Justice Department Takes Down Barriers in Retirement Homes

Jun 09, 2015 · 99 comments
Robert (South Carolina)
These places are businesses and businesses are driven by profit, often short term profits, and marketing practices that must be monitored to ensure they are fair and legal.
susan levine (chapel hill, NC)
Most of these comments are so negative about CCRC and I'm not saying they aren't valid concerns.
However my Mom lives in one and its very difficult for me to find fault with anything. The residents who have needed to move from independent living to assisted living ALL say the care is wonderful. People can eat anywhere they please or join any activity.
Just want to tone down the fear in these comments and assure people to shop carefully but good ,kind, healthy places do exist.
I am not involved in anyway with CCRC except as a daughter of a resident.
Eric Schrader (Canton, Ga.)
The nine most scariest words in the English language, " I'm from the Government and I'm here to help", quoting Ronald Reagan. Leave it up to the government to promulgate "dericulous" regulations. Medicare won't pay for a $ 50 grab bar, but they'll gladly pay for a hip replacement. And you wonder why we are in such dire financial straits.
Bella (Texas)
I agree with the settlement of the target case in this article. Why? Because it deals with real problems attached to real DISABLED people.

However, a majority of residents in a privately owned multi-unit residence are legally handcuffed by the LEGAL definition of what "disabled" means. For example, in our condominium which forbids dogs in the residence because dogs defecate in the elevators, raise a ruckus at every load noise and are not controlled even on a leash, a new owner who knew the rules before buying the unit insisted her dog is a "service" dog she needs because she is hearing impaired. What's more, her husband needs his "service" dog and her son needs his "service" dog when he visits. The fact is, none of these dogs, including hers, accompanies her to work or anywhere else because "She has the service of other people."

The condominium assn. turned to their insurance company for help and ended up paying a $10K settlement because THE FAIR HOUSING LAW REQUIRES NO PROOF OF DISABILITY OR THAT THE ANIMAL IS A BONA FIDE TRAINED SERVICE ANIMAL. All a "disabled?" person has to do is verbally state they are physically impaired and need a service animal. Since then, other dogs are now allowed because they are "service" animals.

HOW FAIR IS UNFAIR? How dystopian can a government law be in a privately owned residence where even the police cannot enter without a warrant?
Spike5 (Ft Myers, FL)
My sister has lived in a continuum of care facility for several years. At first she was in a lovely apartment in the independent living building, made many friends, played bingo, went on excursions, etc. When she became ill and needed more individual attention (frequent diabetes and blood pressure checks, insulin injections, more medications), she was moved across the street to the building that contained the assisted living apartments, the nursing home semi-private rooms, and the alzheimer's units. She wasn't able to cross the street on her own to see her former friends and participate in the activities she had enjoyed and was dependent on her friends visiting her instead--which happened less as time passed. Of course, over time, many of them also ended up in the assisted living facility. But now, although she is still mentally alert and physically able to get around by herself using a walker, etc, she is now very isolated. Too many of the people in the assisted living section are not really able to carry on a conversation, and others seem unwilling to start new friendships (it sounds a little like junior high). so she now takes most of her meals alone in her apartment. Having to live across the street from the main building has constrained her life and limited her enjoyment every day.
AKA Susie (Norfolk, VA)
What hasn't been mentioned is that Harbor's Edge "insurance" will pay for all or part of the DOJ penalty and set-aside for residents who were "harmed." That means insurance rates for the facility will go up, and that increase will then be passed on in increased "monthly fees" for current residents (already more than $4,000/month in Independent Living). I'm delighted with the DOJ ruling and believe it will have a positive impact on other facilities as well, but for those of us living here, it is a somewhat "mixed blessing."
Paula Span (NJ)
Yes and no, Susie. Harbor's Edge's statement did say that its insurance will pay for the settlement. But the consent order specifies that it may not raise rents or fees because of the cost of this litigation or the policies it sets up. (It can raise them for other reasons, as in the past.)
rainer1 (SGA)
The increase will be spread across the entire population of residents, so the justice is in the fact that the "unharmed" residents will have to pay for their lack of tolerance. They should have immediately protested this discriminatory policy. somehow i doubt the policy was made by management alone.
Colleen (Rockville, MD)
I'm sorry but I must have missed the part where the residents didn't know that as 'renters' - though long term - there would be increases in costs until they die. Insurance, no insurance, Independent, Assisted Living, Nursing care. None of it is free - and most of it isn't even reasonably priced. Spare me the "Oh I didn't realize you would charge me for _________________".
Jim (Baltimore)
I haven't read all the comments but I don't think this wrinkle has been addressed - I know of some CCRCs (Continuing Care Retirement Communities) where the independent living residents DON'T WANT their fellow residents in assisted living to dine with them, and resist the efforts of the administration to encourage residents to dine together. Sad but true.
HER (VA.)
This was the case at Harbors Edge. But as you know, in a split second you can go from independent to assisted.Then you are banned from the main dining room. I also found that the wealthier people who could afford round the clock care in their apartment and never planned to move assisted were quick to ban their friends from dining and events.
Honeybee (Dallas)
I predict that these communities will eventually have completely separate sites for IL and AL/Nursing residents.
AL/Nursing will be moved down the street to make it impossible for the AL/Nursing residents to offend the IL residents by being present in the dining room or in the bridge room.
That's the only way to get around the federal ruling while also keeping the IL residents (and those shopping around) happy.

