>> Sreenivasan: THERE ARE ABOUT 12 MILLION AMERICANS WHO DEPEND
ON SOME FORM OF LONG TERM CARE. THAT CAN RANGE FROM NURSING
HOMES TO ASSISTED LIVING. AS BABY BOOMERS AGE, THE DEMAND
FOR LONG-TERM CARE IN THE U.S. IS EXPECTED TO OUTPACE SUPPLY
AND FUNDING WITHIN A DECADE. THERE IS NO ONE WAY TO MEET THAT
NEED, AND STATES ARE LOOKING AT A PATCHWORK OF SOLUTIONS.
ONE APPROACH IS ADULT FOSTER CARE.
SPECIAL CORRESPONDENT JOANNE ELGART JENNINGS REPORTS FROM
OREGON. ADULT FOSTER CARES HAVE BEEN
AROUND THERE FOR MORE THAN 40 YEARS IN THE STATE.
THIS STORY IS PART OF OUR ONGOING SERIES ABOUT POVERTY AND
OPPORTUNITY IN AMERICA: "CHASING THE DREAM."
>> Reporter: WHEN STEVE LARRENCE WANTS TO VISIT HIS ELDERLY
MOTHER, IT'S A SHORT WALK TO HER CARE FACILITY.
IT LOOKS LIKE MOST OF THE OTHER HOMES IN THIS SUBURBAN PORTLAND
NEIGHBORHOOD. >> HI MOTHER.
>> HI. >> HOW ARE YOU DOING?
>> I'M DOING WELL. >> MOTHER WAS A VERY ACTIVE
PERSON. SHE WAS ONE OF THOSE KIND OF
PEOPLE JUST GO, GO, GO, GO, GO, GO, GO.
>> Reporter: BUT AT 99-YEARS- OLD, MARJORIE LARRENCE IS NOW
PARTLY BLIND. AND AFTER SUFFERING MANY FALLS,
SHE CAN'T WALK ANYMORE. >> HOW'S YOUR LEG DOING?
>> IT'S DOING WELL. >> NO PAIN TODAY?
>> NO. >> Reporter: 13 YEARS AGO, WHEN
LARRENCE REALIZED HIS MOTHER COULD NO LONGER LIVE ON HER OWN,
HE DIDN'T WANT TO PUT HER IN A LARGE NURSING HOME.
>> I WANTED ADULT FOSTER CARE BECAUSE I'D SEEN THE ADVANTAGES
OF THE INDIVIDUAL CARE YOU GET HERE AND HAVING YOUR OWN ROOM.
YOU DON'T FEEL LIKE YOU'RE IN AN INSTITUTION, YOU FEEL LIKE
YOU'RE LIVING WITH A FAMILY. >> THERE YOU GO.
>> Reporter: THAT'S BECAUSE MARJORIE LARRENCE IS LIVING WITH
A FAMILY. IN THIS CASE, IT'S CARMEL
DURANO'S FAMILY, IN CARMEL DURANO'S HOME.
>> WHAT WE DO FOR YOU EVERY DAY. >> Reporter: I THINK A LOT OF
PEOPLE HEAR THE WORD FOSTER CARE, THEY THINK OF KIDS BEING
TAKEN FROM THEIR FAMILIES AND PLACED IN HOMES.
WHAT DOES IT MEAN IN THIS CONTEXT?
>> THE RESIDENTS ARE PLACED IN YOUR HOME OR THEY CHOOSE YOUR
HOME TO LIVE LIKE A NORMAL, YOU KNOW, IT'S LIKE A NORMAL HOME.
I THINK YOU FOSTER A HOME-LIKE ATMOSPHERE FOR THEM, COMPARED TO
LIVING IN ASSISTED LIVING OR A NURSING HOME.
>> Reporter: FIVE ELDERLY RESIDENTS LIVE IN THIS ADULT
FOSTER HOME. THAT'S THE MAXIMUM ALLOWED UNDER
OREGON LAW. AS WITH TRADITIONAL NURSING
HOMES, RESIDENTS HERE RECEIVE 24-HOUR CARE AND CAN ACCESS A
RANGE OF SERVICES FROM PREPARED MEALS TO ASSISTANCE WITH HYGIENE
TO PHYSICAL AND EMOTIONAL SUPPORT.
