SALT LAKE CITY — “Unsanitary conditions” at a Utah nursing home, where residents were observed wearing “soiled clothing” and some rooms had mattresses on the floor.
Three men at a day treatment program for people with disabilities dead from carbon monoxide poisoning, after they were left without supervision in a closed garage for multiple hours.
And children in a residential treatment center reporting a “pervasive sense” that they were not safe amid allegations of self harm, fights and sexual assault.
WATCH | Disability watchdog group calls for greater oversight of Utah’s long-term care system
A new report released Monday by Utah's Disability Law Center criticizes the state’s approach to regulating these long-term care facilities, as it says some providers have continued to cause serious harms to vulnerable populations while prioritizing their own profits.
“There’s all this money coming into these entities that are supposed to provide care,” said Nate Crippes, an attorney with the nonprofit watchdog group, in an interview with FOX 13 News. “And ultimately, somebody’s getting a lot of money. But we’re not seeing the level of care that I think people need and deserve.”
The report, titled “Profits Over People: Utah’s Oversight Failures Create a Lifetime of Harm,” highlights allegations of abuse, neglect and maltreatment inside the state's nursing homes, residential teen treatment facilities and programs for people with disabilities.
Common concerns inside them all include a lack of transparency over how large amounts of public funds are spent; failures to prioritize resident care “over the potential for profits”; and a “weak” state oversight system that doesn’t have the necessary resources.
The Disability Law Center said it often sees providers engage in “the same type of harm for years” without “increased fines or repercussions” from the state. That exposes residents “to repeat and escalating incidents that can sometimes lead to a loss of life” and also allows public funds allocated for patient care to be diverted from their intended purpose, the nonprofit contends.
“I think this is a statewide failure,” Crippes said of the report’s findings. “I don't think our policymakers are aware of some of these issues. I don't think often the Legislature or the governor have taken enough of their own power to really try to reform the system."
The report calls on the state to improve transparency around spending, enhance requirements for providers and increase staffing levels for state entities tasked with oversight.
“That's what we'd like the state to do: do everything you can to minimize these kind of harms from happening,” Crippes said.
In an unsigned statement provided to FOX 13 News, the Utah Department of Health and Human Services (DHHS) said it shares the Disability Law Center’s goal of ensuring health and safety, particularly in licensed programs.
“This is at the core of our purpose and the stories outlined in the Disability Law Center’s report weigh heavily on us,” the statement continued. “When safety is compromised and lives are lost, we feel it deeply. We absolutely agree that taxpayer dollars should be used as intended.”
The department noted that it has already identified many of the concerns raised in the report after internal reviews and is working to implement changes.
DHHS hired a contractor last year "to assess and mitigate the risk of abuse, neglect and exploitation for people with disabilities” and has focused on strengthening oversight and identifying areas of weakness. The department has also hired new staff members and a quality assurance administrator to improve oversight.
Moving forward, DHHS said it is looking at ways to keep problematic providers from getting contracts and is also exploring new qualifications for providers that serve people with disabilities.
Nursing home concerns
As Utah nursing homes have received hundreds of millions of dollars in federal funds through the state’s Upper Payment Limit Program in recent years, “we can’t necessarily say where it went to,” Crippes noted.
“And yet we have nursing facilities that are understaffed and people living in conditions that aren’t sufficient for what they should live in,” Crippes said.
A recent state audit found about 51% of the funds facilities have received through the program went to administrative costs, owner compensation and hospital operating expenses rather than direct patient care.
At Paramount Health and Rehabilitation, the nursing home where Disability Law Center investigators observed unclean conditions, the report noted that there have been some recent cosmetic upgrades.
But the nonprofit said it was otherwise not "readily apparent" how the facility has spent the $22.8 million in Upper Payment Limit funds it has received since 2017.
WATCH | Millions meant to improve Utah nursing homes were never spent on care
FOX 13 News called and emailed Paramount requesting comment for this story and also emailed Ensign, the facility's private operator. Neither provided a response.
Amid mounting questions about spending in the program, Beaver Valley Hospital CEO Scott Langford has pushed back on the audit’s finding that more than half of Upper Payment Limit funds go to the hospital rather than to nursing facilities.
“That would be true if you consider no cost of participation in the program,” he told a legislative committee earlier this summer. “But there's a big cost of participation in the program. And our actual percentage is much lower than that.”
He estimated that Beaver Valley Hospital, which owns more than 40 of the state’s nursing homes, will make a net profit of just 4% this year.
But for Rep. Steve Eliason, that figure seemed to raise more questions than answers.
