Arizona's nursing home board is about to close. There's no clear plan for its replacement
The board that licenses and investigates nursing home administrators might have met for the last time Monday, but it would have been hard for anyone in attendance to know that for sure.
One member referenced the board's closure, and the board's president mentioned staff had to finish work by June 30, but the rest carried on as if Gov. Doug Ducey hadn't recently revoked their power.
Ducey shuttered the Arizona Board of Examiners of Nursing Care Institution Administrators and Assisted Living Facility Managers after The Arizona Republic reported that members let a man with a troubling felony record run a nursing home. Then, during the COVID-19 pandemic, that man — Larry Michael Rasmussen — forced sick employees to work and at least 15 residents died.
Board members only launched an investigation into the matter after a Republic reporter pestered the executive director at the time.
The board's authority is set to expire at the end of this month.
But no one at the meeting Monday discussed how the board, which has existed for about 30 years, will transfer its responsibilities to the Arizona Department of Health Services.
This may be because they have no clue. Member Susan Archer said the Governor's Office has given no direction to her. The only communication she's received was a call more than a month ago thanking her for her service and notifying her that her last day would be June 30.
That also happens to be the deadline for statewide assisted living manager certificate renewals, and it's unclear if staff will stay through the end of the month to finish this massive task because they may have to start job searching, Archer said.
The Governor's Office told The Republic the details of the transition are still being worked out.
The assistant attorney general who attends the meetings said he didn't know if the board would meet again. And the board's executive director refused to even confirm that Monday's meeting was their last.
The board's investigator said he didn't know what would come of the dozens of unresolved investigations. He told the Republic he figured he'd just keep working on them.
The tone of the room was somber throughout the meeting. During roll call for attendance, the executive director was sternly corrected when she referred to Vice President Charles Seal-Villafranca as "Mr. Villafranca."
After a studied pause, he said he was present, but told her to call him "Doctor."
When Archer later proposed that the members defer the investigations on their agenda because the board was shutting down, the rest of the board responded with silent stares. The motion failed for a lack of a second.
They went ahead and reviewed six investigations on problems spanning from paperwork issues to a resident suicide. It's unclear who will follow up to ensure the managers complete training the board ordered.
At the end of the meeting, board president Pauline "Wally" Campbell thanked the board's four full-time employees and her peers on the board, who receive a small stipend.
She said members had opened an average of 136 complaints each year since 2014.
“This board is the only avenue the public has to file a complaint against an administrator or manager and to know that that manager will be investigated," she said.
After she adjourned the meeting, members milled around talking to each other quietly. Staff collected their nameplates off the tables where they had been sitting – probably for the last time.
'Of good character' – difficult to define
In the past, state Department of Health Services has inspected facilities and sent citations to the board, which then considered whether to penalize the leadership.
Archer, who manages two assisted living homes, likened this setup to the criminal justice system. The state is like the police. The board is like a jury of peers to the managers facing violations, she said.
Most board members work in the industry.
Handing the whole process to the state will be like having the police decide if someone they arrested is guilty, she said.
"So I could get pulled over by a police officer, I'll get hauled into the precinct. The jury are the brothers and sisters who are other police officers and the final decision is by the chief," she said. "Where did anybody hear from me as a civilian to explain anything, or to take a second look at perception, at the reality, at a misconception of whoever it was that wrote the citation in the first place."
As a facility manager herself, Archer said the state inspectors can be heavy-handed, exaggerate in their reports and even fine the facility for things that are not technically violations.
She questioned the accuracy of the inspector's notes about Larry Rasmussen, the administrator whose appointment ultimately got the board disbanded.
According to the state, Rasmussen forced employees at a Prescott nursing home to work when they had Covid-19. The inspector's notes say Rasmussen hesitated to hire additional staff, which could have helped relieve the sick employees, because hazard pay was $5 to $10 more per person.
About 50 residents got sick and at least 15 died in the aftermath.
