Willamette Springs Memory Care, a senior living facility in Corvallis, was under “enhanced supervision” by the state but continued to operate. As reported in Willamette Week, within the past two years the facility has been cited with upwards of 50 instances of abuse. In September, the Oregon Department of Human Services considered removing the facility’s license. However, last month the facility passed its latest inspection, removing admission restrictions and regulatory oversight. Lucas Manfield covers health care for Willamette Wek. He joins us to share more on the facility and the state’s regulatory power.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Willamette Springs Memory Care is a senior living facility in Corvallis with a years-long history of substantiated abuse violations. As reported in Willamette Week, within the last two years alone, the facility has been cited with 50 instances of abuse. In September, the Oregon Department of Human Services started the process to remove the facility’s license, but you would not know that if you look right now at a state website intended to give Oregonians crucial information about problems at these facilities. Lucas Manfield has been writing about this for Willamette Week. He joins us now. Welcome back.
Lucas Manfield: Thank you. It’s a pleasure to be here.
Miller: I want to start with a story of one family that you focus on. The family of a woman named Michelle Wolf who was diagnosed with early-onset dementia eight years ago, when she was 52. What did her family do when they decided that they couldn’t provide her adequate care at home?
Manfield: They really did a lot of research, frankly. They were just looking for facilities. It takes kind of a specialized facility to care for someone with these late stage dementia like that, and there weren’t that many options around them. But they toured facilities, they looked online for reviews. I think they really put a lot of diligence in trying to find the best one. And they ended up settling on Willamette Springs.
Miller: Well, can you describe what you heard from members of her family about what the facility was actually like?
Manfield: Well, when they first toured it, it looked great. They toured it during the daylight hours and just saw the best parts of it. Then during the subsequent year, when they really found out what it was really like in there, Michelle’s husband and kids, who all basically spent every day there for many months, kind of just describe horrific short-staffing; people just wandering around unassisted and just falling, hurting themselves; no one there to help; fecal matter kind of spread around the carpet. Just really traumatic stuff. And yes, they felt they had to be there every day to protect not only Michelle but also the other residents there.
Miller: What have former employees there said about their time?
Manfield: So this facility opened in 2016 and the lawsuits began almost immediately. Basically, they said that this facility in particular had significant staffing problems. And one top executive that was hired and essentially brought in in 2018 to figure out what was going wrong in the facility – and this was just an allegation, never proven – said that she believed that the facility was attempting essentially to cover up the lack of staff at the time.
Miller: What did you hear when you reached out to the owner of the facility?
Manfield: I mean, frankly, they just released a pretty short statement. And their point – and it’s a valid one – is that this is not just a Willamette Spring problem. And this is something that I’ve been reporting on, frankly, for the last year, just how horribly understaffed these facilities are. It’s a serious problem. It’s a national problem. It’s just very hard to get people to work in them at the wages that are being offered.
So, their point was (a), this is a national problem. And (b), I think this gets back to the point you made, very well-said at the beginning of this, which was their facility right now, according to the state, is doing everything right. They essentially passed their most recent inspection, which therefore kind of lifts all of the restrictions on their license – which is surprising because it is happening at the same time that the state is essentially telling them, we’re going to attempt to remove your license. Two very different things that are happening at the same time and are kind of creating a weird dissonance for someone if they were looking at the facility and trying to figure out if this was a place they wanted to send a loved one.
Miller: I want to dig into that more in just a second, but just to finish part of the Wolf family story, what did eventually happen to Michelle Wolf?
Manfield: Well, she ended up passing away. She basically spent almost until her very final days at the facility. I mean, a lot of horrible things happened to her there, but she ended up suffering like a brain hemorrhage after falling once. And she was essentially unassisted after being given pretty powerful sedatives, which is something that is not supposed to happen. She also lost an extreme amount of weight, a significant portion of her body weight, because she wasn’t essentially able to eat without help. And the facility wasn’t providing her anyone to help her eat, besides the family when they were there. So her family believes that the combination of those things really sped up her decline in her final months.
Miller: That family, the Wolfs, brought many of their concerns to the state. What came from that?
