With no notice, he was told his mother could not return to her long term care facility

“EOHHS, DOH, and the AG all failed my mother and, in effect, all seniors in long-term care facilities of any kind. With no consequence, any facility can essentially ignore the law with impunity.”

John Albanese: My mom has been a resident in memory care assisted living at Halcyon at West Bay in Warwick for two years, and she has done reasonably well there. Memory care units provide extra assistance to residents, more than standard assisted living. My mother has dementia, like everyone else there, and also aphasia, so communication is difficult, but she converses in her way. She’ll tell stories and words you can’t understand. She has been a bit clumsy, especially in recent months, and has had some falls. Most of the time, that hasn’t required her to go to the hospital.

On April 26, she fell and broke her nose. She had to go to the hospital, but she healed well. They didn’t have to do any intervention surgery or anything, nor did I want them to at her age and condition. When she was ready for discharge around May 1, case management informed me that Halcyon wouldn’t take her back. I was gobsmacked. I had no indication from them that this was coming up. I had no idea that Halcyon thought she needed higher-level care or anything. It’s always been the opposite, in fact, from all the staff there.

They’re required under Rhode Island law to give a 30-day notice, and you have the right to appeal, even if the patient is in the hospital. The hospital is not a means of avoiding the required 30-day notice. I got nothing in writing, no eviction notice, no nothing. They just kept telling the hospital they were not taking her back.

So I pushed back. I worked with the Ombudsman’s office - I’ve done other work with them before - they’re very good. They tried reaching out to Halcyon and didn’t get any response. Then Halcyon started ghosting our calls. They would not put anything in writing as to why they didn’t want her back or any reason why she needed more skilled care, or what that care would even be.

It’s been going around and around. We ended up involving other people. I called Vivian Spencer at Senator Whitehouse’s office, and she was supportive, but they have limited options available. She sent something off to the Centers for Medicare and Medicaid Services (CMS), as did the Ombudsman. We filed a complaint with the Rhode Island Department of Health (DOH), which is responsible for holding facilities accountable to these regulations. DOH didn’t do much at all. They said the facility feels that they don’t have to take her back, and they don’t believe she’s receiving the right level of care.

That may be true, but they didn’t put it in writing or provide a 30-day notice. DOH wouldn’t share the notes they received from Halcyon. What I did get my hands on doesn’t indicate that she needed extra care. The notes they shared were on her recent falls, all of which show that she didn’t have to go to the hospital. I also got Steven Bagian, the director of Rhode Island Legal Services, involved.

Meanwhile, my mom was ready to be medically discharged from the hospital on May 1. Four doctors said she’s ready for discharge, that she does not need skilled nursing, and that she didn’t even need to go to rehab. She needed to go home with intermittent physical therapy (PT), yet Halcyon is saying they’re not going to take her back.

I’m also disappointed with case management. They told me they can’t do anything, and they’ve been pressuring me to put my mother in a nursing home. They say the issue is between me and Halcyon. They were also saying that Medicare will not continue to cover her. She’s been in the hospital 12 or 13 days longer than she should have been. I agreed there’s no medical reason for her to remain in the hospital. I want her out too, but Halcyon has been obstructing her return, and since they’re not providing notes or a 30-day notice, they’re not giving me enough time to find a new place.

She’s still in the hospital, lingering like this, and it’s disrupted her entire routine. Today she’s having a great day. She finally slept through the night, but her sleep has been topsy-turvy - awake all night and sleepy in the daytime, with rare exceptions. Today’s an exception. She’s alert and eating lunch now, but it’s not a good situation. She’s socially isolated. In memory care, she was sitting around a dining room table with other residents, socializing. Here, she’s in a hospital room, and it’s doing physical and emotional harm to her and me. I put off starting a new job to be here. I live in New York and visit my mom regularly, but not for 17 days straight. I’ve been spending a fortune on a hotel to make sure I’m here.

I made a call to another residence yesterday, and they said, looking at the notes, that the hospital says she needs skilled nursing, so they can’t take her. I said that’s odd, because that’s not what the doctors told me. It appears that case managers are overriding the doctors, and they’re not helpful about placing my mother appropriately.