Of course, costs for everyone will go up.
A better way would be to tell people at sign-up that the trade-off for more reasonable prices will be banishment and exclusion once the resident changes from IL to AL or nursing. Some people won't mind and they'll get to benefit from lower fees.
veganmagistra (San Juan Capistrano)
A year ago my mother was happily living in an independent living facility in upstate New York that did not offer any medical services, but did offer meals, social activities, and rides. While the facility was for residents who were 55 or older, the average age was 80 ish, and a number of the resident used walkers, wheelchairs or oxygen, and several more had outside attendants who would assist them in daily chores. The university that this facility was associated with wanted to project a younger, more vital image, and one day the management announced to the residents that the facility had been sold and the residents had 10 days to decide whether they would stay in in apartments with no amenities or move. You can not imagine the upheaval and trauma this caused those residents as they scrambled to figure out new living situations. In the end the management ended up giving residents more than 10 days, and my mom ended up leaving the city that had been her home for over 90 years and moving to an apartment in California. We can't afford the facilities in California, so she's living in a nearby apartment that has bus services and social activities, and my sister and I give lots of support and encouragement as she adjusts to a new region and makes new friends. She wants what most elders want - to be as independent as possible and to enjoy life. I'm really happy that the Department of Justice pursued this.
TruthOverHarmony (CA)
veganmagistra: The change in management and rules at your mom's old retirement home might have been the best thing that could've happened to her: a new start, beautiful San Juan Capistrano, new friends, and a return to more independence than where she was or where she was headed shortly down the road. Within every setback or failure lies the seed of an equal or greater success (Napolean Hill.)
Colleen (Rockville, MD)
While I realize that change is never easy - and as we get older, takes more energy, commitment and time - the truth is that keeping your mind open and experiencing new people, places and ideas is exactly what keeps you young in heart.
I've moved more than 20 times in my life so far - some voluntary, some not. I am much much happier and open to life than my two sisters who live within blocks of where they went to high school 50 years ago! They are older thinking, feeling, and more negative about life than I.
Frankly - a rolling stone may gather no moss - but we collect friends, and events and stories galore!
Jan Bone (Palatine IL)
As a n 84-year-old with Parkinson's who's about to give a healthy portion of my late husband's annuity for care by joining a continuing care commitment community, I read this story with intense interest! Hooray for the Justice Department for its rulings on the Norfolk Va. home being financially penalized when they trued to prevent husband and wife from having dinner together because one was in "independent living" and the other in "assisted lliving." Or for taking away a patient's prime parking place for daring to complain! However, perhaps these penalties will cost sufficiently that the facilities that continue these kind of restrictions may start rethinking their policies. Let's hope so!
TruthOverHarmony (CA)
Speaking of annuities, a widow who lived in a middle class independent living rental community where I worked was running out of money for her monthly rent. Her late husband had put most of their savings into an annuity which the salesman had hoodwinked them into buying that ended it's payouts when the husband died.
Justice Holmes (Charleston)
Taking advantage of our most vulnerable citizens for profit seems to be the new American way of business. No morals, no conscience and no limits. Whenever you think of voting, consider how this attitude plays out in Congress and the courts. We need to refuse to allow corporations to continue to abuse humans. If a corporation violates the law, the humans who made that decision should be prosecuted along with the corporate entity.

Thanks To the courageous residents. It takes a lot of courage and I am sure the retaliation was petty and vile. Thanks to the DOJ for getting involved.
Julie Meier Wright (San Diego, California)
The key descriptor in this article is "continuing care." I applaud the Department of Justice for pursuing this case. Based on my personal experience with my parents' assisted-living arrangements in Eugene, OR, there are some other issues the DoJ should consider: staffing ratios and cost-to-expense ratios. My parents lived in one facility whose profits were twice that of other facilities and they achieved it by inadequate staffing and less than first-rate meals. One never knew who would show up to bathe my mother and quite often they were late without expianation. We moved my parents after two years to a more expensive facility (the first one wasn't cheap!) and the quality difference was amazing -- the food was outstanding (my Dad loved that they served high-quality ice cream at lunch and dinner), the care ratio was much better and they assigned caregivers by section so that the residents would get to know their caregivers. But after my Dad died and we retained a private caregiver to assist my Mom, who had dementia, they evicted her with 30 days' notice -- because they wanted to promote an "active seniors" community. So I appreciate this issue receiving attention and the reforms that have been enacted -- but much more oversight of these organizations needs to take place.
Paula Span (NJ)
Part of the regulatory problem, Ms. Wright, is that in these CCRCs (continuing care retirement communities), different levels are overseen by different entities. The nursing unit, like other nursing homes, is federally regulated. Assisted living, however, falls under state regulation and can vary greatly from state to state. Independent living may be regarded as simply local housing and not be subject to any regulation.

The federal Fair Housing Act governs all these levels, but its purpose is to prevent discrimination. It can't do anything about adequate staffing or high staff turnover or food quality.
Cedarglen (USA)
Wow! The management of that progressive living facility has learned an expensive lesson, one that underscores the importance of the 'progressive' part. They also have to deliver and they CAN deliver. Their attempt to go a bit cheap has cost them and let this be a lesson to all such facilities.
Kevin (Northport NY)
The problem is that the fine was likely much less than one day's profit at this type of facility. The real crime is the enormous fees that such facilities charge.
leftcoastTAM (Salem, Oregon)
I learned in several years experience as a volunteer long-term care ombudsman that too many facilities are not what they claim to be. Their corporate owners are not in the business of "caring." They are real estate investment firms. Their objective is to make money from their investments.

