A media expose of wretched nursing home conditions in the 1970s led to federal legislation in the 1980s that professionalized that industry, says gerontologist Mary Shapiro.
Shapiro is an owner of Senior Direction, a Las Vegas service that manages geriatric care cases and trains caregivers.
But Shapiro and other local senior advocates say they still worry about what goes on at home -- either under seniors' own roofs, where care is provided by relatives or personal employees, or at commercially operated group care homes.
In Nevada, anyone can bring up to two paying senior clients into his or her home as long-term residents without a stitch of supervision. The sole requirement is to register with the state's Bureau of Licensure and Certification.
The one-page registration form asks little beyond the operator's name, address and phone number and names of residents in the facility. "Do you own or rent the premises?" is also asked. So is, "Do you personally provide 24-hour care and supervision? If no, who provides care for these residents?"
If a group care operator wants to care for three or more people, a license from the bureau is required. He or she must be at least 21, trained in first aid and CPR, have a high school diploma or the equivalent and submit three letters of recommendation and a doctor's statement as to physical and mental health. The top employee must have an administrator's license from the state.
Operators also identify parties who own at least 10 percent of the business and provide proof of insurance, policies for admission and rates, as well as a current financial statement and three-month financial plan.
Owners and administrators must share their work history for the last three years. As of Oct. 1, all associates -- owner, administrator, employees -- now must undergo a criminal background check and submit fingerprints.
Licensed homes that have opened since January 1997 have to be equipped with indoor fire sprinklers.
Registered group care sites are never inspected, except on complaint. Licensed homes -- which usually have no more than 10 residents -- get one inspection a year by the Bureau of Licensure and one courtesy visit a year from the Nevada Division for Aging Services. The division acts on behalf of residents but has no enforcement power.
The county has approximately 220 licensed group care homes and 200 registered homes, says Bruce McAnnany of Las Vegas, who travels the state as chief investigator for the Division for Aging Services. "And a hundred we know of, at least, that are unlicensed," he adds, referring to complaints in the last three years that have led to the discovery of illegal operations.
Complaints often involve overcrowding.
Some shifty operators run a shell game, whereby they shunt surplus residents to a newly opened home if they are caught over their limit, according to McAnnany.
Others falsely claim some residents are their relatives, who are excluded from the resident count. McAnnany is familiar with local cases in which the operator claimed kinship to a resident who was of a markedly different ethnic background. But when a senior has lost the ability to speak coherently, it can be impossible to disprove family ties.
To keep staffing costs down, some operators of multiple homes illegally consolidate all their residents at one address. "They run them to one home during the day and take them home at night," Shapiro explains.
McAnnany confirms the shady practice. "They call it having a party" and deny it's a daily routine.
If a licensed home opened before sprinkler systems were mandated, it is permitted to house only one resident who needs a walker or wheelchair. Such residents need more assistance, which affects staffing. As a ruse, devious operators have excess nonmobile residents "resting" in bed whenever an inspector comes by.
The Bureau of Licensure levies sanctions when facilities break its regulations. When a violation occurs, it does not always mean abuse or neglect has occurred. But some senior advocates say the bureau's punishment is often a painless slap on the wrist.
Penalties range from a so-called directed plan of correction -- in which the bureau specifies how a facility must correct its deficiencies -- through extra monitoring, limiting admissions, up to revoking a license.
Monetary fines are also possible, says Lisa Jones, spokeswoman for the bureau's Las Vegas office. Initial fines would be $500 per deficiency; fines for repeat violations can be up to $750 per deficiency.
Since late 1993, the bureau has revoked three group care licenses statewide, denied two license applications and suspended five licenses. Of the five, three businesses subsequently closed voluntarily.
In 1999, Clark County and the Metropolitan Police Department both want the Legislature to eliminate the category of registered group care so that all homes -- even those with fewer than three elderly residents -- receive government oversight.
"In my opinion, the registered home is a category that has come back to haunt us," says Sandie Durgin of the police department's abuse and neglect section. "Right now I can charge whatever I want, treat them however I want. No one is coming in and checking."
For all the horror stories of unscrupulous group care operators, Shapiro is the first to admit that a well-run group care home can also be the perfect solution to a family crisis.