I’m not keen on my mother being long-term at Halcyon anymore because it now seems a hostile environment, but she does have resident rights that seem to be blatantly violated. DOH is completely ineffective and is not advocating for her. I called the Healthcare Rights Division at the Rhode Island Attorney General’s office, and they said that there wasn’t much they could do, which doesn’t make any sense to me. There is a law on the books, and the Attorney General and DOH are not enforcing it. If this is allowed to stand, not only my mom, but anyone like her can be evicted without 30 days’ notice. They can say they don’t want her back, and that’s it. It seems that no one is going to hold them accountable. In effect, that law is meaningless.

Steve Ahlquist: Many people don’t have somebody like you to advocate for them, and could find themselves in a terrible position.

John Albanese: I’m a fighter in this. My mom instilled a healthy sense of justice in me, and I’m savvy about these things. I know her rights. But you’re right, the vast majority of people don’t know this. This is what they call hospital dumping.

Patients are sent to the hospital by the facility, and they wash their hands of them. Then, the patients go to places that are not suitable for their needs. There’s this cottage industry between memory care facilities, hospitals, and nursing homes with the one-way exits, which is not ideal for seniors, let alone for my mom.

Steve Ahlquist: Have you considered a personal injury lawyer? They seem to be putting your mom’s health at risk and costing you money. If they violated the law, you could sue them. Even if the Attorney General declines to enforce the law, it’s still the law.

John Albanese: I was told Attorney General Neronha was passionate about these issues, but he’s not holding Halcyon accountable. I mean, this isn’t about compelling Halcyon to accept my mother, no questions asked; this is about enforcing the process, that’s all.

Steve Ahlquist: If the process had been followed, you would have had the time to make this change in a better way for your mother and you. It could have been so much easier.

John Albanese: Earlier this week, I thought we had something in place. It seemed that there was a verbal agreement that Halcyon would take my mom back and issue a proper 30-day notice. I would compromise by waiving my right to appeal, and they would give me a little bit more time, beyond 30 days. That seemed reasonable. However, they reneged and wanted to add provisions stating that I would also not hold them liable for any fall, and that if she had to go to the hospital for anything else, she wouldn’t be able to return.

Steve Ahlquist: This is so annoying, I honestly don’t know what questions to ask.

John Albanese: I want to make sure she’s getting the socialization she needs.

Steve Ahlquist: Is there anyone else in your family to help?

John Albanese: I have an older brother in Florida, so he doesn’t come up as much. He’s going to be away, so it’s been mainly on me, which is fine. I’ve always had a good relationship with my parents, and my mom and I have her power of attorney.

Steve Ahlquist: I’m thinking of you, not only her. This affects your health as well.

John Albanese: Oh, I know, I know. Believe me, I know. I’m supposed to start my job on Monday, so I’m hoping to get some movement. The Ombudsman secured a hearing for us at the Executive Office of Health and Human Services (EOHHS). They have filed an emergency appeal, and it’s scheduled to be heard soon. Halcyon is going to have to answer in that sense at least.

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Since our conversation, John told me, “My mom’s current (temporary) placement is not appropriate. It’s a glorified hospital. She needs memory care; she does not require anything that skilled nursing has. She needs to be around residents who are in her ‘lane.’ Here, at Oakland Grove, it’s a wide spectrum of residents, including stroke recovery, Parkinson’s, and other ailments that have nothing to do with dementia and memory care. I need to find a new placement still.”

John said that during the EOHHS hearing about the lack of notice, Halcyon’s lawyer “doubled down.” He told me that Halcyon’s attorney said, “You can pound the table all you want, Halcyon does not feel she belongs there…”

EOHHS determined that Halcyon had failed to provide proper notice and facilitate a new placement for John’s mother. They did nothing to hold Halcyon accountable. “So Rhode Island seniors have no protection, and the 30-day notice law is meaningless,” said John. “EOHHS, DOH, and the AG all failed my mother and, in effect, all seniors in long-term care facilities of any kind. With no consequence, any facility can essentially ignore the law with impunity.”

[Halcyon did not reply to a request for comment.]