"Did he make calls? Probably. Did he refuse to take extra staffing because of $5 to $10? I highly doubt it," she said. "Do the surveyors extend their reality and implications onto us? Yes. I could give you example after example of how surveyors treat us."
She also argued that Rasmussen's background, which involved defrauding people out of tens of thousands of dollars, had nothing to do with his performance running a nursing home.
If the state didn't want the board giving licenses to candidates with felonies, the Arizona Legislature should make it law, she said.
The board considers a number of legal requirements when deciding whether to approve someone's license, but they also must consider whether someone is "of good character," according to its website.
Archer said "of good character" is difficult to define, and it is incumbent on the board to consider mitigating factors when judging candidates.
"We take it upon recommendations for that individual. We take it upon what they present themselves at this moment in time, versus something that happened to them ... 20 years ago. We're looking at them here and now. That doesn't mean we exclude the information from the past, we just try to discern," Archer said. "Of good character? I don't know how to draw that line."
Rasmussen presented himself to the board as a man, caught up in an exciting investment plan, who collected money from people and sent it to an overseas business partner who scammed him and disappeared. He told the board that he worked hard to pay them back.
In reality, Rasmussen never gave police the information to track the man down. He was also court-ordered to pay restitution.
'Had the right people been in charge'
At least nine families are suing Rasmussen, his former nursing home Granite Creek Health and Rehabilitation Center and the company that owns it, The Ensign Group. Most are for wrongful death.
Families interviewed by The Republic feel the board is also responsible.
Courtney Frasier, whose 61-year-old mother Stacey caught Covid-19 at Granite Creek and died, said she's had to answer more strenuous questions during job interviews for retail than the ones Rasmussen had to answer during his board appearance.
The board talked to Rasmussen for about six minutes, most of which involved softball questions and friendly banter.
"It could have gone so many different ways had the right people been in charge," Courtney said.
Her mom lived at Granite Creek because an automobile accident left her unable to care for herself. Courtney described her mom as her hero, her determination to become self-sufficient and inspiring.
After her mother’s death, Courtney had “Stacey” tattooed on her index finger to remind her to be strong each time she looks at her left hand.
Though her mom lived at Granite Creek, Courtney talked to her every day and grocery shopped for her often. Salt and pepper, two 30-liters of Smartwater, Burt's Bees pomegranate lip balm, Werther's Originals.
Courtney found comfort in collecting the things on her mother's grocery list and delivering them. The chore especially brought a sense of normalcy as the pandemic came crashing down between them in the spring of 2020.
But she quickly learned she couldn't even count on that. Her mother would call and ask if she'd gone to the store yet – hours after Courtney had dropped off the goods to the front desk.
Staff would just leave them there.
Nothing felt real. Courtney couldn't pinpoint the exact last day she saw her mother. She remembers the conversation, though.
She asked her mom if she was worried about catching COVID-19. Her mom told her it was scary but brushed it off.
"She thought she was in there to be safe," Courtney said. "You would think if you're bounding someone to their bedroom for weeks on end, going into months, you would think it would be for your own good."
Courtney thought she was safe, too. But in June the robocalls started coming in, informing her family of an increasing number of sick residents every single day.
She'd walked the halls at Granite Creek. She couldn't imagine how the facility could possibly separate sick residents from ones who were not.
They couldn't. Soon after the calls started, her mom became one of the numbers. Stacey was transferred to the hospital, where she died.
Courtney said goodbye over the phone. Stacey was unresponsive.
Shortly thereafter, Stacey saw a Facebook post about the state investigating Granite Creek for making sick employees work.
Salt in the wound.
"You put your trust into people that it's their job, and their moral compass to do the right thing, especially in a place where people are so vulnerable," she said. “She was quarantined in a tiny room for God’s sakes. It was literally for nothing and she died alone.”
Reach Caitlin McGlade at email@example.com or 602-444-0582. Follow her on Twitter @caitmcglade.