This objective carries down through management and administrative ranks directly into individual facilities. Facility administrators' jobs are to fill rooms, keep costs low, and be successful profit centers. Consequently, facilities are typically understaffed and their staffs, mostly CNA's (Certified Nursing Assistants), are often under-trained and underpaid.

The usual style of "golden years" advertising by corporate owners does not represent realities: models of healthy, youngish-looking, happy-to-be-here retirees simply do not represent the norm among residents of most facilities.

Most CNA's and other staff do the best they can, and many are dedicated and caring. But they are put in difficult positions where demands are great, and they often lack the training and support necessary to provide what is needed especially by elderly and disabled residents.

Unless elderly retirees have well-above average wealth and can afford to pay high rates and expensive buy-ins to up-scale facilities, they will need to be prepared for a lot less than they hope for in long-term care. In most cases, they will need supportive, active family members to regularly check on and oversee their care.
pat (USA)
While many cringe to here this, the truth is that many if not most people do not have an accurate understanding of the care given in a nursing home. Even the directors and people in leadership roles can be insulated and given information "with a twist."

People do not want to here it, but in fact, in my experience, most of the caregivers are not "dedicated and caring". Care is inadequate. Residents who have dementia and/or can not communicate are at highest risk for neglect and abuse. Aides are overworked, often angry, impatient and many lack empathy and are indifferent to resident's well being. Many aides feel the work is beneath them. I have seen it first hand.

This problem can not be corrected until we admit it exists. Families and those wanting to support staff understandably want to show appreciation, but painfully, there are serious problems with staffing.
To start:
1. mandate increased staffing, regulations should not contain loopholes
2. increase and improve resident care training for aides. Require increased continuing education to maintain license.
3. license and certify trainers
4. mandate ongoing empathy and patient dignity training
5. enlighten aides to the value of their work so they may understand why the work is not "lowly"
6. zero tolerance for abuse and dignity violations (loss of license)
7. zero tolerance for falsifying documents (a huge problem)(loss of license)

that a good start
Honeybee (Dallas)
Low pay + unreasonable expectations = bad nursing home aides.

You've got quite a list of expectations there, but are you willing to pay double to find people willing to submit to them? If not, the quality you're seeing is the best you're going to see.

Making people's jobs harder instead of easier while paying them subsistence-level pay is a recipe for disaster.
leftcoastTAM (Salem, Oregon)
I should have made it clear in this post that I'm referring mainly to assisted living and nursing home facilities.
PB (CNY)
What kind of educational background in gerontology and experiences with older people do the "managers" of facilities with these kinds of discriminatory practices have?

Robert Butler, a renowned psychiatrist in the area of aging, wrote multiple editions of a wonderful textbook called "Aging and Mental Health: Positive Psychosocial and Biomedical Approaches." I used it in the gerontology course I taught to students going into the health professions.

Butler says that the most important interview question to ask each staff member (from top to bottom) is whether there was an older person/persons in their life that had an important effect on them, and to describe some of their experiences with older people. Why? Because research indicates those who work best with older adults had positive experiences in their own lives with older people.

Unfortunately, some of the managers and staff who "run" housing facilities for older people come from a hardline business perspective and think of themselves as CEOs and executives in charge, who are know-it-alls and consider themselves higher status than the residents who pay their salaries.

Empathy is the key, such as being able to grasp what an older person is feeling, what it is like to lose functioning, and how to communicate imaginatively, esp. with older adults having cognitive issues.

What is one of the worst things to do when working with older adults? Take away what little sense of control they have left. Good for the activists!
Carla P (Miami)
Youth is an illness cured only by time and when the younger executives at this place are cured, hopefully they will not be segregated because of problems they might have due to old age.
gAttarRNBSN (Midwest)
As an RN that has worked in nursing homes, I also know the ruling is fairly easy to get around. Members of an independent living community do not need to be supervised. That is not the care in an assisted living or skilled care center. There are ratios of nurses to residents and aides to residents that must be followed. The center need only state they have no one to supervise the residents, and they will not be permitted in the dining area, or on the patio, etc. The center's director and Director of Nursing know this, and that's how this wonderful ruling falls apart -- in its execution.

