In Florida, state regulators are failing to protect residents of assisted living facilities, according to an investigation by The Miami Herald and NPR member station WLRN. An analysis of state records revealed dozens of questionable deaths in assisted living facilities.
The revelation is a reversal for Florida, which was among the first U.S. states to regulate assisted living facilities, and to adopt a Residents Bill of Rights. The state now has nearly 3,000 assisted living facilities, which house tens of thousands of people.
As the U.S. population ages, Florida is a case study for how the country protects some of its most vulnerable citizens. And one case in particular — that of Aurora Navas, who drowned at age 85 — exposes both the failings of some assisted living facilities and a lack of state oversight.
Aurora Navas spent her life terrified of water. And yet in 1962, she put her three kids — by themselves — on a Pan-Am flight, sending them out of Fidel Castro's Cuba and over the ocean to America. One year later, her husband, Manuel, came over by boat.
It wasn't until five years later that Aurora would fly to the United States and be reunited with her family, in Chicago. There, she spent 13 years working on an assembly line at a transistor factory.
She helped pay for a vacation to Miami Beach, where Aurora watched from the sand in fear as her kids played in the ocean. And as her children grew up, she never forgot the six years she had lost with them.
Even long after they'd grown up, "she still referred to me as 'baby' — the baby, nene," says Alfredo Navas, the youngest of Aurora's three children.
After her husband died in 1983, Aurora retired and moved to Tampa, to be near Alfredo and the rest of her family. Alfredo says he visited her every day — but that as his mom got older, he had to hire extra help.
"Just to keep an eye on her and make sure she took her medication, [and] she didn't leave the stove on," Alfredo says. "She was still cooking — she was a strong bird."
In her early 80s, doctors diagnosed Aurora with Alzheimer's disease. Not long afterwards, she moved to Isabel Adult Care III, a six-bed assisted living facility in Southern Miami-Dade County. Isabel Adult Care III has fancy sconces, a covered walkway, and an elegant stone façade. It also sits right next to a lake.
The first time Alfredo visited, he noticed the lake. By then, his mother had started to wander out of bed at night. And with her fear of water in mind, he wanted to make sure she would be safe.
"They had like a little chain-link fence that separated the lake from the property there," Alfredo says. "I did see a surveillance camera. You could see the alarm on the door. And there's always a person there. So it — everything seemed fine."
A Son Gets An Urgent Call
A Miami-Dade Police report describes what happened on Jan. 27, 2008. Around 3:45 in the morning, Aurora Navas got out of bed. She put on her light-blue house slippers and shuffled out of her room.
She walked past an unconnected surveillance camera. She wandered out a door with an improperly set alarm. She shuffled through an unlocked back gate. Two on-duty caretakers failed to stop her.
That night, Alfredo Navas woke up to the phone ringing. The call was from his older sister.
"She uh...she told me that there had been an accident at the nursing home, and that Mom had passed away," he says.
Police found his mother's left slipper lying next to the lake. And they determined that Aurora Navas, had drowned in around 18 inches of water. She was 85.
Dozens Of Deaths, And Few Consequences
A year-long investigation by The Miami Herald and WLRN has turned up at least 70 questionable deaths in Florida assisted living facilities over the last decade.
Herald investigative reporter Mike Sallah reads a list of deaths culled from thousands of state documents:
"Angel Joglar, 71; killed when left in a bathtub of scalding water."
"Gladys Horta, 74 years old; strapped so tightly the restraints ripped into her skin, causing a blood clot that killed her."
"Walter Cox, 75 years old; Alzheimer's patient. Wandered out of a facility for the fourth time; his body was found torn apart by an alligator."
We found deaths resulting from residents being deprived of their medication, and from residents being over-medicated. The cases stretched from Miami to the Florida Panhandle. Questionable deaths occurred in both 100-bed facilities and 6-bed facilities.
And in almost all 70 cases, there were few or no consequences for caretakers. Florida, once a national leader in policing assisted living facilities, has fallen behind in enforcement, our investigation shows.
