David Hartrick buried his mother this month and believes her death was hastened after she had to move out of an adult foster care home in Medford that was shut down by the Oregon Department of Human Services.
"That transfer was more than she could handle," Hartrick said of his 72-year-old mother's move to a Grants Pass care facility. She had suffered from dementia.
DHS ordered several homes in Jackson County closed this spring because of serious health and safety violations.
In the wake of the closures, caregivers are speaking up about a grueling profession in which they feel underpaid and over-regulated. Meanwhile, DHS is trying to keep patients safe from neglect, abuse, fraud and dangerous and unsanitary living conditions.
Hartrick, himself the owner of an adult foster care home that remains open, was renting a house he owns on Northcrest Circle in Medford out to Francis Simbulan to operate a home. Simbulan's clients included Hartrick's mother.
During unannounced April visits, a DHS inspector found only one caregiver working at the home operated by Simbulan. The business also allegedly fabricated information about a March fire drill, inflating the number of caregivers present. DHS shut down the home.
Two caregivers were required at all times at the site because of the high needs of its four residents, including a quadriplegic. One caregiver on duty would not have been able to evacuate the residents properly in case of a fire, according to DHS.
The required ratio of caregivers-to-clients in homes varies based on the needs of clients.
Simbulan, who lived in the house and held the license to provide care, said the state was not providing enough Medicaid funding for him to pay for around-the-clock caregiving by two people. He said he received enough extra funding to pay for only six hours of care per day — not 24 hours.
"I'm trying to clear my name with all these allegations," said Simbulan, who moved out of the house and had his clients relocated when he lost his foster care business.
Simbulan said he received base pay of approximately $2,000 per month for each of his four Medicaid clients, plus about $2,000 extra to cover higher needs, for a total of about $10,000 per month.
Service Employees International Union representative Clara McPhee said it costs $8,640 per month to hire caregivers at $12 per hour to provide 24-hour care for a month by one caregiver at a time. That left very little for Simbulan to pay himself and cover his business expenses.
If Simbulan ever left the house, he would also have to hire back-up caregivers, further cutting into that small amount of money, McPhee said.
"The truth is, he's severely underpaid at that rate. A good adult foster care home business model is to have three private pay clients and only one or two Medicaid clients. All four of Frances' clients were Medicaid clients," said SEIU Union Steward Michael McPhee.
Ashley Carson-Cottingham, director of the DHS Aging and People with Disabilities Program, said providers are responsible for assessing the needs of residents before taking them on as clients. If residents need extra care, she said, providers should seek an exception that allows them to receive extra funding.
"If they aren't able to meet the residents' needs, it is their responsibility to seek the exception or not take on the resident in the first place," Carson-Cottingham said. "They are not allowed, under licensing rules, to allow unsafe conditions to exist and continue."
DHS officials expressed sympathy to Hartrick concerning the death of his mother, but said they can't overlook unsafe conditions.
"We’re sorry for his loss," Carson-Cottingham said. "Moves can be extremely traumatic for residents, and the agency takes these decisions to do immediate suspensions very seriously. We have to balance the need to move with the need to ensure that residents are safe. This was an emergency closure that required residents to be moved because of immediate risks to their health and safety. These are actions of last resort, and the agency only takes this step in the most severe cases."
Caregivers upset by the spate of closures said state regulations make it difficult to add new workers.
They said new prospective employees have to pass a state criminal background check that can take a month. A foster home owner can offer someone a job, but that person has often moved on and accepted a job in a different industry by the time a background check clears.
DHS acknowledged background checks can take a month.
"We are adding staff to the Background Check Unit to help reduce the wait time for someone to be cleared for employment," Carson-Cottingham said.
Jenrico Viray, whose wife held a license for them to provide care at a home on Seckel Street in Medford that was shut down, is also speaking out about the closures.
"Our residents were crying the day they moved," he said.
He conceded the house was not kept as clean as many foster care homes, but said an inspector came when they were in the midst of cleaning. Viray said one resident in particular wanted her possessions nearby so she could reach them from her bed — resulting in a messy bedroom.
"They didn't even give us a chance to explain ourselves," Viray said of DHS inspectors.
According to a DHS inspection report, the home operated by the Virays had dirty walls and carpet, a dirty bathroom, a sticky floor, a urine odor, a broken window, an overflowing container of soiled incontinence garments and an inoperable fire alarm with the battery removed.
"The Virays' place was not clean to my standard, but the clients chose to live at his house," Michael McPhee said.
A March inspection found temperatures in the residents' rooms were in the low 60s.
Viray said the temperature gauge inside the house read 70 degrees so he wasn't aware of low bedroom temperatures.
DHS found residents were left alone with a substitute caregiver who was unable to care for them, and the home had a history of multiple past instances of unqualified caregivers.
Both Viray and Simbulan said they feel they faced extra inspections and scrutiny because they were licensed by a DHS worker who also licensed the Heart of a Man adult foster care home in Grants Pass.
Donald DuBose, 83, walked out of Heart of a Man Feb. 17. His body was found March 16 on the lower Rogue River.
DHS officials said four homes that were shut down this spring in Jackson County received extra scrutiny because of Adult Protective Services complaints, not because of any actions by an individual DHS employee.
Clara McPhee said the closures have put caregivers on edge. In addition to being a SEIU representative, she operates adult foster homes that have not been shuttered.
McPhee said adult foster care homes provide an important service that typically costs about $5,000 less per month for each client compared to other care settings such as nursing homes. She said foster care homes save the state money when it comes to care for Medicaid clients.
McPhee said her business survives because the majority of her residents are not Medicaid clients.
A mother of three, McPhee started her caregiving business because one of her children had severe medical problems.
"This job is a thankless job — unappreciated and stigmatized. This is not an easy job. We change diapers daily," she said. "Every provider is nervous about losing their livelihood. If I see someone who says, 'I'm going to start a home,' I would say, 'Don't do it.' "
DHS officials said they do appreciate the work done by caregivers.
"There are many providers across the state providing excellent care for adults in home-like settings, and Oregon puts a lot of value in people being more integrated into community care settings like these," Carson-Cottingham said. "Making sure residents are safe is not over-regulation — it’s the most important function these facilities provide."
Suspected abuse or neglect of an adult or child can be reported to DHS by calling 1-855-503-7233.