>> HOW ARE YOU FEELING TODAY? >> Reporter: FOR THOSE WHO
REQUIRE IN HOME MEDICAL CARE, A NURSE OR DOCTOR IS CALLED IN.
MEDICAID, MEDICARE, OR PRIVATE INSURANCE MOST OFTEN COVERS THE
EXPENSE. THE COST OF ADULT FOSTER CARE
RANGES FROM ABOUT $3,500 TO $5,000 A MONTH.
AGAIN, THOSE ON MEDICAID ARE COVERED.
IN ANY CASE, IT'S ABOUT HALF THE AVERAGE COST OF A BED IN A
NURSING HOME IN OREGON. CARMEL DURANO HAD JUST EMIGRATED
FROM THE PHILIPPINES WHEN SHE FIRST OPENED HER HOME TO ELDERLY
RESIDENTS 27 YEARS AGO. >> IN THE PHILIPPINES, OUR
GRANDPARENTS ARE ALWAYS AROUND US.
IT SEEMS LIKE THE GRANDCHILDREN'S LIVES CAN CENTER
AROUND THE GRANDPARENTS WHO WERE EXPECTED TO LOVE THEM AND
RESPECT THEM. >> Reporter: IT WAS A NATURAL
FIT FOR DURANO. SHE WAS ABLE TO RAISE HER
CHILDREN AND RUN A BUSINESS CARING FOR ELDERLY PEOPLE, ALL
UNDER THE SAME ROOF. >> I HAD THREE SMALL BOYS THEN
AND I FIGURED, YOU KNOW, INSTEAD OF WORKING OUTSIDE I CAN DO THE
ELDERLIES AND MY OWN FAMILY AT THE SAME TIME.
>> Reporter: DURANO'S SISTER, WHO RUNS ANOTHER ADULT CARE HOME
IN THE NEIGHBORHOOD FREQUENTLY VISITS.
AND THEIR 78-YEAR-OLD-MOTHER LIVES HERE TOO.
DURANO'S KIDS HAVE SINCE GRADUATED COLLEGE.
BUT SHE WILL ALLOW EMPLOYEES TO BRING THEIR CHILDREN TO WORK ON
OCCASION. PAULA CARDER, A RESEARCHER AT
PORTLAND STATE UNIVERSITY'S INSTITUTE ON AGING, HAS BEEN
STUDYING OREGON'S ADULT FOSTER CARE SYSTEM FOR THREE YEARS.
SHE'S IMPRESSED WITH THE QUALITY OF CARE THAT'S DELIVERED AT A
COST LOWER THAN OTHER ELDER CARE SETTINGS.
>> THE FOLKS WHO LIVE IN ADULT FOSTER HOMES IN MANY WAYS LOOK
MORE LIKE PEOPLE LIVING IN WHAT WE CALL MEMORY CARE UNITS.
THEY'RE CARING FOR PEOPLE WHO HAVE SIMILAR KINDS OF NEEDS IN
TERMS OF ASSISTANCE WITH EATING, ASSISTANCE WITH USING THE
BATHROOM, MOBILITY, AND STAYING IN THE RESIDENCES UNTIL THEY
DIE. >> Reporter: AND WHY IS THAT
IMPORTANT? >> THAT'S IMPORTANT TO ME
BECAUSE SOMETIMES PEOPLE WORRY THAT ADULT CARE HOMES CAN'T
PROVIDE A HIGH LEVEL OF CARE TO PEOPLE WITH MULTIPLE CHRONIC
ILLNESSES AND DISABILITY AND DEMENTIA AND THE EVIDENCE SHOWS
THAT THEY CAN, AND THEY DO, AND THEY CHARGE MUCH LESS.
>> Reporter: IN OREGON, ADULT FOSTER CARE IS REGULATED BY THE
STATE'S DEPARTMENT OF HUMAN SERVICES OR D.H.S., THE SAME
AGENCY THAT REGULATES OTHER ELDER CARE FACILITIES LIKE
ASSISTED LIVING. LICENSEES MUST MEET SEVERAL
REQUIREMENTS INCLUDING LIVING ON SITE OR PROVIDING A QUALIFIED
RESIDENT MANAGER, PASSING A BACKGROUND CHECK, HAVING A HOME
THAT MEETS STRUCTURAL AND SAFETY REQUIREMENTS, COMPLETING A
TRAINING COURSE, PASSING AN EXAM, AND BEING RECERTIFIED EACH
YEAR. CARDER SAYS REGULATION IS KEY TO
ADULT FOSTER CARE AS IT IS WITH ALL ELDERLY CARE.
