Dept. of Health pushes back against bedbug reporting at Long Term Care Coordinating Council meeting

"It is correct that they do have them ...they have had them for the approximately five years that I've been here," said Autumn Bishop from DOH. "We looked at this [issue] ... 29 times."

In the last five years, Summer Villa Assisted Living has been the subject of 29 Rhode Island Department of Health reports that noted the presence of bedbugs. “It is correct that they do have them,” said Autumn Bishop from the Center of Health Facility Regulations, which falls under the Rhode Island Department of Health (DOH). “They have had them for the approximately five years that I've worked here. They've always had them.”

Nevertheless, both Bishop and her boss, Diane Pelletier, who heads up the Center of Health Facility Regulations, took issue with the story I wrote, calling it “inaccurate.”

“That's inaccurate. That's not accurate. There are not hundreds of bugs,” said Bishop in answer to a question from Kathleen Gerard, an organizer with Advocates for Better Care in Rhode Island. “That's not a finding… I'm not sure where these [photographs] came from or where the information in the article came from but I can tell you, again, they're treated daily and they have regular pest control.”

In truth, Autumn Bishop knows exactly where the information comes from. “Most of the answers that Joseph Wendelkin supplied [the reporter] came from me,” admitted Bishop later in the meeting. Wendelkin is the DOH spokesperson quoted extensively in my piece.

The DOH’s main objection to my piece seems to be my use of the word “infested” and the pictures residents sent me about the bedbugs. DOH officials openly doubted the veracity of the photos. That said, I verified the pictures with multiple sources who chose to remain anonymous due to fears of retaliation.

The DOH officials at the meeting were confident that despite the ongoing and documented prevalence of bedbugs at the facility, the owners of Summer Villa Assisted Living were doing everything they could.

That being the case, residents should get used to the bedbugs.

The discussion referred to above and presented in full below took place at the April 17 meeting of the Long Term Care Coordinating Council (LTCCC) an unwieldy 33-member council chaired by Lieutenant Governor Sabina Matos. The LTCCC “develops and coordinates state policy concerning all forms of long-term health care for the elderly and adults with chronic disabilities and illnesses. Members include representatives from healthcare organizations from across the state.” [Reporter Nancy Lavin has a story here about the controversial effort to streamline the meeting process for the LTCCC.]

Here’s the video. The audio was often garbled so I’ve done my best with the transcription, which is edited for clarity. In certain parts of the transcript, I made my best guess as to whether Diane Pelletier or Autumn Bishop were speaking.

Diane Pelletier: ... and then there was a concern about an article regarding bed bugs in an assisted living facility. My Deputy for the Center of Health Facility Regulations Autumn Bishop is here today. She is the program manager for assisted living and knows this story inside out so I will defer to her.

Autumn Bishop: It has been in the media a couple of times recently regarding a bedbug situation in a facility in Coventry. It is correct that they do have them, however, they have had them for the approximately five years that I've worked here. They've always had them. At times the situation is much improved over other times. The reality of the situation is that the facility is following every single pest control recommendation that is given to them. They're doing everything that can, everything that they've been asked to do they have done, aside from the one request that they limit the activity of the residents to remove that situation, which is the one thing they cannot do regarding the residents' rights to come and go as they please and unfortunately, that's contributing significantly the issue at this facility and has been over time that contributing to the issue. It's the one recommendation they are unable to follow, but they have followed every other recommendation.

As a regulatory agency, the only thing that we can expect of them is that they follow guidance given to them by professionals. I'm not a pest control expert so therefore I have nothing to add. As long as they are looking at and doing all the interventions that are requested of them they remain in compliance. I'm more than happy to answer questions, but that's where that facility is at this point.

Does anyone in the room have questions for me regarding this facility?

Kathleen Gerard [Advocates for Better Care]: I know it's a tough problem to solve, but I also know that the residents have the right to live in a safe and clean environment. Has there been any discussion of moving the residents into respite care for a temporary period while the place is completely cleaned, all textiles removed and then some sort of prevention plan is implemented before they're moved back?

Autumn Bishop: Unfortunately for these residents, there isn't anywhere to move them to or I'm sure there would be a plan to do that. This particular facility is always at capacity. There's never an open bed. The residents that are living in this facility - we already have wait lists of residents for placement because, unfortunately, there's a lack of facilities that take Medicaid and the majority of these residents are either on Medicaid or Social Security-based payment [plans].

We already are struggling to find placement for people with that type of insurance in assisted living. The facility has tried. When they have vacancies they've tried closing off rooms, they've tried everything. As far as moving 62-plus people out of the building temporarily and still having the ability to manage that, I don't know that that's been considered mostly because where would they place them?

Diane Pelletier: There's also the issue that these people are younger, they're transient, they come in and out constantly. They go visit their families. There's one resident that is the major issue here. Their family's home is filled with bedbugs. And the issue - I'm not identifying them - is constantly bringing them back in. It's a constant battle. When we say infested - this article was [in]accurate, but we're talking sometimes about one or two [bedbugs] in an area. There's not a huge infestation in this building. It's usually these one or two rooms where again the resident goes out and yada-yada, the family brings in used clothing are there are bedbugs in them. It's really difficult to control. They are doing the best they can. Yes, you're right, they have the right to live in a clean environment but when they go into an environment that's not clean and bring them back it's a challenge.

