Exceptions by state regulators raise questions about oversight.
After she was caught, Lisa M. Blair told police that her criminal behavior at a South St. Paul assisted-living facility "just got out of hand."
For months, the Cerenity Residence worker stole thousands of dollars from elderly residents who relied on her for day-to-day help, including paying their bills. At least two residents were bilked for nearly $63,000 in a scheme that ended when an 88-year-old raised suspicions in December about Blair, police records show.
State health investigators found no fault with Cerenity Residence for the breakdown, which lasted for more than 18 months. Blair pleaded guilty this month to four felony counts of financial exploitation of a vulnerable adult. "I maybe took advantage," she told police. "I knew it was the wrong thing to do."
The case is part of a broad problem of elder abuse in Minnesota that raises questions about the state's oversight of a rapidly growing industry.
In at least a handful of cases, state records show, breakdowns left vulnerable adults exposed to abuse. Either facilities missed warning signs or applicants with known criminal histories were approved to work because regulators granted exceptions to rules aimed at protecting vulnerable people.
Since 2005, state investigators have reviewed 171 cases of alleged financial abuse or exploitation in nursing homes, assisted-living facilities and in-home care settings. In 77 percent of those cases, investigators substantiated those charges, almost all of which involved staff members stealing from residents, according to a Star Tribune review of state investigative files.
Officials with the Minnesota Health Department declined to be interviewed for this story. The agency does not track the number of people who have been allowed to work in health care settings despite their criminal records, but in an e-mail officials estimated that the agency grants "very few" such variances each year.
Employing care workers with criminal histories or other problems is an outgrowth of a national shortage of people available to work in a field with low wages and demanding conditions, according to Deb Holtz, Minnesota's ombudsman for long-term care.
Holtz said the presence of background checks may give some clients a false sense of security, not knowing some offenses may be forgiven.
"The general public isn't aware of everything that goes into a background check," Holtz said. "The information should be public, and it should be easily accessible on all the state agency websites. There should be information given to consumers when they are considering employing people."
Nationally, seniors lost at least $2.9 billion in 2010 through financial abuse, with about one in six cases involving nursing homes, assisted living facilities or paid caregivers, according to a recent study by a research group affiliated with insurance giant MetLife.
"This has been happening a lot, and we probably haven't gotten a handle on it," said Sandra Timmermann, executive director of MetLife Mature Market Institute. "How do you get your arms around this hidden problem that is becoming more and more prevalent?"
Thief gets second chance
State law is designed to prevent people who commit significant crimes from working in nursing homes or other care settings. Health care workers undergo criminal background checks, but their new employers can ask the Health Department to overlook previous wrongdoing and allow them to work. There's nothing in the law that requires regulators or caregivers to disclose such variances, leaving seniors or their loved ones largely in the dark about who may be caring for them. The state Department of Human Services can also grant exceptions to individual workers.
Kilolo Claiborne had a well-worn criminal past when she went to work as a home health aide in Ramsey County. Claiborne was a suspect in separate incidents of theft, credit card fraud and providing false information to police, according to law enforcement records. In 2003, she was convicted of felony theft.
That didn't stop the state Health Department from granting a waiver in 2008 that allowed Claiborne to work with vulnerable adults. Less than a year later, she stole $1,575 from a terminal cancer patient who lived in a group home where she worked. She was convicted of felony theft in 2009.
"There is nothing in the law which prohibits granting a variance to a convicted felon," Health Department spokesman John Stieger said in a written response to questions about the case.
In Claiborne's case, the waiver came with conditions the facility was supposed to follow, such as not allowing Claiborne to work without a supervisor present or have access to client funds. However, the Health Department's investigation showed Claiborne was left alone for a period of time on the morning the theft occurred. State records do not show that the facility was disciplined.
In the case of Michelle Ann Jensen, the state flagged her criminal history in June 2009, shortly after she went to work at Whispering Pines Ranch in Austin. A previous felony conviction for prescription fraud disqualified her from direct contact with residents. She requested reconsideration and was supposed to be under continuous supervision until her appeal was resolved.
In August 2009, Jensen stole about $900 intended for the facility's locked cash box, which included residents' cash and rent payments, according to state records. In April 2010, she was convicted of misdemeanor theft.
Jensen blamed her problems on an addiction to prescription drugs. She said she wishes she'd never gotten the job at Whispering Pines.
"I take fault for my actions," said Jensen, adding that she regrets what she did and has been drug-free for nearly two years. "But they could have all prevented it if they would have followed state guidelines and not let me work alone."
A Health Department investigation did not cite the facility for failing to provide continuous supervision of Jensen. Regulators noted that Whispering Pines addressed the problem by requiring two workers to count cash at the beginning of each shift and log disbursements. The facility management did not return phone calls seeking comment.
Signs of past problems
Betty Frye was victimized twice.
In 2007, her bank discovered her checking account was overdrawn. In a period of two weeks, about $3,100 in fraudulent checks were written against her family's accounts. Investigators traced the fraud to a personal care assistant who came to Frye's south Minneapolis home to help the 88-year-old with her personal needs. The aide, who was not identified in police records, passed the checks to acquaintances who cashed them.
A nurse who worked with the woman had expressed concerns about the worker, according to Dennis Frye, Betty's son. "She was quite adamant about not wanting her to come here," Frye said. "Obviously there was something in her background."
The family also had problems with a previous aide who ran up long-distance charges by calling a dating service in California. "It's a betrayal," said Dennis Frye, whose mother has since died. "They are supposed to take care of you. When you have nurses, bath aides, other people coming and going in your home, you have to be careful."
Blair also figured in two different cases, according to police records. Blair was investigated in 2007 over a case involving her grandfather, who was a resident at Cerenity's facility in White Bear Lake. Blair told police she reimbursed her grandfather for his losses and no criminal charges were filed for the incident, police records show.
Cerenity officials said they had no reason to suspect Blair, the tenant services coordinator, was stealing from residents last year, according to Chuck Heidbrink, president of Cerenity Senior Care, which has five locations in Minnesota.
"The tenants loved her," Heidbrink said. "She was a tremendous employee. It was a shock to us and the tenants."
As a result of the Blair case, Cerenity began requiring the presence of two employees on any matters where clients need financial assistance.
Blair, who will be sentenced Sept. 12, did not return phone messages seeking comment.
State Health Department investigators failed to uncover the full scope of Blair's wrongdoing. The agency's report identified only one victim, but police investigators noted that Blair stole from two seniors at the South St. Paul facility. The first victim lost nearly $47,000, while a second victim lost about $16,000, police records show.
In each of the past four years, federal officials have faulted the Minnesota Health Department for failing to properly investigate complaints of abuse and neglect.
Health officials defend their investigation of Blair, saying its work was "adequate to substantiate financial exploitation" under Minnesota's Vulnerable Adults Act. "The finding would remain the same no matter how many victims there were," Health Department spokesman Stieger said. The department interviewed about a dozen staff members and residents. Said Stieger: "We do consider this a thorough investigation."
Brad Schrade • 612-673-4777