The DOJ isn't going to tell the center to hire more staff; it can't require that of a business. The center will simply state that it will comply when it has the staffing to do so, and the DOJ will say "fair enough."
Paula Span (NJ)
No, the consent order allows assisted living and nursing residents to sign a release of responsibility, sign themselves out and go to the dining room without supervision, if they are able to do so. I don't think Harbor's Edge will be able to use that excuse.
Liz T (Washington State)
Actually, Federal LTC resident rights regulations at 42 CFR 483.10 protect a SNF resident's right to access services - such as meals in a dining room - outside the walls of the SNF WITHOUT signing a release of responsibility. Per Federal regulation, it is the obligation of the SNF to always have a current assessment (signed by a licensed nurse whose license is at stake) and a current individualized care plan (signed by a licensed health care professional) based on the individual's right to access services in the community based on the individual's highest practicable level of functioning. As a practical matter, there are some SNF residents who would need a licensed or certified health care professional with them to comply with the care plan. There are other SNF residents who are able to express their own needs, who would need NO companionship to be safe outside the SNF. For most, the care plan - if residents and family members were truly informed about care plans - would say that the SNF resident may be outside the walls of the SNF, in the community, so long as they have a family member or friend (who is not a certified/licensed health care professional) as a companion. NONE of this requires the SNF resident to sign a "release of responsibility." Federal regulations are unambiguous about the SNF's responsibility for the resident 24x7, and are equally unambiguous about the resident's right to interact in the community, consistent with the care plan.
Elizabeth Barry (Toronto)
I'm going to find out exactly where this horrible place is and NEVER EVER GO THERE.
pat (USA)
Elizabeth, sadly, there are places that are much, much, worse.
rlk (chappaqua, ny)
I am a senior. And for those that would take advantage of my old age:
Don't mess with my rights and privileges.
I've got nothing but time to fight you.
And I've got the resources from years and years of hard work and high earnings. And friends in high places.
And I've got lots of friends in the same circumstances who are more than willing to help.
Cross a Senior at your risk and peril.
TruthOverHarmony (CA)
Having worked in sales in a CCRC for the past 3 years, and prior to that 2 years in an IL community, and having my father living in an IL/AL community prior, I have seen this issue from a few different vantage points. Prohibiting couples from dining together in the IL dining room when one has move to Al is definitely wrong and accomodations must be made. But the fact is that CCRC's would be half empty if they allowed their IL dining rooms to turn into assisted living/independent living dining rooms. It's not only a turn-off to the current IL residents who don't need any assistance (yet), but a major turnoff and deal killer for IL prospects. This may be viewed as cold-hearted salesman talk, but the reality is CCRCs must continue to attract new and more independent residents if they are to remain open and take care of all their residents, IL, Al, Memory Support, and Skilled Nursing. The CCRC where I currently work allows AL residents to eat in the IL dining room by when invited by an IL resident. This takes care of keeping couples together, and accomodates those in AL who prefer IL. They just need to get invited.Now we have a very small Al population compared to our IL. If it was more evenly distributed then this would lead to the situation described above. A comlicated situation without an easy solution. Seeing it as a sort of civil rights issue, while attractive to support, misses the larger picture.
Denize Springer (Mill Valley, CA)
Marketing is NOT the larger picture. Residents who have moved from independent living to assisted living or skilled nursing units were once marketed to, and they have a right to enjoy everything they bought and enjoyed as independent livers. DIGNITY IS THE LARGER PICTURE. Besides, there are far more independent livers than assisted and skilled nursing residents in CCRCs, so I don't get the "too many wheelchairs or walkers" argument. If folks can't appreciate that some of us are luckier than others after 80, then they should make other living arrangements.
Ginger (DE)
What we saw with our parents was that new CCRC communities attracted young retirees who were all within 10-15 years of age of each other. Little groups from neighborhood or churches would move in together.

As time went by the initial residents made their way through the levels of care, leaving significant vacancies in the independent living section. To keep the place solvent younger retirees needed to come into the community. CCRC communities who were newly built had an edge in selling units because their un-populated spaces perpetuated the idea that everyone there would be similarly young. Older CCRC communities had a harder sell to make because the population was more representative of older seniors.

