By Brandon Stahl, Duluth News Tribune for the Associated Press
Duluth, Minn. (AP) - On Jan. 1, 2007, Hermantown police responded to a call from the Stepping Stones for Living home at 4165 Midway Road for an out-of-control resident. Joseph Francis Leuer, 25, who had a history of violence, was threatening to cut himself or a staff member, according to a police report. Police came and soothed the situation and no one was hurt.
Three months later the police were back again to deal with him.
This time, according to a police report, a staff member told police that Leuer was using a chair frame to break things and was threatening to hurt people. He told police that he had done a lot of meth and threatened to kill a staff member.
The incidents offer a window into a world - right in local neighborhoods - unknown to many: adult foster homes, which include facilities for residents with traumatic brain injuries, severe mental illness or drug addiction - and sometimes all three.
Despite a clientele with sometimes-violent pasts, the homes often have staffs unequipped to deal with such residents, according to public records and former staff members. And that can lead to incidents as serious as physical and sexual assault.
It was at another Stepping Stones home at 5922 Helm Road where a female staff worker allegedly was almost raped by a resident June 28.
According to court records, Robert Edward Berendt, 20, was civilly committed for mental illness in Anoka County for a year on Dec. 12, 2008, and recommitted starting Dec. 1, 2009. He had been charged with two weapons violations in 2008 and was convicted of carrying a weapon in a public place.
Yet court records show that he was alone with a female staff member, playing video games with her, before the alleged assault.
A review by the News Tribune of sheriff, police and state Department of Human Services records of Duluth-area homes run by Stepping Stones for Living, a for-profit company based in Hermantown, shows more than two dozen incidents going back to 2006 involving registered sex offenders or residents with severe mental illness, drug abuse problems or criminal records.
In 2008, according to St. Louis County, the 295 homes run by all companies or nonprofits in Duluth accounted for 3 percent of all police calls. Those homes housed a maximum of 1,180 residents, or just over 1 percent of the population. At most, the homes are only required to have one staff member for every four residents. Staff members don't need any kind of licensure or specialized education. At most, they're required to take 12 hours of training a year.
That's all well within the law. The Minnesota Department of Human Services, which oversees regulations and licensure for state group homes, does not place any restrictions on which clients can live in the adult foster care homes, leaving it up to county staff to "make appropriate referrals to, and placements with, providers that they believe can meet the needs of the vulnerable adults."
Even if they're not a threat to others, some residents are suicidal and have tried to hurt themselves in violent ways. One example is a Sept. 1, 2009, incident at a Stepping Stones home at 6445 Duncan Road, when a resident used a steak knife to try to remove her own uterus.
St. Louis County Sheriff Ross Litman said that, while he understands the need for adult foster care homes, he has concerns about the safety of other residents and staff members in the homes, adding that he's seen an increase in calls for service to them.
"It's also potentially dangerous for the people that live in those neighborhoods," he said. "My fear is that what we're seeing based on these calls, whether it's based on lack of staffing on hand, or lack of training, we're seeing more and more incidents."
Katie Rathke, a former operations supervisor at another Duluth adult foster care home not run by Stepping Stones, said staff members are typically paid low wages given their job requirements and the clients they have to work with, starting at $8 to $8.50 an hour. Sometimes, she said, staff members aren't aware of a client's criminal background.
Because of that, she said she is not surprised to hear of incidents like the one involving Berendt.
"I think something like that was just waiting to happen," Rathke said. "To be honest, I'm surprised something like that hasn't happened sooner."
Not everyone expresses such concerns. Loren Colman, assistant commissioner for continuing care with the Minnesota Department of Human Services, responded to a request for comment for this story with the following statement:
"Our policies set up a structure to allow for informed choice of services and providers so there is a good fit between the selected provider and the person receiving services. There are service planning and placement processes to engage the provider in planning for the person's needs, and clarifying service expectations. From there, providers have a foundation to plan, train and support their staff, knowing the person, others living in the home, and their staff."
Stephanie Ericksen, president of Stepping Stones for Living, did not respond to a request for comment on this story.
The types of incidents seen at the Stepping Stones homes aren't unique to the chain; they probably happen at other adult foster care homes, said Ann Busche, director of the St. Louis County Public Health and Human Services Department.
People living in adult foster care homes would, in the 1980s, have lived in large institutional settings, Busche said. Medicaid, which often paid for the residents' lodging and care, required that they live in an institution.
But that requirement changed, Busche said. If a resident could be served in a community setting for the same or less cost than an institutional setting, Medicaid would waive the institutional setting requirement.
In essence, instead of being institutionalized, those patients could live in neighborhood homes.
"A new industry was born," Busche said. "Adult foster care homes are that industry."
There are now 395 such homes in St. Louis County, 295 of them in the southern part of the county. The facilities can house up to four residents at a time, providing up to 1,562 beds. The average cost for each resident's stay is about $66,312 a year, according to St. Louis County, money that comes from the state and federal Medicaid dollars.
Minimum staffing levels at a home is one staff member for four residents, said Kim Hoffmockel, an adult foster care licensor for St. Louis County. But if residents need more direct care, those staffing levels can increase.
"Two staff members to four residents is the norm," Hoffmockel said.
County social workers determine resident placements by looking at whether their needs would be met by the provider and its personnel and how they would interact with other residents in the home, Busche said.
Sometimes residents can be so violent that they need a staff member watching them at all times. That has a downside, said Richard Malzac, a former behavorial specialist with a Stepping Stones home: It often leaves the other staff member watching three residents.
Because of the short staffing, Malzac said, residents are usually told what they can eat and when, when they can sleep, and where they can go. And that can lead to angry residents.
"It's pretty much because the client doesn't get what they want," Malzac said. "And that makes them angry. I've been punched in the face several times."
He said while he was there, female staff members were left alone with dangerous or violent residents "pretty much all the time." At one of the homes he worked at, staffing at night consisted of one woman left with three men.
And what did they have to protect themselves should a resident become aggressive?
"A telephone," he said. "That's it."
Malzac was fired from Stepping Stones in March 2010, he said, for giving a patient the wrong medication. He is now filing suit against the company, claiming the company forced employees to work without pay during their lunch breaks.
Hoffmockel of St. Louis County said she believes the regulations in place keep residents and staff safe, "99.9 percent of the time. Unfortunately, there will be some percentage when something unexpected happens," she said. "You can't plan for everything when you work with people."
Records also show staff members abusing clients. In April 2010, a resident at a Stepping Stones home at 4165 Midway Road reported being dragged from his bed to the bathroom by a staff member for refusing to take his medication.
In December 2006, a staff member was found to have repeatedly had sex with a vulnerable adult resident with severe traumatic brain injuries and difficulty "defining what is real and what is not real," according to Department of Human Services records.
That resident told investigators she initiated the sex with the staff member because he would give her "lots" of caffeinated coffee.
Stepping Stones' punishment for the worker: to transfer him to another home, according to the DHS report. DHS ultimately stripped him of his ability to work with vulnerable adults, records show.
Sue Abderholden, the executive director of the National Alliance of Mental Illness in Minnesota, said that most adult foster care homes can be a benefit to residents with mental illness and help them to more quickly reintegrate into society.
Still, she said, she does see problems, including lack of oversight and training for the workers.
"We have no way of knowing what types of training they have," she said, "or if they have any at all."
Information from Duluth News Tribune
(Copyright 2010 by The Associated Press. All Rights Reserved.)