amy Kay’s hair and admire her smile; a man joins Brianna, 6, on the floor to play with Barbies.

For Harriet Diehl, 83, moving to an adult-family home from a nursing home meant more attention and affection.

Caregiver Nancy Brown knows Diehl’s past, what she likes to eat, what makes her laugh.

“We don’t have to worry about Harriet,” said John Manion, who moved Diehl, his aunt, to Brown’s Valley home with two dogs and a big back yard. “There’s no comparison to where she used to be.”

More potential for abuses

But not all homes have the cozy, familylike atmosphere people envision when they help someone move in.

According to inspections records, recent investigations in Spokane County found:

A woman said a caregiver sexually abused her during baths since she moved in 10 years ago. It was OK, she said, because he’s her “daddy” and would go to jail if she didn’t keep quiet. Another woman in the home said that during breakfast, the man unbuttoned her pajamas and fondled her breasts. The man voluntarily surrendered his license, and social workers referred the case to police.

An elderly resident was left on a cot in a laundry room where the temperature was about 32 degrees. A wooden gate blocked one doorway, and another was nailed shut. A padlock kept other residents from entering the area at night. State officials closed the home.

A caregiver admitted she left her 11-year-old son in charge of elderly residents for 60 to 90 minutes at a time. Health workers who found the boy supervising three residents described the scene as “chaotic.”

Investigators don’t always win when they try to shut down homes.

An administrative law judge sided with the adult-family home after inspectors wanted to close a house in which a caregiver was convicted of negligent homicide involving a car crash.

“We felt a person who was convicted of homicide shouldn’t be providing care to vulnerable people,” said Ben Blake, manager for the state Department of Social and Health Services.

Blake appealed the decision. Another judge will make the final call.

Linda Miel, the region’s long-term care ombudsman, applauds the crackdown.

“Prior to last year,” she said, “they weren’t real successful in shutting down the ones that need it.”

Inspectors with crammed schedules are working to weed out the worst homes, relying heavily on the new law allowing unannounced inspections.

Six regulators and two complaint investigators cover the 499 homes in 19 Eastern Washington counties. Annual inspections and a monthly average of 30 complaints stretch investigators to the limit, said Blake.

Yet the workload for inspectors is expected to soar. At the current pace, 100 more homes will open in Eastern Washington within the next year.

Caretakers face new scrutiny

Already, government workers pay more attention to adult-family homes than ever before. They want quality care to survive the rush of people opening new homes.

Gone are the days of little training and announced inspections.

All caretakers in the homes now must be trained. Inspectors can show up anytime. Homeowners who won’t let in state-appointed advocates face fines of up to $1,000 per day.

Workers who once needed only basic firstaid training now must spend 22 hours in various classes.

Consequences are more severe for homes violating the law. Inspectors can issue fines of $500 a day, although they haven’t yet issued such fines in Eastern Washington.

Caregivers already ask for permission to skip training, claiming they don’t need it, said Blake.

“I really don’t think we should excuse people from training. I get that demand every day,” Blake said. “It’s the ones that aren’t trained that we end up sending our investigators out.”

Sometimes volunteer ombudsmen appointed by the state handle smaller complaints, such as ensuring a woman who ate oatmeal every morning for years continued to get her favorite breakfast.

Another time, they helped someone get a restraining order to keep a harassing relative from visiting. An ombudsman also referred someone to small claims court when a homeowner refused to refund money after a client died a few days into the month.

The volunteers have no enforcement power but can report problems to state inspectors, who then might investigate.

“So many times,” she said, “we can get it straightened out before it gets bad.”

No bed of roses

Brown dislikes all the governmental oversight, but it’s not the only thing that makes her job more difficult than her initial fantasy of “an elderly bed and breakfast.”

Maxine, 82, claws at Brown’s face when her Alzheimer’s is at its worst.

Helen, 94, roams the living room almost every evening, searching for Joe, her late husband.

Brown sleeps fitfully on the couch many nights, worried a restless sleeper will wander and fall.

Much of her day is spent giving showers, changing sheets, shopping for food and clothes, cooking and taking her charges on outings: bowling, church, birthday dinners.

The new regulations, in a way, are just one more thing.

But please, Brown asks, don’t call her adult-family home a business. “This isn’t a business to us,” she said. “This is our family.”

, DataTimes ILLUSTRATION: 5 color photos

MEMO: Changed from Idaho edition

This sidebar appeared with the story: CHOOSING A GOOD HOME When choosing an adult-family home: Look at more than one home. Ask for references. Ask the local adult-family home license agency for information regarding complaints. In Eastern Washington, call 456-3911. In Idaho, call 208-769-1400. Ask for the basic rates. What services are covered? Are there additional charges? Check refund policies should a resident leave midmonth. Consider the wishes of the person being placed. Their preferences are most important. Ask about policies regarding pets and visitors. Check the home for unusual, offensive odors. Check the home for cleanliness and adequate supervision. Are residents actively participating in life around them? Watch to see if workers treat residents with respect and dignity. Make sure meals are nutritious, adequate and attractively served. Be certain religious preferences are honored. Make sure you can bring special furniture, photographs, books and other personal belongings to ease the transition. Find out how physical therapy, recreational therapy and other special services will be provided if needed. Once you’ve selected an adult-family home, make sure you make a written list of all possessions and clothing. Give a copy to the facility operator. Visit regularly. Source: Washington State Department of Social and Health Services.