Tending to the financial health of a community is something that needs to be considered. Costs for CCRCs rise quickly. No one should be discriminated against, but not tending to replenishing the population doesn't work to ensure that the oldest and least able are can be cared for to the end of their lives.
TruthOverHarmony (CA)
Denize,you make some good points, especially your last one where you say "If folks can't appreciate that some of us are luckier than others after 80, then they should make other living arrangements." That is precisely what "those folks" will do - make other living arrangements, and they will not move into CCRCs, and thus, CCRCs will cease to exist. I don't think that is your's or anyone's aims. At my community the changes that come with moving to a higher level of care, including switching over to the AL, or Memory Support, dining rooms, is not hidden by sales and is openly discussed. I think one solution to the dining room issue is for communities to build one large dining room that is sectioned off by level of care, but offers the same views and amenities throughout, and is also located closer to the Assisted Living apts. The Al sectioin could allow walkers and wheelchairs that don't have to be hidden away, and allow private caregivers to accompany AL residents if needed.
Kin Clinton (Nashville, TN)
I appreciate the courage and perseverence of the Evans family. I know you've been through the ringer. Your efforts are already making a difference. Mike, regret that your Mom could not enjoy the fruit of your labor. Paula, thank you for staying with this!
Mike Evans (Norfolk, VA)
Kin, the policy actually changed in Feb 2012 as a result of the local uproar resulting from Paula's 1st article, TV coverage, and front page coverage one morning in our Virginian-Pilot. She had free run of the facility, and a return of her car to the parking garage. She died about 6 months later.
The irony of your situation being cited is that I brought Mom & Dad to Norfolk from Decatur in '07 after they had lived in Alabama for the previous 32 years.
Sarah (Boston)
My mother lived in a beautiful and very expensive private facility in Massachusetts. Their policy was that anyone in a wheelchair had to eat in a separate dining room. As a nurse, I thought this was an outrage and called the ADA hotline. I was told that as a private facility, they could have any policy they wanted. If you are advertising as a life care facility, the reality is that the vast majority of your residents will be in a wheelchair at some point. To separate people from their friends just because they are in a wheelchair is totally unreasonable. I was also told by some of the employees that management did not want any potential new residents to see wheelchairs in the dining room. That made me even more furious. While the care my mother received there was excellent, there was always an effort made to keep the sicker residents out of view.
Paula Span (NJ)
But now we see, Sarah, that private facilities cannot have any policy they want. However much they may want to keep sicker residents out of view, they are bound by the federal Fair Housing Act, which makes discriminating against people in wheelchairs illegal.
Honeybee (Dallas)
When the AL residents are excluded from Dining Room A and now must eat in Dining Room B, can their Independent Living friends/spouses eat with them in Dining Room B?
Because if that's possible, then it seems the IL seniors are dropping their AL friends.
Personally, I think it's ridiculous to ban anyone from the dining room based on the level of care they need, but that seems to be what the IL residents want, doesn't it?
Paula Span (NJ)
Yes, the independent living residents could have joined their spouses and friends in the assisted living or nursing home dining areas. They sometimes did. But the spouses and friends in assisted living or the nursing unit wanted to continue to use the main dining room as they had been, to see friends and enjoy the view, and that was verboten.
Megan (Northfield, MN)
To all of us who are getting older and may need to go somewhere, this is terrifying. I hear so many stories of people paying huge amounts, like $ 5000 a month, and not getting the care they need and/or not allowed to have anything to do. It's clear these places want healthy young seniors to pay in and need little care, and that's why they try to prevent the disabled ones from enjoying the nice amenities and just hope they die soon. I hope the Justice Department strictly enforces the law from now on.
Gail (durham)
Guess what? You think $5000 per month is a "huge amount" to pay for someone who needs care? Try much more than that. As some of the previous writers have said, CCRCs need IL residents to help offset the huge expense of caring for the nursing (and some AL) residents. If a potential IL resident sees nothing but people much worse off than they are (and you have to experience nursing homes to understand what that means), they'll decide to go somewhere else. Some of the suggested solutions are reasonable--let couples be together, or invited guests, or a separate section with more room for wheelchairs, etc. Most communities play a delicate balancing act, trying to keep everyone reasonably happy.
Theresa N (Washington DC)
Hi Paula,
Thank you for the wonderful article and the attention that you brought to this matter from the very beginning. Were it not for you and the prestige of the NYT bringing this to the forefront, I am not sure where we would be. I am heartened that DOJ believed this was a pursuable and important case to investigate. Most of all, I am thrilled with the results and the precedent that has been set. Again, thank you Paula. You have been a wonderful advocate.
kw, nurse (rochester ny)
I worked in a continuous-care facility, and I can tell you that there were a number of residents who did NOT want to consider their own future aging process. People with any sort of physical or mental issue, except for use of a walker, were made unwelcome in subtle ways.
gastonb (vancover)
I think the petty officials who used to get jobs in school administration are now running senior living centers. During the 5+ years my mom was in one, moving from independent to assisted living with some time recuperating from falls in the nursing center, we were lucky to run into only a few of the martinets. Most of the staff are just overworked and not able to spend any quality time with the residents. But some are full of themselves and they love saying 'no.' I found the social workers to actually be among the worst of the power-mad.
Kevin (Northport NY)
This is why I am doing everything I can to care for my parents in my home.
CTKAT (CT)
There is another element at play here and that is the desire of "healthy" seniors not to witness the physical and mental decline of the residents around them. Someone starts using a walker or wheelchair and the they are no longer welcome at certain "independent" activities where the residents have control, such as card playing groups or book clubs. It was often mentioned at the facility my mother lived in.
Catharine (Philadelphia)
sounds like you'd have more rights in a federal prison.
Anne-Marie Hislop (Chicago)
My last church was near a large extended care facility. We had about 60 members who lived there at various levels. The idea that walkers or canes or wheelchairs in the dining room will be a turn off for younger seniors is nonsense. Folks who move to such communities know that they are getting old - that's why they are there. In general they are also comforted by the knowledge that as they age and (perhaps) lose abilities, they can continue to be part of the community interacting with friends they have made and being with spouse (if any). Seeing those who are less able then they presently are is simply a reminder that they, too, can continue to be valued and to participate, even when they need a walker or "a chair." Quite a few of our folks volunteered around the community often being the ones to wheel or assist the less able to get to activities or the dining room.
Concerned Citizen (Anywheresville)
My guess, having a lot of experience with AL homes in my area, is that this is a marketing decision. A lot of people tour such facilities, and are reluctant to go "into an old home" and judge them as depressing if they are filled with walkers and wheelchairs. Yet this is reality. If you are a fit, active senior who is very mobile, why would you move to such a place and pay $5000 a month, or about 4 times the cost of a similar non-AL apartment?

If you look at the advertising for these places, they make them out to be like luxury resorts with chandeliers and dining rooms. They look so nice almost anyone would be thrilled to stay there! But the truth is that the fancy stuff is all a sham, to show the adult children of potential residents -- the reality is typically people in a lounge, sitting in a wheelchair in a diaper and looking slackly at a TV all day. Few adult children visit -- it is horribly depressing and the food is tasteless hospital food -- so the staff can provide minimal services with impunity.
Sister Sarah (Denver, Colorado)
"The idea that walkers or canes or wheelchairs in the dining room will be a turn off for younger seniors is nonsense."

It may be nonsense but we humans are great nonsense-makers -- especially in expectations of our own aging and dying.

