City of Port Townsend Writes to Ms. Bebo

I'm so sorry about the delay in getting this letter up on the blog. We have had technical difficulties plus holidays plus vacation. Anyway, here it is and I think you will find that it is worth waiting for. Please send the mayor and council members notes with your appreciation. There is a link to them below to the right.


December 11,2007
Laurie Bebo President and CEO Assisted Living Concepts, Inc. W140N8981 Lilly Road Menomonee Falls, Wl 53051
Re: Victoria House, Port Townsend, WA
Dear Ms Bebo:
As Mayor and on behalf of the City Council of the City of Port Townsend, ! am writing to express the City of Port Townsend's deep concern about the way Assisted Living Concepts, Inc. ("ALC") has made eleven residents of Victoria House innocent victims of an apparent dispute that ALC is having with the State of Washington concerning Medicaid reimbursement rates. The treatment of these individuals is contrary to our community's values as a place that cares for its people, and inconsistent with basic principles of caring and kindness.
Each of these individuals entered Victoria House with an implied understanding that they would be able to stay unless discharge or transfer was caused by the need for a higher level of care than the facility agreed to provide. Indeed, in some instances this understanding was expressly stated. Yet we have been told that none of these eleven individuals impacted by ALC's decision have experienced changed conditions requiring transfer, despite assertions by ALC personnel or representatives to the contrary.
ALC says these residents need more care and blames the State for not responding to ALC's request that they be transferred. Yet it appears that ALC never chose to seek discharge of any of these residents under the criteria authorized under Washington State law. Note that one such criterion is that "the transfer is necessary for the resident's welfare and the resident's needs cannot be met at the facility." (Letter from Robin Dale, Counsel to ALC, dated December 2, 2007 and appended hereto) Had ALC initiated a transfer or discharge as authorized by law, the resident would have had the opportunity to dispute the alleged reason for your action and have the matter adjudicated by a Superior Court judge.
Why, we wonder, did ALC choose not to take such action? Why, instead, did ALC opt to terminate its Medicaid contract with the State for Victoria House and one other facility of the 21 that ALC operates in Washington? It would appear that this choice is an "end run" on ALC's part enabling you to avoid demonstrating that the situations of the residents meet the requirements of the law. How can we conclude otherwise? The Legislature crafted a detailed and logical framework for determining whether residents of a facility like Victoria House should be discharged or transferred, yet ALC apparently didn't want to avail itself of those provisions.
We also note that you chose to terminate your Medicaid contract at only two of the 21 facilities you operate in Washington. Are those two radically different from the other nineteen? It seems likely that the kinds of clients your facilities attract will be reasonably comparable in communities throughout the state, so we are mystified as to why you felt that keeping a Medicaid relationship was so onerous in two instances but acceptable in nineteen others. Perhaps you would like to explain this as well.
We understand that several of the involved Victoria House residents have exercised their rights to complain to the State in the past about conditions and that such complaints may have brought about actions by the State seeking improvements to the way Victoria House has been operated. Some have suggested that your recent termination of the Medicaid contract has more to do with this than your concerns about rates. We hope this is not the case, for retaliation against someone exercising her or his rights under the law is totally inappropriate.
Your representatives assert that Washington's reimbursement rates under Medicaid need to be reviewed and increased. We have no opinion on that matter, but we do recognize that this is a legitimate concern and that regular review of such a matter is warranted. But elderly, indigent persons should not be pawns to be sacrificed during such review.
To that end, and triggered by ALC's behavior in this instance, we urge the State take prompt action that allows the remaining ten affected clients to stay at Victoria House or to return there, should they so desire. We further recommend reforms to the Medicaid program as follows:
• Requiring that any facility entering the Medicaid program must continue to serve any individual accepted for residency, absent changed circumstances warranting transfer or discharge, even if the facility opts not to accept new Medicaid clients;
• Requiring a determination by an independent decision-maker in any instance where a Medicaid client asserts that he or she is being discharged or transferred improperly;
• Requiring that the owners of multiple facilities in the State have consistent policies such that if they accept Medicaid clients at any of them, they must accept them at all of them;
• Strengthening rules pertaining to retaliatory actions against Medicaid recipients who exercise their rights and subsequently suffer adverse action.
ALC's actions have caused extensive anxiety, confusion and trauma to the lives of these eleven individuals, their families and their friends. One of them is deaf and blind; getting accustomed to a new facility will be exceptionally difficult for her. Another lost 20 pounds after ALC's decision was announced in early November. A third recently passed away. While it cannot be proved that her death resulted from the eviction, it's certainly plausible that there was a connection; studies have long documented that there are significant adverse psychological and physical effects from involuntary relocation, particularly among the elderly.
We urge you to rescind your announced intentions and, instead, to allow the remaining ten affected clients to stay at Victoria House or to return there, should they so desire. At that point you can pursue issues with the State without victimizing innocent seniors. Changed circumstances in the future may give rise to a judgment on your part that transfer or discharge is warranted; should that occur you have adequate remedies under existing law and those remedies ensure that residents are treated fairly and with adequate due process.
This letter is written on behalf of the City Council of the City of Port Townsend, which unanimously approved this letter in open session on December 10, 2007. Thank you and all whom we have copied for your consideration.
Sincerely,
Mark Welch, on behalf of the City Council of the City of Port Townsend Mayor

Copies of this letter were sent to the Governor, State Representatives for our area and DSHS administrators.