"It's not a complicated financial analogy that if you're all making a 4% profit margin and only about half of it's making it to patient care, then the private operators are probably benefiting significantly with that difference in margin,” he said. “Because the money has to go someplace, right?”
After the hearing, the Interim Health and Human Services Committee opened a bill file to explore ways to address concerns raised in the audit.
“It’s something we’ve got to take a look at,” Rep. Katy Hall, a committee chair, told FOX 13 News in an interview earlier this month. “We can’t ignore it.”
As lawmakers look at policy options moving forward, the Disability Law Center’s report recommends more transparency of Upper Payment Limit spending and requirements that funds are spent on direct care. The report also calls on legislators to adopt state-level staffing requirements for nursing homes.
Hall told FOX 13 News earlier this month that the committee is “looking at all the options.” But she noted that the goal is to ensure proper care for residents in these facilities.
“The money that goes into them should go to patient care above all,” she said.
In its statement, DHHS said the Upper Payment Limit program operates “under strict federal oversight and approval from the Centers for Medicare and Medicaid Services (CMS).”
The department added that it remains “committed to total transparency, ensuring Medicaid funds are managed in full compliance with federal standards and working closely with regulatory partners to maintain the highest quality of care and accountability.”
Teen treatment centers
In addition to concerns within nursing homes, the Disability Law Center’s report also takes aim at the state’s youth treatment centers, which have received increased scrutiny in recent years amid high-profile allegations of abuse, including from celebrity Paris Hilton.
The Disability Law Center said its interviews at Provo Canyon School highlighted “deeply troubling findings,” including that one child who attempted suicide was never taken to the hospital after losing consciousness. Teenagers also reported being “forced to get on their hands and knees and bark like dogs.”
The state recently revoked Provo Canyon School’s licenses at its Provo and Springville campuses.
WATCH | State revokes license for Provo Canyon School
The Disability Law Center applauded that “swift action” but indicated that the state’s approach had fallen short at other times. In one instance in June, state regulators found eight program managers at the Springville campus did not meet the qualifications required for their positions. But the facility was only fined $150, the report said.
The nonprofit also said it was unclear how public funds – including $4 million Montana reporters found their state paid to Provo Canyon School over the last decade — have been spent. Other states with children attending Utah’s teen treatment centers are also sending payments from their state Medicaid programs, the report noted.
“That's a lot of money for conditions not to be adequate, for staffing not to be adequate, for kids not to be in a safe situation,” Crippes said.
Based on its observations, the Disability Law Center flagged concerns that Provo Canyon School “was not making the type of expenditures of public dollars they were receiving that was necessary to provide individualized care for children in need of help.”
Provo Canyon School did not respond to a question from FOX 13 News about its spending but said in an emailed response to the report that it “cannot substantiate or respond to broad claims about patient or staff encounters.”
“We also do not believe that isolated comments or claims presented without full context should be used to characterize the care provided to all patients or the practices of the entire organization,” it added.
Services for people with disabilities
In the final section of its report, the Disability Law Center highlighted concerns within the day treatment center for people with disabilities where three men died earlier this year of carbon monoxide poisoning.
Prior to those fatalities, the report says the health department had been notified of multiple concerns related to the provider, Safe and Sound: “including many altercations during transport, medication errors, physical assaults, and failure to provide medical care after injuries.” Yet the Disability Law Center said none of these incidents resulted in significant repercussions.
The staff member who left the men in the garage had also received a written warning for “client abandonment” just one month prior, the report notes.
After the deaths, the Disability Law Center says state regulators visited six other Safe and Sound sites to assess the safety of those still in the organization's residential services. There was no heat or running water at one and staff at another admitted to locking residents in the basement at night. Only one had no significant problems.
“These complaints all demonstrate the provider was not using the money appropriated by DHHS to provide even basic utilities or a clean environment,” the report contends.
The state shut down Safe and Sound in March. But Crippes believes the harms there, and at other facilities outlined in the report, could ultimately have been prevented.
"Not to say that there's never going to be a harm of anyone in any type of facility,” he said. “But I think if we can reduce that and do everything we can to prevent that, I think we'll have a much better system for people with disabilities in our state.”
This isn't the first time the nonprofit has raised concerns about conditions in long-term care facilities. But Crippes said he’s hopeful this report will wake legislators up to the need for systemic change.
"These are our friends, these are our families, these are our neighbors,” he said. “And we want them to be in safe conditions, receiving the support they need, the care that they need, and not having things like we detail in the report happening. And we hope that if we can make some of these reforms, we'll prevent a lot of this.”