Lieutenant Governor Sabina Matos: That's the question I was going to ask - if it was throughout the whole facility or limited...

Autumn Bishop: No, it's isolated rooms with specific [garbled] they are treated... so they actually [garbled]. As I said, it's a very aggressive pest control in comparison to what most facilities are giving. But the issue, as they pointed out, is that these residents go out for several days at a time, sometimes bring back furniture from outside, they bring back clothing, and they sleep on somebody's couch. We looked at this [issue] - I counted yesterday - 29 times. It's not like they're not being supervised. We are there all the time looking at this situation. And certainly, if we were ever to find that they were not following the guidance of the professionals and the pest control companies, we would certainly cite them for it. It's just that short of abandoning the building, I don't know what else they could do at this point. They're doing everything else and so I don't know - I'm not a pest control professional so I can't say they're not doing enough [garbled]

Kathleen Gerard: What can we or anyone else do to support you in helping those residents? Are there any regulatory tools that you don't have that you wish you did have that would help with this? My understanding of bed bugs is that they can't be isolated within a facility. I read the same article and saw the photos and videos of just hundreds of bugs.

Autumn Bishop: That's inaccurate. That's not accurate. There are not really truly hundreds of bugs. That's not the finding. I will tell you that the photographs are not actually even by people that are a concern to us [?][garbled] I'm not sure where these [photographs] came from or where the information in the article came from but I can tell you, again, they're treated daily and they have regular pest control. There are no findings - which we've reviewed - we review all of their reports, we review all of those things. Those are not the findings of the pest control company. So I don't know where that information… I'll just say that.

Most of the answers that Joseph Wendelkin supplied [the reporter] came from me. That's where that information came from. But as to where the reporter got his information, my surveyor was just there on Thursday and Friday of last week and this is the same time as this article and that is not the case.

Sabina Matos: Can we follow up down the line? We are interested in following up on this issue. Any burning questions?

[The conversation moved on from Summer Villa Assisted Living until a question from an online participant brought it back.]

Deborah Burton [RI Elder Info]: I too have seen the article videos and pictures regarding Summer Villa and I understand the challenges in housing in general related to bedbugs, et cetera. Summer Villa is one of the very few facilities that accept Medicaid as a payer. I know that when an individual is in a hospital and has a hospital-acquired infection, the hospital is responsible for the costs. Is the same true in a situation like this? If the residents came in without a history of scabies or any skin issues related to bedbugs, and they entered the facility and then had an issue and needed to be treated, is that cost the responsibility of the facility or is that something that Medicaid pays for?

Diane Pelletier: It's the responsibility of the facility so they're responsible for all of the care for any resident that comes into that facility. We did cite them for the scabies issue recently. And again for the bedbugs. I saw those photos. I'm no physician but we'll leave it at that. But they are responsible for the care and the services of that resident. As soon as they enter that facility, they own them. I mean they own them - it's their home. You're required to provide all the care and services.

Deborah Burton: If I'm understanding that correctly then if individuals did need to get additional treatment out at their phycician’s office - being that it's an assisted living facility and not something like a nursing home where a doctor is overseeing the facility - if individuals needed to go to their physician to receive care, then the physician would bill Summer Villa - or is that not correct? How does that work?

Autumn Bishop: They would follow the normal process of any other healthcare situation where the physician would bill the insurance. Anything that's not covered would be absolutely Summer Villa's responsibility.

Deborah Burton: Medicaid would cover for Summer Villa to provide the assisted living level of care but if someone became unwell because of being in that facility, then Medicaid would provide payment to the providers related to becoming unwell in the facility that Medicaid is paying for care for.

Sabina Matos: I want to take this conversation offline because I want to go into the details. I would love for you and Kathleen, to join us in having a conversation offline on a Zoom meeting.

Deborah Burton: That would be great.

Diane Pelletier: We can go into those details and then we can report back at the next meeting what was the result of that conversation. Let's take this conversation offline so we can go into details because I'm running out of time with this agenda.

Deborah Burton: Thank you very much, Lieutenant Governor.

Dr. Louis Cerbo [Deputy Director at RI Department of Behavioral Healthcare, Developmental Disabilities & Hospitals (BHDDH)]i: I have a quick point. You may want to consider a mitigation plan. I know you have an external exterminator coming in and they've done everything they can, but you may want to consider looking at - since it seems to be a small group of patients - [the way you've underscored it and the way you said with the room and so on.] Am I right what I heard? You might want to look at maybe when they come back, maybe they should take their clothes off and change.

Autumn Bishop: They do that already.

Dr. Louis Cerbo: That's something that you didn't highlight - a mitigation plan on how to deal with this and what the agency's doing might answer a lot of questions. We have the same thing at the state hospitals. We have people go on passes and come back. Having a mitigation plan to make sure - and it's documented as such. Is that what they're doing?

Autumn Bishop: Yeah, they're already doing that and unfortunately, it continues to be an issue. They are doing that already, but it isn't probably as documented well so that's not a bad suggestion to have the documentation. That would be very helpful.

Dr. Louis Cerbo: If you don't document it it never happens.

Sabina Matos: We've got to continue moving on with the agenda.