In my experience the fitter seniors were more ruthless in creating and enforcing social exclusion than any marketing person would have the gumption to even imagine.
jazz one (wisconsin)
You are so right on both counts!
Denial is a powerful force.
Ted wight (Seattle)
There is no stopping the federal government.
Anne-Marie Hislop (Chicago)
@Ted wright in Seattle: so your preference is discrimination because someone now needs a walker to get around? You would prefer that getting to that point means that a husband and wife are no longer to enjoy lunch together in the nice dining room? You too will get old.
human being (USA)
I hope you mean this positively but suspect not. This, instead of wars, is where the Feds shine. It may take time but they often come through.
JW (Tallahassee)
So that is what is important to you? Not individual rights? Not basic human dignity? It is easier not to think or feel, I guess.
shirley confino rehder (norfolk va)
I am the Chair of the Norfolk Comm. for Persons with Disabilities. I was trained in both ADA and FHA. In Feb’12 I read Paula Span’s article about Harbor's Edge and called a meeting with Dr. Shapiro, and a friend, who resides there. They told me about the conditions they were living under. An attorney told them it was a ADA problem and it would cost lots of money and time to go to court. I told them this was a FHA violation and that it would cost nothing to call the DoJ. I met Mr. Evans and Mr. Bilisoly and suggested we hold a meeting with residents and Board. I offered to facilitate a discussion about laws that protect owners’ rights. A meeting was held, their attorneys on hand, and about thirty residents and family. Management agreed to change their policies. It didn’t take long for them to renege on their promises. The DoJ was called.
We now see the result. As I see it, management ignored the FHA/ADA, and based on recent interviews, still does not accept they were wrong. Just as important, attorneys hired by the residents in 2011 gave poor legal advice, charged them a hefty fee, and wasted ten months of very precious time. Our Commission helped to resolve the discrimination and paved the way to today's results.
The elderly and persons with disabilities are a vulnerable population. This doesn't have anything to do with finances or education. Our country has laws that protect all peoples, but there are always people that feel they are immune to the frailties of life.
queenxena (Cleveland, Ohio)
Unfortunately it is not only the elderly who are affected by the fact that lawyers will not take cases unless they can see a big payoff at the end. I personally think many laws are being broken by the people who understand this fact. Maybe if some of the unemployed attorneys started to act on the wrongdoings that really will not generate large settlements, we would have a better country and lawyers would not be held in such contempt. Or not.
Rachel Kreier (Port Jefferson)
Thank you for the very interesting information, especially with respect to the poor advice and hefty fees from the private attorneys that the residents and family members consulted originally.
Lisa Rice (Maryland)
Shirley, good for you! This is why it is so very important for disability organizations to be trained on the Fair Housing Act. The National Fair Housing Alliance, Department of Justice and Department of Housing and Urban Development are all "no cost" resources to people who are facing this kind of problem. My hat also goes off to the AARP which has long been at the forefront in advancing fair housing rights for older Americans.
Betsy (Georgia)
I wish the Department of Justice would investigate Falcons Landing in Sterling, VA. This is an Air Force Retirement community that does not allow those in Assisted Living to join their friends in "The Dining Room" without an "invitation". Those who transition to Assisted Living are moved away from their friends and support systems to another campus with real lack of access to other residents, dining, activities and enrichment. Each time I visit my mother, residents tell me that the CEO, a retired Air Force General, discourages wheel chairs and walkers in public areas. Isolation is the name of their game and it is shameful.
human being (USA)
Report them. I would also go through the Dept. Of Veterans Affairs and contact their and the DOD's Inspector General.
sherry (South Carolina)
I believe the commenter Shirley Confino Rehder has given you the avenue for recourse: Call the DOJ.
Brandi (Virginia)
Hello Betsy,
Housing Opportunities Made Equal of Virginia, Inc, is a non-profit organization that investigates possible housing discrimination. Please call them at your earliest convenience to provide more details: [email protected] or (804) 354-0641
Best Regards,
Brandi
Melpub (Germany and NYC)
See Atul Gawande's BEING MORTAL.
It's about time the old were treated as if they were human.
http://www.thecriticalmom.blogspot.com
Janis Mara (San Francisco Bay Area)
"'You’re talking to an activist,' said a gratified Judith Schapiro, 87, a retired professor and assisted living resident who had been barred from the dining room by the policy." Go Judith, go Judith! I hope to be kicking butt and demanding my rights when I'm her age. Thanks for sharing this story!
michjas (Phoenix)
From a legal standpoint, one facility cannot discriminate between the healthy and the disabled regarding access to common areas and activities. The assumption here is that this victory will help put an end to such discrimination. But all any facility has to do is separate the different units sufficiently --in separate buildings run by separate corporations -- so that separate access is not discriminatory. Instead of encouraging mixing, this lawsuit is just as likely to put an end to mixing.
ebmem (Memphis, TN)
You do not understand the nature of a continuous care community. The selling point is that you move in while capable of independent living, but stay on in new quarters if you need assisted living or nursing services.
L (NYC)
@michjas: WRONG!! Facilities CANNOT discriminate if they receive federal funding.
michjas (Phoenix)
You're both wrong. The 3 facilities can be sufficiently separate to be independent under the law while sufficiently related to be perceived as providing continuous care. A shared dining hall, a shared pool and other shared amenities in otherwise separate facilities, for example. As long as the facilities are predominantly separate, there would be no federal discrimination based on who gets to go to Fourth of July celebrations. Federal funding doesn't matter if it goes to legally separate entities.
paulf (Montclair, NJ)
Great work, Paula Span. This should have been on the front page today. (Perhaps it was in the print version, but not online). Thank you for bringing this story--and this ridiculous discrimination--to light and for letting often-marginalized voices be heard! Congratulations to everyone who came out winning from this.
John Smith (NY)
I understand the desire for people living in assisted living to pretend that they can participate in activities without undue accommodations but the reality is that the additional costs they incur can become substantial. Perhaps if they all signed waivers absolving the facility of any wrongdoing and paid for the extra costs out of pocket then there should be no reason to exclude them. But if they do not sign the waiver and pay the additional costs then it would be financially irresponsible for any retirement community to allow them to attend. I suggest Harbor's Edge just cancel all events for everyone.
L (NYC)
@John Smith: I have read a number of your comments on other topics at the Times, and you have a very sour outlook.
CM (NC)
Rolling a wheelchair into a dining room is not an undue accommodation. This discrimination comes about because management thinks that the sight of people with wheelchairs or walkers might distress others. Let me tell you, what is more distressing is that a person who has shared the better part of his or her life with someone who is now disabled and who still loves that person very much is no longer able to share meals with that loved one. Just because someone can no longer walk independently or perform all of the so-called activities of daily living for himself/herself does not mean that that person cannot participate in most social activities. There is no pretense about it.
human being (USA)
Depending on the type of CCRC, they do pay extra.
BlueDog (North Carolina)
So many quotes come to mind when describing management's reaction to this situation. Common sense is most uncommon? You can't fix stupid? While I can appreciate management's concern in the intricacies of providing services--including dining and food--to populations of varying abilities, this is a senior living center. It is what they are paid to manage. Managers obviously should have dropped or amended their myopic policies instead of stubbornly clinging to them. By remaining steadfast, they caused a bigger business problem for themselves by their actions. And now they pay the price...
David (Acton MA)
Sorry, but once again the price is being paid by the corporation, not by the guilty individuals. When Mr. Volder is put under a three year decree forbidding him from employment related to senior housing, then someone will have "paid the price". A few felony convictions by the DoJ, or even misdemeanor convictions, which focus on responsible (irresponsible) individuals would send a real message.
Jane (Madison, WI)
This is encouraging if very sad. It would be nice if the people in memory assisted living could get out to the places they used to go when they were "incarcerated." (It took my Mom a long time to stop referring to the place as a prison.) It's a "nice" place, with good workers, but too many residents. Winter is really hard. No one will take them outside. She pays nearly 5000 a month but has to pay people on the side to spend time with her and get her out. As time goes on she wants to be out less and less time but a little goes a long way.
Megan (Northfield, MN)
I hear stories over and over of people paying enormous amounts every month and not getting the care they are paying for. They shouldn't be allowed to take so many residents if they can't care for them.
sherry (South Carolina)
My mother also spent her last 10 months in a very nice place. I took her outside, and so did her grandchildren and the Hospice Social Worker once she was admitted to their service. Not only did the staff not take her outside, I frankly didn't expect them to do so. Who would you suggest for this activity? The Nursing Assistants who have anywhere from 6-11 people to care for, depending on the facility and level of care required for the residents? Who takes care of my mother and the other residents in that CNA's charge while she takes YOUR mother outside? Perhaps you feel it should be the nurse on the floor who takes your mother out for some air. Once again, if the nurse running that floor or unit takes your mother outside, who is supervising all the staff that is supposed to be caring for MY mother?
The director, maybe? So if my mother's doctor comes to do his rounds, or a family needs to ask questions about their loved one, or a doctor returns her call about her concerns about a resident's condition, all that should wait because she took your mother outside?
Sorry. Not seeing an issue with your mother paying someone for extra service and attention that the staff can't manage. If you want one on one attention, reality must be faced--it costs money and someone has to pay for it.
Concerned Citizen (Anywheresville)
That is so sad, but I have seen it myself. WInter is wretched in such places. The staff at my aunt's AL home stopped "excursions" in their van, because it was too difficult to get multiple seniors in and out of restaurants or other locales. From November to April, basically they did nothing but indoor games like Bingo. For weeks on end, I would see people INSIDE -- there was no sunroom or indoors greenspace -- just sitting in their wheelchairs, looking blankly at a TV screen. The facility lost a very good activities director, and stopped offering art or craft activities.

