February 7 2006 - New scrutiny being focused on adult-family-home deaths

In Seattle, a police detective has started investigating most deaths in the city's adult family homes in collaboration with the county medical examiner and prosecuting attorney for possible cases of abuse or neglect.  Because of limited resources, the effort is focusing only on adult-family homes, which can care for as many as six people, in Seattle. Compared with nursing homes, these smaller facilities have fewer employees and typically are more isolated from public scrutiny.

The effort is part of an evolving mission to combat crime against elderly and vulnerable people and to help assure they receive proper care. The project also gives experts more experience in determining what is a natural death in an aging adult and what isn't.

"The aging population is increasing," said Dr. Richard Harruff, King County's chief medical examiner. "The economic burden is increasing. The questions about adequacy of care are increasing."

After Detective Suzanne Moore gets a call from the Medical Examiner's Office that a death has occurred, she goes to the adult-family home, observes the cleanliness of the surroundings and condition of the body: skin, hair, teeth and nails.  She also takes a look at the care plan that documents treatment of conditions such as bed sores.  She can call in a medical examiner if she has any doubts or questions.  The medical examiner in turn decides whether or not to take jurisdiction over the body.

So far, no cases have been referred to the prosecutor, though a handful of cases remain unresolved.

"It's the type of death we probably haven't looked at as closely over the years," said Capt. Tag Gleason, supervisor of the police department's violent-crimes section.

"As we start to look at these situations, we find people whose neglect has been criminal. We find people triple-wrapped in diapers, people with impacted bowels, food impacted in their teeth, abscesses that go to the bone."

Moore also responds to reports about crimes in nursing homes and assisted-living facilities. For the first time, police are using search warrants in some cases to obtain documents from facilities to review the history of a resident's care.

"It's exhausting. It's beyond anything I've ever had," said Moore, a 22-year veteran of the police force.

While Moore's job is to help detect suspicious cases, proving a death was caused by abuse or neglect is extremely difficult.

The medical examiner can determine cause of death. But questions also need to be asked about the context of that death. For example, did workers make appropriate decisions about the resident's care? Families also have a responsibility for their loved one's quality of life in a facility. They have the right to ask questions and should not simply assume all is OK, experts said.

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