Editor’s note: Caregiving — and taking — is a complicated, constantly evolving concern for many in the Grand Traverse region. “Taking care” is the Record-Eagle’s ongoing exploration of how this high-dollar, high-stakes issue impacts our community.

TRAVERSE CITY — Adult care homes are licensed separately from nursing homes or assisted living facilities.

Here, between three and 20-plus adults — some over age 55, but many who are much younger — face physical, emotional, mental and behavioral challenges that make it difficult and/or unsafe for them to live independently.

But a recent study found that challenges don't end with placement.

More than one-third of adult residential care facilities in northwestern lower Michigan were cited for serious health and safety violations during the past three years, according to data analyzed by the Traverse City Record-Eagle.

Publicly available Department of Licensing and Regulatory Affairs (LARA) records of 88 care facilities in Antrim, Benzie, Grand Traverse, Kalkaska, and Leelanau counties revealed that since 2016, 34.3 percent of adult foster care, group homes, and homes for the aged, were cited by the state.

Among the care home violations uncovered were persistent bed bug infestations at Crystal View AFC in Frankfort, a “ponding” of raw sewage outside King Adult Living Center in Traverse City, and using a backyard “smoke shed” to house mentally ill adult residents when the licensee of Piper’s Place in Traverse City, was away from the facility to run errands or attend church.

LARA Special Investigation Reports reveal that when initial complaints of those and other incidents were submitted on the department’s online complaint system, or by phone, from any of a number of sources — relatives of residents, doctors, government workers, transport drivers, facility employees, and care home residents themselves — LARA staff responded quickly with unannounced site visits and conducted thorough investigations.

Yet the resulting recommendations were almost always the same: “The status of the license remain unchanged” — as long as the licensee submitted an acceptable corrective action plan within 15 days.

“There’s not always a clear answer,” said Jay Calewarts, director of LARA’s AFC/HFA and Camps Licensing Division, when asked how recommendations are made following one or more violations.

“Our goal is to get them (the licensee) into compliance. Typically, we are going to try to give them an opportunity to correct whatever went wrong.”

A corrective action plan is required by the state whenever a facility is found to be in violation of licensing rules, Calewarts said.

The licensee must address how compliance will be achieved, who is responsible for making the corrective action, how soon it will be done, and how compliance will be maintained over the long term.

One facility in the five-county area, Johnson’s AFC, on Plum Valley Road in Mancelona, did have its license revoked in January by LARA after years of repeated violations.

Following the revocation, records regarding these violations were removed from public view but the Traverse City Record-Eagle obtained a 70-page redacted version with a Freedom of Information Act request.

In 2016, LARA licensing consultant Bruce A. Messer determined multiple areas of the facility’s floor were rotten; that at times residents did not have an adequate supply of water because it was being used for a medical marijuana growing operation, and that licensee Missie Johnson “shouts, screams and is argumentative,” subjecting at least two residents to “verbal abuse.”

According to Messer’s Oct. 11, 2016 special investigation report, “Ms. Johnson stated that the water to the home is shut off for one to two hours each day ‘when we water the marijuana.’ Ms. Johnson stated that the facility’s water well and pump system is not strong enough to provide water to the facility and to her husband’s medical marijuana growing operation contemporaneously.”

Other infractions included a lack of smoke detectors, protruding wiring and “six overflowing cans of garbage” on the porch.

Repeated calls by the Traverse City Record-Eagle to the phone number listed in Johnson’s LARA files were not answered or returned.

In a rare rebuke from LARA, Messer recommended Johnson’s AFC license be downgraded from “Regular” (inspected for renewal every two years) to “Provisional” (inspected for renewal every six months) contingent upon Johnson’s submission of an acceptable corrective action plan.

Johnson submitted a handwritten action plan, accepting the provisional license and said she would “just talk to them instead of yelling,” and “keep a better eye on things that need to be fixed.”

LARA approved Johnson’s plan on Oct. 28, 2016.

