AIKEN - South Carolina employs 21 inspectors to monitor 1,516 health care facilities, a heavy caseload that often leaves families with the responsibility for catching elderly abuse and neglect.
Each of those inspectors must survey 72 facilities yearly. Some health care experts say the South Carolina Department of Health and Environmental Control needs more inspectors to properly monitor the facilities that care for the elderly.
"They do a great job, but they could do a better job if DHEC had the resources to employ the people that they would like to have," said Sandra Linn, executive director of the South Carolina Association for Residential Care Homes. "I think all of the facilities might be surveyed more frequently if they had the resources to employ the staff to do it."
Ms. Linn blames the shortage of personnel on low funding in the state budget and says inspectors perform a vital role.
DHEC officials argue that the inspectors' caseload is actually about 50 facilities each year - the national average - because other employees help out with inspections.
But with the recent shutdown of the Ranson Community Care Home in Aiken for allegedly abusing its patients, questions remain about why the alleged abuse wasn't caught during the inspection process.
The operating license for the eight-bed residential care facility was revoked last month after allegations arose that the Ranson family abused and neglected the residents and operated an unlicensed facility.
The home's residents, who allegedly endured harsh conditions in a shack that was hidden deep in a plush Aiken subdivision, were taken into emergency protective custody and moved from the Ranson home to places such as Millbrook Manor.
DHEC spokesman Jerry Paul said his agency receives 120 complaints a year from families and other people who come into contact with residents. Each of those complaints leads to an investigation that might catch wrongdoing.
At the Ranson facility, he said, inspectors never substantiated the frequent complaints.
"We were in there on a regular basis, and we were not verifying the complaints that we were getting. With more people, you could go more frequently. But that doesn't necessarily say that you are going to find a very unusual problem like this," Mr. Paul said. "When we found the abuse, we reported it immediately.
Only 25 percent to 30 percent of complaints are substantiated. Some cannot be proved, but DHEC can better substantiate the allegations with the help of others, Mr. Paul said.
"There's a lot of eyes and ears that go into facilities besides DHEC," Mr. Paul said. "When they see something and report that to us, that assists us. ... I wouldn't say just family. There are a lot of individuals that go in and out of these homes that assist us. For instance, home health nurses are going in and doing intermittent care, and they are alerting us to problems that they see."
Who's to blame?
State Rep. Robert S. "Skipper" Perry, R-Aiken, said he is willing to hold hearings or introduce legislation if it will prevent another Ranson-type situation. He said he wants to hold someone accountable.
Mr. Perry has heard that some elderly patients at the home lived on air mattresses in a feces-ridden residence that some call a "house of horrors."
Formal grievances brought inspectors to the Ranson home at least 10 times - including three times in 1996 and four in 1997.
DHEC inspectors made an unannounced visit Sept. 8 and found eight residents there with no staffers present. The unsupervised residents said a few other women were kept in a nearby log house, considered an unlicensed facility by DHEC. When the inspector gained entryto the locked building, he found open cans piled in a corner, low lighting, a strong odor of urine, dried feces on the wall and a partially collapsed roof.
Clifford Ranson, 59, Alice J. Ranson, 53, and Jared Ranson, 34, all of the 1000 block of Brookhaven Drive in Aiken, were arrested Sept. 14 and charged with two counts each of elderly neglect.
After hearing about the arrests, Mr. Perry wrote letters to DHEC and the state Department of Social Services, requesting a copy of rules and regulations for monitoring community residential care facilities. He has yet to receive a response, he said.
"I just want to find out what they feel their responsibilities were," Mr. Perry said. "We are just going to make damn sure that this doesn't happen again."
Residential care homes are defined as health care facilities that provide residents a place to live and a staff that provides personal care and helps with daily living activities, such as bathing, eating, taking medication and getting to medical appointments.
The Ranson home went through the same process that other residential care facilities must go through to open. According to Mr. Paul, the new homes must pass a physical building requirement, and the owners must go through a lengthy application process, which includes a criminal background check. The home's administrator must also obtain a separate license through the state Board of Long-term Care.
After the home is given a provisional license, the facility must pass a 90-day comprehensive inspection. Once it gains a permanent license, it is inspected annually.
All visits by DHEC inspectors are unannounced, department spokesman Thom Berry said.
Inspectors carry a checklist that deals with quality-of-life issues: Is the place clean? Do the residents get enough food at mealtime? Is there proper lighting in the patients' rooms? Is medicine distributed properly?
DHEC inspectors can be strict at the health care facilities, Mr. Berry said. His mother-in-law resides in a nursing home in West Columbia.
"The inspectors delayed the opening for three weeks because the DHEC inspector made them change the wallpaper," he said. "They said it was a fire hazard."
Still, there is evidence that the Ranson home failed many categories during some inspections.
A case file clearly shows that DHEC received complaints for several years that the Ransons were violating state law by operating an unlicensed residential care facility. It also shows other complaints, including reports that administrator Clifford Ranson "verbally and physically abused residents, locked them in their rooms and threw things at them."
When inspectors came to Aiken to interview the residents, an elderly women "appeared generally favorable in regards to treatment at the facility," a DHEC file showed.
But a woman who left the home in 1996 told DHEC that Mr. Ranson "has everyone so scared to make a complaint that he has them believing that they don't have anywhere else to go."
There's not a lot that DHEC can do in this case because of state laws, Mr. Berry said.
"Obviously, you have to have a situation where there is an immediate and imminent and demonstrable threat to the patients' safety and lives," the DHEC spokesman said. "And so that's a factor that has to be weighed in any decision because anything that we do as the regulatory agency can immediately be appealed to the court.
"Under the appeal process, everything stops while that appeal is under way. So we have to be very sure and very prepared to be able to defend any of our actions in court."
Shutting down a place is difficult without solid proof, he said.
While the Ransons are out on bond and awaiting trial, they have appealed the revocation of their DHEC license, a process expected to take months.
Families can help
Because DHEC performs annual evaluations at facilities, catching elderly abuse and neglect often falls on the residents' relatives.
"So this is where families can really be helpful: watching and reporting instances of where they think conditions are in need of improvement," Mr. Berry said.
Families also can help by checking around before they select a home for a loved one, Ms. Linn said.
"Don't automatically place someone in the first place you go to. It's good to be able to look around before making a decision," she said.
Although the Ranson arrests shocked the community, other local residential care homes have operated for years without problems. Aiken County has 22 community residential care facilities, with 618 beds.
One of those is Aiken Adult Care Inc., which operates a 39-bed residential care home known as Millbrook Manor, located off Whiskey Road behind Shoney's restaurant. It is just down the street from the Ranson home and is where some of the residents were relocated.
"When I first heard that a family had to call up there (before visiting), that to me was a red flag," said Brenda Iverson, Millbrook Manor's owner and administrator. "But to others, maybe not."
At Millbrook Manor, family members can visit any time.
Residents there also enjoy daily activities and occasional field trips. This week, a group of residents will go to the state fair in Columbia. Residents also are provided ceramics classes, church services, monthly birthday parties, and arts and crafts.
The administrator opened the home in December 1995.
"I love it," she said. "I think that you have to have a passion to work with the elderly. And I think my niche is working with the elderly. You never know what they're going to do. We just love to have a lot of fun with them."
Reach Greg Rickabaugh at (803) 279-6895.