DSHS gets mixed reviews on care of elderly, disabled

Thousands of complaints involving the mistreatment of elderly and disabled people in Washington's state-licensed residential facilities aren't being investigated fast enough, a state auditor has found.

But in the most serious situations, in which residents are at risk of immediate harm, the state Department of Social and Health Services is starting investigations within the required two working days about 96 percent of the time, the auditor determined.

Those top-priority complaints typically include allegations that a resident is being physically or sexually abused, or that the facility is not responding to a life-threatening turn in the resident's health.

When it comes to lower-level complaints, the department's Residential Care Services Division failed to respond within 10 working days as required by agency policy in one out of three cases, the auditor found.

Those complaints include allegations that a resident is not getting needed physical therapy or doctors' visits, or enough turning in bed to prevent pressure sores.

State Auditor Paul Knapp said his six-month investigation of DSHS response times didn't leave him worried about the safety of elderly and disabled people in nursing, adult family and boarding homes.

The department, he said, was investigating all complaints and was usually only a few days late in getting to the lower-level concerns.

Knapp, however, said the residential care division is severely understaffed, with investigators handling unmanageable numbers of complaints and support staff struggling to keep pace with the required paperwork.

"God, they need more people," Knapp said this week. "When you look at the number of complaints they receive with the number of investigators they have, it's scary."

Between 1999 and 2000, the number of complaints the division received statewide jumped 36 percent, to 18,198. Nearly 900 "priority one" complaints were filed last year, records show.

The division has just 32 complaint investigators now, but the Legislature has agreed to add at least 20 more over the next two years.

Larita Paulsen, the division's chief of consumer services, said that's about half as many investigators as are needed, "but they should make a difference" in speeding response times.

The audit was triggered by a whistle-blower's complaint. That person, who works for the residential care division, declined to be interviewed.

According to her written complaint, she was concerned that a departmental reorganization had resulted in long delays in investigations and that vulnerable elderly residents were paying the price.

That was true in only a handful of cases, Knapp said. He looked at 258 "priority one" and "priority two" complaints alleging mistreatment of residents from 1999 and 2000 that, based on division records, appeared to still be open this year.

But after further checking, he found that only six of the investigations hadn't been completed.

The real problem was that final reports weren't being written and approved by managers, and case outcomes weren't being entered into a database, Knapp said.

The whistle-blower also alleged that the state's complaint investigators weren't qualified to conduct investigations. But Knapp learned that, in fact, Washington is one of just two states that require its investigators to be registered nurses, according to a September 2000 report by the General Accounting Office.

Until the new investigators arrive, Paulsen said, the existing staff will continue to use a triage system to handle the non-life-threatening lower-level complaints.

Those coming from the public are dealt with before those from the facilities themselves. That's because the facilities are legally required to report any care problems they become aware of and so are likely to begin addressing them independently.

But a family member or friend who complains of mistreatment depends on the state alone to react quickly. Investigators also prioritize the less-regulated boarding and adult family home complaints at the top of list, because those facilities have traditionally had more serious care problems than nursing homes.

Paulsen said that since the investigation was conducted over the summer, the division has caught up on getting investigation outcomes properly recorded into its database.