One year later, a complaint from a source whose name state official redacted from released documents stated, “The house is filthy.”

Messer made an unannounced site visit the same day, observing “four large mud/water holes which were 10-15 feet in diameter” blocking any necessary emergency vehicles; that “a couch, a motorbike and gas can” were partially blocking the facility’s entryway; the kitchen sink was “overflowing” with dirty dishes; the laundry room had a “large amount” of dirty clothes; residents’ bathrooms were “not clean” and at least one toilet was inoperable.

According to Messer’s report, Johnson agreed to submit another corrective action plan, but “did not offer any explanation as to why the home was found to be in the condition noted above.”

Johnson’s second corrective action plan, received by LARA on Nov. 15, 2017, and obtained by the Traverse City Record-Eagle, addressed the violations and stated, “Missie will keep up on every thing. I am sorry for the trouble.”

In August 2018 the facility was cited for four violations, the most serious of which was failing to provide a diabetic man referred to only as “Resident A,” with his prescribed medications. A month prior, the man had been hospitalized, and, “Pharmacist states that this admission is the result of Johnson’s AFC home administering Resident A’s medication incorrectly.”

In October 2018, the same man was hospitalized again. His physician had discontinued at least one of his medications, but when he returned to Johnson’s AFC, the discontinued medication was still being administered.

When Messer conducted an unannounced visit Oct. 22, 2018, he “heard a smoke alarm in the resident dining room area ‘beeping.’ Mr. Messer spoke with Licensee who acknowledged that the smoke detector had been beeping for several days. Mr. Messer instructed Licensee to change the smoke detector battery immediately.”

Johnson’s AFC’s license was revoked Jan. 11, 2019.

But this is the exception as dozens of other facilities stay open after accruing multiple violations.

For example, on Jan. 9, 2019, licensing consultant Matthew Soderquist made an unannounced inspection of Crystal View AFC on Frankfort Highway in Frankfort, and, according to his report, was told by a female staff member they’d “been dealing with bed bugs at the facility for 4-5 years ... she stated they have had bed bugs in pretty much all the rooms in the facility at one time or another.”

Crystal View is licensed to care for as many as 40 physically handicapped, mentally ill, developmentally disabled, and aged adults.

During this same visit, Soderquist asked one man who lived at Crystal View to roll up his sleeve. Soderquist observed, “six fresh bed bug bite marks in a row that were scabbed over,” on the man’s arm. “There were also numerous other bite marks that appeared to be old and scarred.”

When Soderquist returned Jan. 17, 2019, he checked on the man, helped remove his bedding, and “observed a bed bug on the box spring mattress that appeared to have recently fed.”

On April 9, 2019, another man living at Crystal View was taken to a podiatrist appointment, where an unnamed medical worker remarked on the man’s “exceptionally bad” personal hygiene.

According to an April 24, 2019 report by Messer, the man was wearing dirty clothes, there was dried food stuck to his shirt, “his socks were caked with wet dead skin and wet with what (the medical worker) believed to be urine ... the stench was almost unbearable.”

Of the documents examined by the Traverse City Record-Eagle, Crystal View was the only active facility to have its license downgraded from regular to provisional by LARA. When contacted, Crystal View licensee Paul Kerridge said he was surprised by the action.

“I’ve been in business 40 years,” he said, “so I must be doing something right.”

Kerridge said the bed bug problem was frustrating because he thought the pest had come from off-site, and no matter how hard he tried he could not locate its source. Months would go by with no sign of the bugs and then they’d return without warning.

“It’s being addressed,” he said. “We have it under control because we’ve found a different way of treating them and we’re on a maintenance plan with a service.”

There are more than 4,300 group home facilities in the state, according to LARA, but the situation at Crystal View was serious enough to come to the attention of Calewarts.

“We had cited it a couple times,” Calewarts said. “They were using homeowner remedies and that didn’t work, so they filed a compliance action plan and hired a service but were only treating individual rooms. We cited them again and that’s when we downgraded them to provisional.”

