Desperate, he discovered the phone number of a former Chisago County social worker who used to visit him, at a time when some counties still provided personal care services.
The social worker, Patty Mattson, said she was shocked to learn that Nelson was essentially abandoned.
“He could have easily fainted or fallen and no one would have known for days,” Mattson said.
Alarms go unheard
Across much of the state, former Crystal Care clients tell similar stories of abandonment. Many asked why the state Department of Human Services, which was Crystal Care’s largest single payer, did not act sooner to protect patients.
DHS officials began to monitor Crystal Care in May of last year, after receiving a report of bounced payroll checks. However, they acknowledged, four months passed before the agency made an on-site visit to the company’s Richfield headquarters to examine its records. As part of that review, DHS discovered that Crystal Care had violated Minnesota law by overbilling the state nearly $30,000 for services that were never rendered or lacked documentation, among other violations.
Early last September, representatives from three state agencies met with Crystal Care’s owners in Richfield, where they were told the company planned to close, state officials said. In response, DHS prepared letters to Crystal Care clients with information on how to find new home care providers.
But two weeks later, Crystal Care reversed course and filed for Chapter 11 bankruptcy protection instead, enabling it to stay in business. The letters from DHS were never sent, state officials said. As a result, many Crystal Care patients had no idea the company was in distress and their care might be in jeopardy.
“The fact that [Crystal Care’s closing] dragged out for a period of time longer may have created more of a risk for clients,” said Deputy Human Services Commissioner Charles Johnson.
DHS officials said the agency did not receive any specific reports of Crystal Care patients going without care. And even if the agency had received such reports, it would not have had the authority to investigate them. Under Minnesota law, the state’s 87 counties have primary responsibility to investigate maltreatment of vulnerable adults by unlicensed persona care assistance providers. But counties investigate only complaints involving specific individuals — not companies.
“No one is actually regulating the most important player of all — the [home care] providers,” said Anne Henry, an attorney with the Minnesota Disability Law Center, a legal advocacy group.
Employees, however, did raise alarms. Last November, a Crystal Care personal care assistant, Kimberly Beguhl, wrote to the state’s ombudsman for patient care at DHS. She asked officials to meet with workers and warned of “vulnerable adults that were left without care.” The state ombudsman, Margaret Manderfeld, turned down the request, saying a group meeting might violate patient confidentiality, according to documents filed with bankruptcy court in Minneapolis.
In a report to the bankruptcy court, Manderfeld recommended against any in-person interviews with patients, asserting that “some patients would be upset by a stranger coming into his/her home for an interview.”
In a written statement to the Star Tribune, Manderfeld said her role in the case was narrow in scope. Last October, she was appointed by the bankruptcy court to monitor the quality of patient care during Crystal Care’s bankruptcy. In that role, she wrote to Crystal Care patients three times. Three patients responded, she said, but none reported concerns about their care. Manderfeld said she also wrote to Crystal Care employees but did not receive a response.
“If any patient, guardian or employee had reported any concern about patients’ care or interruption of services, I would have initiated an interview with that patient,” Manderfeld wrote.
In July 2013, the Minnesota Department of Health conducted its own review of Crystal Care, interviewing only seven patients and one family before concluding that patients were receiving adequate services, according to a state investigative report.
William Dombi, a vice president at the National Association for Home Care and Hospice, the nation’s largest trade group for home health care providers, said a case like Crystal Care reveals the need for tighter regulation to prevent more patients from being abandoned. At minimum, he argued, home health care companies should be required to make every effort to secure substitute providers and notify them in advance before closing their doors.
“This shouldn’t happen even once,” Dombi said. “There is definitely a regulatory gap here where consumers … may find themselves at risk of losing care.”