Manfield: So the state investigated and substantiated it. And when I looked through the records, they have substantiated, as you mentioned, a lot of abuse at this facility. I mean, frankly, this is not uncommon. I think the numbers of this place are probably a lot more than you would typically see, but it is not uncommon for the state to substantiate abuse. But I think it really shows what we kind of call this like yo-yo, which is where facilities will rack up a lot of problems, the state will come in, they’ll work with the facility to fix them, the state will leave and then you see the problems very quickly reemerge.
Miller: How do state regulators defend or even just explain that?
Manfield: To the state’s credit, they know this is a problem and we’re seeing some positive movements. One of them is the creation of a website to basically list the most problematic facilities. Of course, the irony here is that this facility isn’t on that list, but the sheer fact that the list exists is forward progress. I mean, I’ve hit DHS [Department of Human Services] pretty hard many times for their kind of lack of transparency. So, they’re trying.
And the other thing to note is that the short-staffing is not just a problem inside the facilities, it is a problem at the state. So the state team that goes out and surveys these facilities to see whether they are short-staffing is, itself, more short-staffed than it has ever been. So the state is running into the same problems. To their credit, they have new leadership and they sent me a litany of things that they are trying to improve to increase oversight of facilities like Willamette Springs.
Miller: One of the more shocking individual moments that you mentioned in some of your reporting is that at one of these regulator visits they saw problems at this site and some of the residents were trying to get the attention of people who worked there. And even the regulators couldn’t find the staff to help them. The regulators were there, but the staff-people were nowhere in sight. Can you give us a sense for the other kinds of issues that this facility and others are regularly flagged for?
Manfield: Sure, it’s a good point. Yeah, it’s smart to pick up on that. I read a lot of these inspection reports, and sometimes you read one of them and you’re like, the inspectors were pissed off. And I mean, that was clearly happening in this case, as you described. One, the eating thing is a huge problem. You see that coming up over, and over, and over again. Basically, there’s just not enough caregivers at these facilities to ensure that everyone has help eating. And especially when you’re dealing with residents that have dementia like this, it can be a very difficult task for them and they need someone to help them. At Willamette Springs, there was essentially a dining room for people that supposedly could eat on their own. As inspectors found, they weren’t able to and no one was helping them. So that’s something I see commonly.
The other – again, I’ve done reporting on this – one of the most frequent things inspectors find is simply just short-staffing. So they will get evidence that call lights are not being responded to. They’ll get evidence from people saying that “I fell and no one was there.” And they’ll end up concluding this facility was not sufficiently staffed. And there are state regulations on what staffing levels facilities are supposed to have, and very frequently, those are not being met.
Miller: What I was left with, after reading all of your reporting, is not knowing … If I were looking right now for a loved one for a facility, I could go to this newish state website and see if there are any very current restrictions on admissions at any facilities right now. But, as you’ve noted, the facility that seems like it has the highest number of substantiated cases of serious problems is not even on that list right now, even though it could be losing its license.
So I don’t know where I would even turn for trustworthy information about a facility where I would be entrusting my loved one. What advice would you give to people in that situation right now about where they can turn for good information?
Manfield: This gets complicated quickly. And this is something that the Wolfs experienced when they were looking for facilities – you can’t just do a basic Google search. The state basically has a map on their website that lists out every single one of these facilities and you want to find that specific facility on a state website. You open it up and then you need to look … basically, they will list out every single inspection and every single violation. That’s kind of your best indication of what inspectors have found at that facility.
But it’s complex, because a lot of these facilities will have problems. Then they’re solved and they stay solved. In a lot of other facilities, they don’t stay solved. And that was kind of the experience of the Wolfs, where this was a facility that kept going in and out of compliance. So it was never quite clear, going on their website, what the actual conditions at that moment were there. There are highly paid consultants that will help people do this. So that’s another option.
Frankly, I was told, when I was talking with Clint, the husband of Michelle, his advice was to tour the facility at night, if you can, because it tended to be much, much worse conditions after the day shift went home.
Miller: Lucas, thanks very much.
Manfield: Yep. Thank you.
Miller: Lucas Manfield is a health care reporter for Willamette Week.
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