When asked whether or not LARA staff considers the scarcity of affordable adult care residential services when making decisions about violation recommendations, Calewarts said, “technically no, but if a facility is in a rural area, and there isn’t another facility for miles, we may go above and beyond to try and get them into compliance.”

The type of license Crystal View AFC has — a “congregate group home” for 20-plus residents, hasn’t been available since state law did away with the category in 1984. Crystal View is, Calewarts said, “grandfathered in.”

In another example of a facility with multiple violations over an extended period of time, Piper’s Place AFC on Sunset Lane in Traverse City, was first licensed to care for up to six developmentally disabled and/or mentally ill adults in 2015. Since that time, licensee Valerie Freeman has received seven violations – the most of any facility with an active license the Traverse City Record-Eagle studied.

On Dec. 9, 2016, a recipient rights officer with Northern Lakes Community Mental Health (NLCMH) alerted consultant Messer that NLCMH staff had serious concerns “regarding Ms. Freeman not being home when residents are returned to the facility on the bus from programs/work. She noted these concerns are recent and ongoing.”

Northern Lakes Community Mental Health Chief Executive Officer Karl Kovacs confirmed that NLCMH and LARA often work together on abuse complaints, but said he could not comment on specific cases.

“We’re not the licensing agency, they have their guidelines, we have ours, and we do share information back and forth within the confines our legal mandates,” Kovacs said. He urged anyone with a complaint, whether resident or provider of services, to contact NLCMH’s Office of Recipient Rights.

In his January 18, 2017 report, Messer, recounted interviewing the family member of a man living at Piper’s Place who reported, “if Ms. Freeman leaves the home, such as to go to church on Sunday, and he does not want to go with her, he must go to the ‘smoke shack’ in the back yard and wait for her or leave the property and go somewhere.”

When contacted, Freeman said she disputed some of the license violations, that the smoke shed had three sides and a roof, but that she never suggested residents wait for her there, and criticized NMCMH for not meeting the counseling needs of their clients.

“The violations I keep getting, they (NMCMH) tell clients if they don’t like something to just file a complaint,” Freeman said. “My problem is, when I leave, they leave with me or go somewhere else. If they come home early, how am I supposed to know it?”

On December 12, 2016, Messer made an unannounced visit to Piper’s Place, found Freeman not at home, the facility locked, and a man just returning to the home on a transport van. Messer reported the man told him, “there are times, like today, when he returns home from work and the house is locked, no one is home. He noted he must wait for Ms. Freemen to return before he can get into the facility.”

Messer interviewed four people referred to as, “Residents B, C, D, and E,” and then cited Freeman for not giving the residents access to the home. In September 2017 she was cited for using residents’ cell phones for personal use, and then again for “denying the residents their right to access their bedroom at their discretion when they are told they must go with her or go elsewhere.”

On January 10, 2018, Freeman told Messer she disagreed with his findings but would submit a corrective action plan. On January 25, 2018 Messer cited Freeman for oversleeping and not providing breakfast to a resident before the resident left for work. Freeman was also cited for not providing adequate heat in the facility and for using space heaters, which are not allowed in adult foster care homes.

Freeman said she is currently in compliance with all LARA regulations, said she hoped she would not receive any more violations, but, “I can’t say for sure. Being a new facility I don’t always know what my options are and I’m learning as I go.”

In response to an interview request, neither Messer nor Soderquist were available for comment, per LARA policy, Calewarts said.

Data analyzed by the Record-Eagle also revealed several area facilities with only minor administrative violations or none at all, including both Boardman Lake Glens facilities in Traverse City, Cindy’s Place in Traverse City, Rainbow of Hope Farm in Kingsley, Forest Road Residence in Suttons Bay, Mapleview Adult Foster Care in Fife Lake, and all seven facilities managed by Baruch Senior Ministries, a large faith-based healthcare nonprofit organization based in Grand Rapids.

