No one rates assisted living centers

No federal rating system exists for assisted living facilities, where more than 2,000 of the tri- county's most vulnerable residents live. Some states, such as North Carolina, have instituted their own rating systems.

But in South Carolina, the only way to learn about a facility's performance is to file a Freedom of Information Act request with state health officials.

Assisted living facilities, licensed as community residential care facilities, are different from nursing homes. Assisted living residents need help with a few activities, such as taking their medicine, dressing or cleaning, but do not require the higher level of medical care nursing homes offer.

The number of complaints of physical abuse in residential care facilities more than doubled to 238 from 111 between 2004 and 2006, according to the S.C. Lieutenant Governor's Office on Aging ombudsman program.

Complaints can range from serious allegations of abuse to dinner being served late. Sandra Belaja, 60, although not abused, did find the conditions of one area facility so substandard she moved out and into a hotel.

Belaja was discharged from an area hospital in the fall to Palmetto Residential Care Facility on Spruill Avenue in North Charleston to make sure she took her medicine. Previously, she paid rent and lived on her own.

Belaja, a tiny woman with a sharp sense of humor, has congestive heart failure, lupus and other related health problems.

"You name it, I got it," she said. "My heart is not even working at 10 percent."

She said the conditions at Palmetto were so bad she left to stay at the Value Place Hotel. She keeps her hotel room, high above Interstate 526, very warm and watches television from a hospital bed. Hospice workers bring her oxygen and monitor her medicine.

Residents at Palmetto often went without toilet paper and soap in the common bathroom, which had two toilets for 12 people, she said. And she said that when the heating broke, the oven was used to keep residents warm.

Clara Lesesne and her husband, Gary, own Palmetto and three other facilities. She said that soap and toilet paper were on hand at all times. Repairs were done to the heating in December, she said, but she was unaware of an oven being used for warmth.

"Everything they need is always on site," Clara Lesesne said.

In October 2006, the S.C. Department of Health and Environmental Control issued a letter to suspend Palmetto's license, according to the agency's Web site. In July 2007, however, DHEC lifted the suspension because the facility complied with standards.

Jerry Paul, former DHEC director of regulations, said closure is hard. "With the administrative law system, you're looking at long periods of time with a facility out of compliance that can operate. You really have to have horrendous goings on at a facility before you can close one down," he said.

Palmetto did close briefly in January and re-opened with new employees and new residents, Clara Lesesne said.

DHEC, faced with state budget cuts, has only 11 inspectors for the nearly 500 assisted living facilities statewide. "We're down. We're way down," DHEC spokesman Thom Berry said about staffing.

Teresa Arnold, legislative director for American Association of Retired Persons-South Carolina said, "We need to look at the entire regulatory process and whether we're keeping people safe."

If family members want to learn about sanctions and violations at an assisted living facility, they must file a Freedom of Information Act request with state health officials. The same is true for nursing homes.

This is not good enough, advocates say. Arnold said that if the government is the entity collecting the information, then the records should be easily accessible. "You should be able to go in and see how many violations there are and what they're for," Arnold said.

DHEC was working on such a system for the facilities the agency inspect about a year ago, when Paul retired from the department's licensing division. But an online database of reports has yet to be realized.

Problem facilities can spiral out of control with complaints quickly compiling, the retired inspector said. "Complaints, more complaints. Everything gets out of disarray," he said. Three or four inspections may be done to follow up on those complaints, he said, but those reports may not show up in a rating system that only follows certain indicators.

People can ask facilities to see their most recent reports, which DHEC provides to them, Berry said. But facilities are not required to share the information.

The only solution, Paul said, is to make everything available on the Internet. Creating such a database takes money, something all state agencies lack. Meanwhile, the facts remain filed away.

Reach Jill Coley at 937-5719 or jcoley@postandcourier.com.