>> AND IT SETS UP AN EXPECTATION AND PROFESSIONALIZATION OF THE
OPERATORS WHEN YOU LICENSE AND REGULATE IT.
IT GIVES CONSUMERS AND THEIR FAMILIES, YOU KNOW, A PEACE OF
MIND TO KNOW THAT IT'S BEING OVERSEEN.
IT ALLOWS THE STATE TO PROVIDE TECHNICAL ASSISTANCE AND IF
NEEDED, SANCTIONS AGAINST ADULT FOSTER CARE OPERATORS WHO ARE
NOT DOING A GOOD JOB. >> Reporter: NOT DOING A GOOD
JOB CAN INCLUDE NEGLECT, OR EVEN ABUSE OF ELDERLY CLIENTS.
ACCORDING TO OREGON'S D.H.S., EVERY YEAR THERE ARE ABOUT 1,000
CASES OF ELDER ABUSE IN ALL LONG-TERM SETTINGS.
AND THE AGENCY SAYS THE RATE OF ABUSE HOVERS AT ABOUT 3% FOR ALL
CARE FACILITIES INCLUDING ADULT FOSTER HOMES.
INSPECTORS NORMALLY DROP IN UNANNOUNCED AT LEAST ONCE A
YEAR. >> HI, HOW ARE YOU?
>> Reporter: THIS PARTICULAR INSPECTION AT ANOTHER ADULT
FOSTER HOME WAS ANNOUNCED IN ADVANCE SO WE COULD GET
PERMISSION TO FILM. INSPECTOR KENDAHL BATISTE-BALL
STARTS WITH A REVIEW OF PAPERWORK, AND AN AUDIT OF
MEDICATIONS. >> THE MEDICATION AUDIT USUALLY
COMES FIRST BECAUSE WE REALLY WANT TO MAKE SURE THAT MEDS ARE
SAFE AND BEING ADMINISTERED AS PRESCRIBED, THAT THERE'S
DOCTOR'S ORDERS IN PLACE, AND THAT ALL THE MEDICATIONS ARE IN
HAND. >> Reporter: NEXT, BATISTE-BALL
LOOKS FOR ANY POTENTIAL SAFETY HAZARDS.
>> I'M JUST GLANCING FOR EXTENSION CORDS OR NON SURGE
PROTECTED MULTI-PLUG ADAPTORS. OKAY, YOU LOOK GOOD.
MAKE SURE YOUR TOILET FLUSHES. YOU HAVE VENTILATION.
>> Reporter: AND FINALLY, SHE INTERVIEWS RESIDENTS TO SEE IF
THEY HAVE ANY COMPLAINTS. PAT, WHO JUST GAVE US HER FIRST
NAME, CAN'T REMEMBER HOW MANY YEARS SHE'S LIVED HERE, BUT SHE
SAYS IT'S BEEN A FEW. >> I'M NOT HERE BECAUSE I CHOSE
TO BE HERE. I'M HERE BECAUSE I WAS PUT HERE.
>> I AM SORRY THAT'S YOUR SITUATION, BUT FOR WHAT IT IS,
THIS ISN'T A BAD SITUATION. I JUST WANT TO MAKE SURE YOU'RE
NOT BEING ABUSED. >> OH NO.
NOTHING LIKE THAT. >> AND THAT YOU'RE GETTING ALL
YOUR NEEDS MET AND YOU'RE GETTING FOOD.
YEAH. YEAH, GOOD.
NO COMPLAINTS AT THIS POINT. >> Reporter: SOMETIMES, OF
COURSE, THERE ARE ACCUSATIONS OR INSTANCES OF NEGLECT OR ABUSE.
>> THERE IS TIMES WHEN THERE ARE REALLY UNSAFE PRACTICES
HAPPENING IN THE HOME AND WE HAVE TO RESPOND ACCORDINGLY.
