Fines might not deter abuse at La. facilities caring for the disabled, audit finds

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A review of how state officials respond to allegations of abuse at Louisiana facilities that care for the developmentally disabled found that fines assessed for infractions haven’t been effective in preventing abuse.

A Louisiana Legislative Auditor’s report issued Monday noted that maximum fine amounts handed down to intermediate care facilities (ICFs) haven’t been adjusted since 1997. But in response to the audit, a state health department leader disagreed with the auditor’s recommendation that the agency should change its enforcement policy.

What’s an ICF?

An intermediate care facility assists residents around the clock with basic daily activities such as eating, hygiene and medication. It also ensures residents receive services such as speech and physical therapies, and medical care such as doctor visits.

The Louisiana Department of Health also disagreed with a recommendation that ICFs be fined for not reporting incidents in a timely fashion. Doing so would more than double the number of sanctions issued to ICFs, the health department said in its response.

If the health department made that change, “it would require a systemic change across all providers to apply the statute equally, and LDH currently does not have the resources to implement this recommendation,” LDH Deputy Assistant Secretary Tasheka Dukes wrote in her response to the audit report.

The state fined ICFs a total of $450,250 for deficiencies revealed through surveys and investigations from fiscal years 2019 through 2023, according to the audit report. ICFs were cited for 4,948 deficiencies over that period, with 614 (12.4%) related to abuse and neglect.

The audit suggested the health department provide more transparency to the public by posting information on deficiencies, complaints and facility-reported incidents on its website. Dukes neither agreed nor disagreed with the recommendation in her response.

Her agency cannot post the information the audit suggests because Dukes said it often includes “protected health information” that is shielded from public access.

“Posting statements of deficiencies and sanction notices on all ICFs would be resource intensive and unnecessary because anyone can make a public records request for the ICF’s … statements of deficiencies and/or sanction notices,” Dukes wrote.

The health department performs inspections called surveys when an ICF initially opens and then performs recertification surveys at least once every 15 months, according to the audit report. It found the agency improved its timely inspection rate from 96% of 378 facilities in 2020 to 100% of 413 sites in 2023.

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LDH received 718 complaints against ICFs during fiscal years 2019-23. Immediate jeopardy status was assigned to 193 of those complaints, and the audit noted health department officials initiated an onsite investigation within two business days as required. However, LDH could not easily identify which complaints were related to abuse and neglect.

The audit attributed the problem to a new system of categorizing complaints that changed the way abuse and neglect allegations were reported. The health department agreed with this finding and intends to go back to the old way of identifying such instances.

Another finding of the audit was that ICFs reported more than 4,000 incidents of substantiated or alleged abuse from 2019 through 2023. But out of nearly 4,700 facility-reported incidents, more than 1,100 (23.5%) were not reported within 24 hours of discovery as state regulations require.

LDH did agree with the auditor’s recommendation to monitor ICF compliance on reporting incidents within 24 hours of discovery.

Also, the audit discovered that, as of May of this year, 25 of Louisiana’s 64 parish sheriffs did not have access to the Statewide Incident Management System (SIMS) to respond to allegations of abuse and neglect within their jurisdictions. According to the audit report, the state health department said it’s up to sheriffs’ departments to keep their SIMS access up to date.

The audit was performed at the direction of the Legislature  in response to calls from concerned parents and “the vulnerable nature of the population served,” the report said. It cited a 2015 report from the National Center on Criminal Justice and Disability that found people with disabilities are four to 10 times more likely to be victimized than people without, and people with cognitive disabilities face the highest risk of becoming victims.

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