Frankly, they ARE prisons. Residents are prohibited, often very harshly, from leaving on their own. This includes people who do not have dementia. They give up any right to take or not take medications -- even vitamins! They are forced to eat in the dining area, usually awful cheap steam table food with no seasoning. They cannot order pizza or chinese food (I tried -- such places won't deliver out of fear that a dementia patient might order stuff) -- they can't go out when they WANT at all.

Many residents only realize, to their distress, all the rights and freedoms they have given up -- in order to get some help with bathing or dressing, or to have an attendant around all night. That is grossly unfair and unjust.

Also the costs are obscene. For $5000 a month, my aunt could have gone weekly on a luxury Caribbean cruise, with gourmet food and entertainment! instead of the miserable facility she was in.
Eugene (NYC)
These suits should also require the administrators or owners to live in the facilities under the restricted conditions for a week. That's probably the only thing that would help them to understand.
L (NYC)
The suits AND the administrators should have to live in the facilities with NO ACCESS to a bathroom until an attendant answers their call button - that would give them a vivid reality check in under 24 hours.
Concerned Citizen (Anywheresville)
Over a 2 year period, my aunt was left countless times in her wheelchair in a soiled diaper, because the staff was "too busy". To be fair, they earned an average of $9 an hour and only 2 staffers worked each "cottage" of 24 residents, most of whom had at least early stage dementia and 90% in a wheelchair or walker. The staff also had to clean up and serve every meal (they came in steam containers from a central kitchen), do the dishes (!) and wash linen napkins and placemats. All that kitchen work meant they were not there to help residents! It was the stupidest division of labor imaginable, resulting in late and missed meals, residents not getting special food orders (like diabetic meals!) despite paying for them and so on.

If it were not for some wonderful residents (the few that still had their minds), I would not have known of the neglect my aunt endured here -- and at prices that would have easily put her on a Caribbean luxury cruise every week.
Sue (NJ)
How to consider 'independent living' is as compared to assisted living? Where is the line drawn or isn't there any?