>> Reporter: IF AN INSPECTOR WERE TO COME ACROSS ONE, SHE
WOULD REFER IT TO A STATE OR COUNTY INVESTIGATOR, DEPENDING
ON WHERE IT OCCURRED. BY CHANCE, SEVERAL WEEKS AFTER
WE VISITED CARMEL DURANO'S ADULT FOSTER HOME, ONE OF HER
RESIDENTS ALLEGED BEING LEFT LYING ON THE FLOOR AFTER A FALL
AND FILED A COMPLAINT. FOLLOWING A THREE-MONTH-LONG
INVESTIGATION, OREGON'S DEPARTMENT OF HUMAN SERVICES
DETERMINED THAT DURANO'S FACILITY "FAILED TO FOLLOW THE
RESIDENT'S CARE PLAN, WHICH IS CONSIDERED NEGLECT OF CARE AND
CONSTITUTES ABUSE." FRED STEELE IS OREGON'S
OMBUDSMAN FOR LONG TERM CARE. HIS JOB IS TO BE A WATCHDOG AND
INDEPENDENT ADVOCATE FOR ALL ELDER CARE RESIDENTS, REGARDLESS
OF FACILITY. >> PROPER CARE PLANNING IS A
FAIRLY SIMPLE THING FOR RESIDENTS AND THAT SOMETHING
SIMPLE AS RECOGNIZING THE ASSISTANCE THAT THAT RESIDENT
NEEDED AND THAT ASSISTANCE JUST SIMPLY NOT BEING PROVIDED AND
WHAT I READ AS ALMOST AN INDIFFERENCE BY THAT CAREGIVER
THAT WAS SUPPOSED TO BE AVAILABLE.
>> Reporter: IN HER DEFENSE, DURANO SAID IT WAS THE FIRST
SUCH ACCUSATION IN HER 27 YEARS OF RUNNING HER FACILITY.
>> NO INSTANCE HAPPENED BEFORE, YOU KNOW, WE NEVER HAD AN
INCIDENT LIKE THIS BEFORE. >> Reporter: SHE SAYS MOST
RESIDENTS USE A CALL BUTTON WHEN THEY NEED HELP.
>> IT'S A LOUD NOISE. IT WILL MAKE YOU JUMP OUT OF
YOUR BED AND GET DISORIENTED. IT'S VERY LOUD.
>> Reporter: THE DAY OF THE INCIDENT, DURANO LEFT HER MOTHER
WHO HAD BEEN WORKING WITH HER FOR 27 YEARS IN CHARGE OF THE
RESIDENTS WHILE SHE WENT OUT. HER MOTHER SAYS SHE DIDN'T HEAR
A CALL BUTTON OR CRIES FOR HELP. >> DURING THE INVESTIGATION THEY
TOLD US THAT SHE CAN'T BE LEFT ALONE ANYMORE BECAUSE SHE'S
OLDER. SHE'S 78 ALREADY, BUT SHE WAS A
HOME HEALTH CAREGIVER. >> Reporter: DURANO SAYS THE
INCIDENT WAS A WAKEUP CALL FOR HER AND THAT HER MOTHER IS NO
LONGER PROVIDING CARE. >> IT WAS JUST A TEACHING MOMENT
THAT MAYBE WE NEED TO REASSESS EVERYTHING.
>> Reporter: UNDER NEW LEADERSHIP, OREGON'S DEPARTMENT
OF HUMAN SERVICES HAS BEEFED UP ENFORCEMENT OVER THE PAST FIVE
YEARS. ADULT FOSTER HOMES WITH REPEATED
LICENSING VIOLATIONS HAVE BEEN FORCED TO CLOSE AT A HIGHER RATE
THAN PREVIOUSLY AND AT A HIGHER RATE THAN OTHER CARE FACILITIES.
AS FOR STEVE LARRANCE, WHEN HIS MOM MARJORIE TURNS 100 IN
SEPTEMBER, SHE'LL HAVE SPENT 14 YEARS IN CARMEL DURANO'S CARE.
I ASKED HIM IF HE WAS CONCERNED ABOUT THE ABUSE CHARGE.
LARRANCE SAID HE STILL HAS FULL FAITH.
HE SAID THERE WERE MANY TIMES HIS MOTHER NEEDED URGENT
ASSISTANCE IN THE MIDDLE OF THE NIGHT AND SHE WAS, "ATTENDED TO
QUICKLY." HE ADDED THAT SHE ALWAYS FEELS
CARED FOR.