Owner: 'All Procedures Were Followed'
The assisted living facility where Aurora Navas died is one of five owned by Isabel Lopez. When our reporting team visited another of her facilities, we spoke to Lopez in the driveway, along with with her three-legged dog named Ron -- or "rum," in Spanish.
Asked in broken Spanish if she remembers Aurora Navas, Lopez says that she does — and that her death was an accident. She says she doesn't know why the alarm didn't work on the night Aurora died. We have more questions, but the language barrier makes it too difficult.
Lopez asks us to call back the next day with an interpreter. When we do, she declines — through the interpreter — to answer any more questions.
The Florida agency charged with overseeing assisted living facilities and investigating deaths like that of Aurora Navas is the Agency for Health Care Administration, or AHCA. Every accidental death in an assisted living facility gets reported to AHCA.
Soon after Aurora Navas drowned, Isabel Lopez faxed her company's report of the incident to the agency. It reads, in part: "We found that all procedures were followed. The facility has door alarms, proper door locks, and a fenced backyard."
An AHCA spokesperson said the agency has no records of the Navas case. And the agency refused to comment on whether it pulled the police report. If it did consult the police report, AHCA officials would have read what we saw about the surveillance camera, the improperly set alarm, the unlocked gate.
The Navas family sued Isabel Lopez's company in civil court for wrongful death; the case was settled for an undisclosed amount. The family's lawyer was Michael Feiler, who specializes in bringing cases against assisted living facilities in Florida.
"On close examination, you see facilities with clearly inadequate living conditions, or improperly trained staff, or improper oversight," Feiler says. "And essentially, what you end up with is basically a bunch of small warehouses for the elderly. And that — I find that troubling."
Oversight Agency Holds Fewer Inspections
Because of a recent legislative change, AHCA performs inspections once every two years, instead of the annual inspections it once held. And as the assisted-living industry has expanded, AHCA's staffing has stayed the same.
Our investigation found that the agency is also taking longer to follow up on complaints: In 2009, AHCA took an average of 10 extra days to complete investigations into complaints compared to five years earlier.
And when facilities are found to have deficiencies, the agency rarely punishes them to the full extent of the law.
In 2008 and 2009, AHCA found enough violations that the agency could have revoked the licenses of at least 70 facilities, according to its rules. Instead, the state closed just seven.
Asked about that disparity, Nan Rich, the Democratic Minority Leader of the Florida Senate says, "Well, my first reaction is that AHCA is not doing their job."
Rich says our investigation shows that the state is headed in the wrong direction.
"So we need to go back and figure out how to make sure that the statutes are actually followed and enforced," she says, "and maybe there need to be stronger ones."
AHCA declined a request for an interview. In an email, the agency said that shutting down a facility is "a very harsh penalty."
The agency says it considers the "gravity of the violation" in each case, along with "actions taken by the owner...to correct violations," and "the potential emotional and physiological harm created by removing residents from their home."
AHCA would not comment specifically on the death of Aurora Navas. But an official wrote: "We are sympathetic to Mr. Navas regarding the loss of his mother."
A Lone Fine, For Medicaid Rules
Nearly all of Isabel Lopez's five facilities have a documented history of problems. On some occasions, the police have had to use bloodhounds and a helicopter to search for runaways from her facilities.
AHCA has found 119 different violations in Lopez's facilities over the past decade. But the only disciplinary action the agency has ever taken against Lopez's company was in 2009 — when it levied a $1,500 fine for not complying with Medicaid laws.
Alfredo Navas says he can't understand why AHCA never followed up on his mother's death.
"So what does AHCA do? It's just a paper-pusher," he says. "Somebody just died, you know. And if they're not applying the laws, and fining or closing these people down, then what are they there for?"
In her original incident report to AHCA, Isabel Lopez wrote, "All precautions were taken so that an occurrence like this would not happen."
But it did happen. And without AHCA enforcing its own rules, there's no governing body to prevent deaths like Aurora Navas's from happening again.