Residents in CCRC's Independent Living units believed that others living there would also be independent. Does that mean independent with an aide? a spouse? Needing to be fed? Not able to communicate because of increasing dementia?

Without some explication of the difference, Independent Living areas seem to be turning into nursing homes rather than resident units, similar to an apartment building on any block in the city/town.
Concerned Citizen (Anywheresville)
Independent Living is pretty clear cut -- it is basically just an apartment for a fully functional senior who WANTS to have the convenience of cleaning and meal services.

Nursing care is also pretty clear cut -- it is for people who are very frail and need 24 hour nursing care.

IN BETWEEN ... there its very unclear. Dementia units are more specific, but my aunt's Assisted Living (so called) Home had 20 patients with obvious dementia and only about 4 people of whom I would say they had their mental faculties but some physical limitations (like a walker). AL is cheaper than dementia care. Also some people can't admit that mom has dementia and not just "she's forgetful".

They push AL as a kind of independent lifestyle, but with greater help -- but mostly that is a lie. It is a kind of prison once you sign in, you cannot get out of. People get dependent there, and lose their ability to function at all for themselves. They get very depressed. I have never seen ANY kind of psychological care or counseling for this -- ever. They leave people unattended for long period of time, mostly parked in front of the TV. They tell families there are "activities" but a lot of it is phony or unstimulating -- stringing beads, bingo.

Staff is poorly paid and overworked -- the result is they are often brusque with residents, or treat them like stupid children.

A common feeling expressed to by residents was despair and unhappiness at having to go into Assisted Living. Yes, its that bad.
Julie Meier Wright (San Diego, California)
Quite often -- and certainly in this instance -- these facilities market themselves as "continuing care" facilities, which implies that a resident can remain in a single location even as abilities diminish. Anything that requires change or increases isolation is very unsettling to the elderly -- and completely unacceptable. I applaud the DoJ for its dogged pursuit of justice on behalf of the elderly.
angelina (los angeles)
I believe that there's an elephant in the room that no one is talking about, namely that many of the more able-bodied residents do not want to be around those with major disabilities or cognitive impairment. They find it depressing and not at all like the delightful BBC comedy, "Waiting for God." I have seen this first-hand since my mother, now 94 years old, has spent the last seven years living first in an up-scale, independent-living facility in New York and now in an up-scale, assisted living facility in California. (She does not choose to live with me although I see her every other day)

Perhaps the retirement communities need to be really upfront to potential residents about who exactly is living in their communities. It is disingenuous to advertise these places for active seniors, only.
human being (USA)
This dynamic exists in nursing homes also. The more cognitively limited residents are not "appreciated" by other residents who may seek to avoid them or prefer not to have them in activities that are certainly appropriate to all. Even in homes where, by definition almost, most residents use chairs or walkers, the residents with fewer limitations do not want to be with those with more, especially at meals.
Another Mom of 2 (New York)
That's ok. They are not actually allowed to advertise them as being for "active seniors only". Even the active elderly must put up with those less fortunate than themselves.
Concerned Citizen (Anywheresville)
I agree. The sad reality is that the younger, more active residents may be in denial (more than they want to admit) that they don't want to see where they are headed -- from a delightful independent lifestyle with meals and cleaning services -- to first the restrictions of Assisted Living, and then nursing home care, hospice and death. Who among us wants to think about that, whether we are 30 or 60?

I have NEVER seen a resident, even a lively one, who moved "up" -- went from AL to Independent. It's all straight downhill. And the "line" is often a fall, resulting in a hip fracture and the use of a walker or wheelchair.
A Goldstein (Portland)
Unfortunate story. The residents of Harbor's Edge should receive representation on its BOD or at least be appointed to an advisory committee that has input on its operational decisions. Harbor's Edge could learn a lot from Terwilliger Plaza, (http://www.terwilligerplaza.com/), an unusually fine retirement community in Portland Oregon. It was founded by educators, is nonprofit and governed by its residents.
hen3ry (New York)
It's great to see that fighting back can have the right results. It's sad that it has to be done and that there is often retaliation when people fight back. I hope that the seniors still in these facilities will remember those who fought for them and that the fight doesn't have to repeated facility by facility.

I still recall how much idiocy surrounded the fight my autistic brother and I had with our village when it came to making a cost free accommodation for him in the lap lanes. You would have thought we were asking them to allow him to bring in his pet tiger or worse. Throughout the entire process not one person in the village stood up for him, spoke out against what was going on, or even said anything kind to us about the fight. The village mayor was so ignorant that he didn't even know how things were working with respect to the municipal pool. It just felt right to him that my brother should be restricted and wrong that we complained and finally, with the help of another organization, filed a lawsuit against them. They harassed us and discriminated against us for years. One local psychologist who should've known better, made claims that were ridiculous. There was no apology, no acceptance, and there is still quite a bit of residual hostility. It makes one wonder if these people ever realize that they could be in the same situation one day and need the same consideration they refused to give to another.
queenxena (Cleveland, Ohio)
If you live in an upscale community, I can understand the response of the people you mentioned. I did not say agree. Sometimes upscale people believe that their money, earned because they are better than everyone else. They also believe, at times, that because of their hard work, etc., they do not suffer the "afflictions" the rest of us poor peons do. To see your brother as a rebuttal to those spurious claims caused them distress. They use their wealth as a talisman against normal problems. Your brother was an in the face reminder that problems can affect anyone. IMHO
Cheryl (<br/>)
Great news! Thanks to all the people who put an end to the marginalizing of people by Harbor's Edge administrators - the very people they were obligated to serve.