Clients of NLCMH, care home residents, and service providers who want to file a complaint can do so by calling the Recipient Rights office at 800-337-8598.

Violation reports for the above facilities and others in the state can be viewed online by searching “Verify a License” and then “Adult Foster Care and Homes for the Aged” at https://www.michigan.gov/lara/.

Crystal View AFC’s provisional license is up for renewal inspection August 26, 2019 and Piper’s Place AFC’s regular license is up for renewal inspection December 9, 2019. Both Kerridge and Freeman said they expect a clean bill of health.

Four steps for choosing safely

By Mardi Link

TRAVERSE CITY — Choosing a safe place for an adult family member who can no longer live independently, whether due to age, illness, or injury, can be difficult and emotionally taxing.

According to Michigan’s Department of Licensing and Regulatory Affairs, there are approximately 4,300 licensed home-based facilities in the state.

There are several types of Adult Foster Care (AFC) and Homes for the Aged (HFA) facilities, and Jay Calewarts, director of the division of LARA that monitors their licenses, has advice for anyone faced with deciding where their family member will live and who will be caring for them.

First, know the difference between the available options.

Among AFC’s there are Family Homes, where the owner lives on site and is licensed to care for three to six adult residents; Small and Medium Group Homes, licensed to care for between three-seven, or seven-12 adults; Large Group Homes, licensed to care for 13 to 20 adults; and Homes for the Aged, licensed to care for 21 or more adult residents 55 years and older.

“What type is best is more of a personal preference,” said Calewarts. “A family home may offer a personal and quick response, while a larger place will have standardized oversight rules that make sure they’re doing things right.”

A new interactive online map developed by LARA with the state’s Department of Technology, Management, and Budget allows site visitors to search by location for a variety of state licensed facilities including adult care homes. You can access it here: https://michigan.maps.arcgis.com/apps/webappviewer/index.html?id=18b7722710fe4068a49e26a6d3edc535.

Second, read the publically available LARA reports of license renewals and violations for any facility you are considering. You can search by name of facility, county, city, address, license number, or facility type here: https://adultfostercare.apps.lara.state.mi.us/.

Third, visit the facility in person, take a tour, and meet the owner or manager and the staff, and talk with residents. Walk around the yard and ask to see the inside any outbuildings. Ask to see the facility’s weekly meal menu. Ask about options for socializing, outings, and transportation to medical appointments. Drive or walk around the neighborhood.

Ask to have all services proposed and the cost for those services put in writing. To help with this, take a look at the state’s Assisted Living Disclosure Form, available online here: https://www.michigan.gov/documents/dhs/Assisted_Living_Disclosure_Form_313179_7.pdf.

Fourth, once you have chosen a facility and your family member has moved in, visit often, on different days of the week, and at different times of the day. A facility should have liberal visiting hours and if they do not, it could be a cause for concern, said Calewarts.

“If visiting hours are a two-hour window, that’s a red flag,” he said. “Make sure you go at different times of the day. If you see something, feel free to file a complaint. Our license consultants get there every two years, so we depend on the public.”

Confidential complaints against adult care facilities can be filed by mail: Bureau of Community and Health Systems Children and Adult Licensing, Complaint Intake Unit, 611 W. Ottawa, 1st Floor, PO Box 30664, Lansing, MI 48909; fax: (517) 284-9739; phone (866) 856-0126; or online: https://www.michigan.gov/lara/0,4601,7-154-89334_63294_27723-353044--,00.html.

In addition, the state attorney general’s office in March organized an Elder Abuse Task Force to help stop physical, financial, emotional abuse and neglect of elderly people in Michigan. As part of that effort, a hotline and website were established to receive anonymous tips, 800-24-ABUSE (800-242-2873), which is answered during business hours, or, https://www.michigan.gov/elderabuse.

Attorney General Dana Nessel and other members of her task force will host a listening tour in Traverse City on June 21 in the McGuire Room of the Traverse Area District Library, 610 Woodmere Ave., from 10:30 a.m. to 12:30 p.m.

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