Tuesday, November 05, 2002

BY SUSAN K. LIVIO AND TED SHERMAN
Star-Ledger Staff

State inspectors last year went through a community home for the mentally retarded in Haddonfield and gave it a clean bill of health.

Just eight months later, an anonymous tipster suggested a closer look at the privately run facility. Inspectors went back and discovered dozens of serious problems, including two cases of physical abuse and three incidents of sexual abuse that had gone undetected the first time around.

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State-licensed residential programs for the developmentally disabled, run by nonprofit organizations as well as for-profit corporations, for years have faced far less scrutiny than state institutions or specialized care facilities that receive federal Medicaid funds.

While the state has been slow to open group homes and has more than 6,000 people on a waiting list for such community housing, the number of new residential facilities in New Jersey has nonetheless increased over the past several years.

More than 7,000 people with developmental disabilities now live in 874 group homes and supervised apartments in New Jersey, a 33 percent increase in the past five years. Those community placements -- homes in traditional one- or two-family houses or apartments in conventional neighborhoods -- offer the developmentally disabled the opportunity to live a far more normal life than in big institutions.

Most provide pleasant places to live. But with even less oversight than the big state institutions, the smaller settings are no panacea. Some have had significant problems.

An examination by The Star-Ledger of state records filed by operators of group homes found nearly 2,000 reported cases of abuse, assault and neglect this year alone. More than 100 reports cited inadequate supervision.

The numbers were based on reports filed with the state Department of Human Services that detail allegations of unusual incidents, including abuse, neglect, deaths, and supervision issues at group homes and other residential facilities for the developmentally disabled.

State officials said the allegations are often proved to be unfounded. Still, about 44 to 45 percent of the complaints alleging neglect are substantiated. About 37 percent of the verbal, physical and sexual abuse complaints are found to be genuine.

Some 50 complaints resulted in calls to local or state authorities.

Parents say what they have found in residential facilities can vary wildly. Ron Victoria of Metuchen pulled his 25-year-old daughter, Danielle, out of the first group home she tried. "It wasn't the right place for her. There were little things that would go on," he recalled.

The facility provided no activities for the residents, aside from the outside work programs, and he found that the staff would allow her to lie in bed all day.

The state is strapped for residential placement, said Victoria. Some group homes he has seen have been "real dumps," while others have been excellent programs.

"If I wasn't advocating for my daughter, things would have been worse," he said.

When Winny Sekula tried to find a place for her son, Andrew, she had a similar experience. She saw one group home with eight or nine residents and just one of them had an organized activity.

"The house was dirty," she said. "The experience was a nightmare."

She finally found placement through Community Options Inc. in a home just blocks from where she lives.

THE LAST RESORT

The state is loath to close down homes, even when it finds problems. "We don't close anybody down because then people lose their homes," said Paula DiVenuto, an assistant director in the Division of Developmental Disabilities who oversees the inspections at group homes and other community housing.

DiVenuto said shutting a program can result in tremendous upheaval, and is the last resort.

"What we do is basically by mutual consent," she noted. "After you have worked with an agency for a long time and you come to a point where this isn't working, then we have asked agencies to mutually walk away from the table so we can get another agency in there."

One of the companies that was asked to walk away was ResCare Inc. of Louisville, Ky., the country's largest provider of services to mentally retarded adults.

After discussions with the state, ResCare agreed to transfer control of six of its 12 homes in New Jersey to other agencies.

ResCare spokeswoman Nel Taylor said those six homes were in the northern part of the state, far from the company's regional management office in Philadelphia. "We could not manage them efficiently," she said.

State officials said there were never any concerns with health and safety issues at the homes, although at least two civil lawsuits in New Jersey have charged ResCare with negligence.

One involved 55-year-old Albert Cevera, a resident of a ResCare-operated group home in Old Bridge, who was severely scalded when he was lowered into a tub of bath water.

Later estimates put the water temperature at 130 degrees.

"They pulled him out with horrific burns," said attorney Sean Callagy of Montvale. "They apparently tested the water with gloves on."

Cevera was flown by helicopter to the burn unit at Saint Barnabas Medical Center in Livingston. He survived his injuries and was later placed at the New Lisbon Developmental Center.

ResCare fired both workers involved, said Taylor, who would not comment on the lawsuit itself.

State officials said such incidents were rare.

"Once would be too much -- I'm not minimizing this," DiVenuto said. "But it boils down to human error or poor judgment. I would call it atypical of what occurs out there."

EVERYTHING GOES WRONG

There have been at least two deaths at state-licensed residential facilities for the developmentally disabled, lawsuits show.

Last February, a boy with autism died in the care of Bancroft Neurohealth Inc. of Haddonfield, a state-licensed facility in Camden County. A state probe later concluded that the teenager, Matthew Goodman, 14, of Buckingham, Pa., had been abused and neglected in the month leading up to his death. The investigation found that Goodman had been improperly restrained and left unattended on several occasions.

Bancroft was inspected months before the incident. After an anonymous source tipped off the state to problems, a more thorough investigation led to a record $127,700 fine for failing to report and prevent abuse, train staff and inform parents about changes in treatment.

Bancroft has denied any wrongdoing.

The case has prompted lawmakers to introduce a bill called "Matthew's Law," unveiled at a rally last month, that would sharply restrict the use of restraints.

Another case now in court involves the death of Lee Brickates, who died in 1999 after a series of incidents at a group home operated by the Training School at Vineland.

While workers struggled to get him into a restraining jacket, Brickates collapsed and died. The incident came just days after Brickates had undergone surgery for a fractured jaw he suffered in a fight with another resident.

A confidential report last year by the state's Special Response Unit, a team that investigates abuse, neglect and exploitation cases at group homes, found that the Training School at Vineland had never reported the altercation that had led to Brickates' broken jaw, and failed to meet his medical and behavioral needs.

"Everything that could go wrong, did go wrong in this case," said attorney Darrell Fineman of Vineland, who is representing Brickates' father in a civil lawsuit.

Until now, the state had been conducting inspections only every other year. And there was no requirement to report anything more than major injuries, or episodes that rose to the level of a so-called "unusual incident."

IMPROVED OVERSIGHT

State officials said after years of cursory inspections of private facilities, New Jersey and the federal government are moving to increase their oversight.

Next month, the state Division of Developmental Disabilities will begin annual examinations of community homes for the mentally retarded. Inspectors have been doing surprise visits since the spring.

The U.S. Centers for Medicare and Medicaid is also expected to begin surprise audits at various community housing programs -- a first for New Jersey.

And also for the first time, the state will start tracking all incidents at the group homes, including all injuries.

"If you saw a high degree of incidents with an individual over time, or a high degree of incidents on the second shift, these would be a red flag for an agency to say what was going on," DiVenuto said.

All recommendations by the department's Special Response Unit will also now be followed up.

State officials said the steps were being taken to reassure parents and the public. "We thought it was necessary to increase the monitoring of licensed programs," said George Kuster, chief of the Office of Licensing and Inspections for the state Division of Developmental Disabilities.

DiVenuto said the most important change would come from the agencies running state-licensed programs to develop their own system of quality improvement.

She pointed to Our House Inc., a nonprofit group that operates group homes in Essex, Somerset, Morris and Union counties, as an organization that "does it right" because of its attention to detail and good management practices.

"Inspections are fine. But unless you really create a culture of quality out there and have everybody buy into it, you would need inspectors sitting at every group home for three shifts," she said. "That is not a way to do business."

Next: Parents take charge.