Following the adult care home money in North Carolina

Despite concerns about the more than 1,200 adult care homes in North Carolina that the news media and advocates for the rights of disabled people have raised in recent years, the way the state regulates these facilities hasn’t seen any dramatic changes.

Some advocates say that’s because the adult care home industry, which is the state’s de facto “solution” for housing mentally ill adults, enjoys out-sized political influence, thanks to years of effective lobbying and generous campaign contributions.

Last year Carolina Public Press launched the investigative series Questionable Care to examine issues with adult care homes in North Carolina and the state’s handling of them. The series explored serious incidents that led to large state fines against some adult care homes. It also looked at the overall system of regulation and oversight, in which a mix of state and county inspections has led to accusations of inconsistency and ineffectiveness.

The article that follows examines how the adult care home industry’s political giving may have affected this situation.

Record of giving

Carolina Public Press found that the North Carolina Association of Long Term Care Facilities has given many campaign donations to politicians of many political stripes according to State Board of Elections campaign finance records that go back nearly 30 years.

Two of the largest individual donations, for $4,000 and $1,000, went to Dennis Wicker, the Democratic former state representative and lieutenant governor from Lee County, in the 1990s. The only other campaign to receive a four-figure gift was former Democratic Senate leader Marc Basnight of Dare County.

But both these candidates and many other candidates also received multiple smaller checks that have added up over the years.

Some prominent North Carolina political figures of past and present who received donations up to a few hundred dollars at a time from the adult care home industry organization include Virginia Foxx, Frank Ballance, Art Pope, Roy Cooper, Jim Forrester, Bev Perdue, Bob Hunter, Beverly Earle, Richard Morgan, Dan Blue Jr., Robin Hayes, Norris Tolson, Phil Berger, Jim Black, Leo Daughtry, Jim Hunt, Jim Gardner, Mike Easley, Wesley Meredith, Martin Nesbitt, Justin Burr, David Redwine, Tony Rand and Joe Sam Queen,

And that’s just a very partial list. Identifying all such gifts from the Board of Elections database is complicated because the same organization’s name is listed in many different ways, sometimes with misspellings or unpredictable attempts at abbreviation. The Board of Elections records these gifts from reports submitted by the various recipients, who may write such donor groups’ names in various ways.

There’s also little way to account for gifts given by the owners or managers of individual adult care homes. It’s also not possible to know whether an individual gift from such a person had anything to do with the industry, or might relate to some unrelated personal political agenda.

Even this partial list might seem like a lot of money going to a lot of politicians. But it isn’t necessarily unusual. Organizations that represent industries regulated by the state and federal government frequently give to political campaigns, sometimes in substantially greater amounts.

Unless the law prevents this type of giving, organizations that don’t play the campaign finance game might be considered derelict in representing their members’ interests.

Buying influence?

Most of the campaign giving from the North Carolina Association of Long Term Care Facilities took place during earlier elections cycles. Jeff Horton, who became the organization’s director last year, told Carolina Public Press last month that the group hasn’t given to any political campaigns since he took office.

Despite saying he didn’t really know what type of giving strategy has been followed in the based, Horton doesn’t generally disavow the past practice of political giving.

“Since I’ve been on board, we haven’t given,” Horton said in a December phone interview with CPP. “That may change.”

Regardless, industry organizations aren’t foolish enough to engage in quid-pro-quo giving to politicians. That’s a bribe and it’s against the law.

“It’s illegal to say to a lawmaker, ‘Here’s some money, get this bill passed,’ ” Horton said.

However, if the long term care facilities organization sees that someone has been “supportive of the industry,” that might be someone to whom the group would consider giving, he said.

He also stressed that the industry organization wants to see a healthy dialogue with state government and reasonable legislation and regulatory policy.

Some of the worst cases of adult care home abuses documented by the state Department of Health and Human Services and reported by CPP have involved companies such as Cedarbrook Residential Center of McDowell County that aren’t members of the industry organization.

Horton said his group doesn’t want changes in the laws that would allow rogue players to run amok. “Most folks in the industry think that if you have someone who is not doing a good job and makes the industry look bad, maybe it would be better if they just went away,” he said.

Asked about whether past political giving has given the adult care home industry an abnormal level of influence in Raleigh, Horton expressed skepticism based on his own experience on the other side.

Before taking his current job, he worked for the Adult Care Licensure Section of the Division of Health Service Regulation within DHHS, the state agency that investigates adult care homes, assigns star ratings, catalogs deficiencies and levies financial penalties.

From within that agency, he encountered a false perception that it was a different but related industry, the nursing homes, that controlled everything. He always found that this perception of either industry’s influence was simply false, he said.

Today, his board members would be very skeptical about the idea that they’ve accumulated immense influence, Horton said.

“If we’re that influential, why aren’t we doing better as an industry?” he asked.

Advocate concerns

Corye Dunn is policy director for Disability Rights North Carolina, a watchdog organization that has concerns about abuses at adult care homes, but also about the lack of choice given to people who end up being housed – “stored,” Dunn says – at these facilities due to lack of options.

She believes the adult care home industry’s strategy has built up sympathy in Raleigh from influential leaders who have insulated adult care homes against more effective regulation and changes in the basic model of care for disabled adults.

“There have definitely been times in the last 10 years when we have seen policy decisions that valued the needs of the adult care home industry over the rights of” their residents, Dunn said.

She also noted that this issue isn’t partisan. Like the record of industry gift-giving, the industry has received support from political leaders of all parties.

Dunn is especially concerned that lawmakers in Raleigh have taken baby steps, such as implementing a review of the controversial star rating system for adult care homes, rather than considering the big picture, including a federal lawsuit that challenges the basic model in North Carolina.

“That’s where we go wrong,” she said. “That’s where we violate the law.”

According to the U.S. Department of Justice legal filing last year, North Carolina has failed to meet its obligations under a previous legal settlement to create real options for disabled adults who do not necessarily need to be housed in adult care home facilities.

Rather than fixing the problems raised in the federal litigation, the state has filed responses in the courts disputing the federal findings.

What’s next?

Several upcoming developments could be telling for the future of adult care homes in North Carolina. Depending on the thoroughness of the star-system review, lawmakers could decide that more far-reaching reforms are in order. That could especially be true if they take a closer look at the state’s 2016 settlement with Cedarbrook Residential Center that resulted in the fabrication of a new four-star rating for a facility that had earned a zero-star rating.

The Cedarbrook case is in many ways an outlier. The deficient findings and financial penalties imposed against the facility in 2015 and 2016 dwarfed those against all other facilities up to that time. The state’s about-face in settling such a mammoth case and leaving Cedarbrook with no penalties was not comparable to any other action involving an adult care home that has come to light.

After CPP began asking questions and seeking state records regarding Cedarbrook in late 2017, DHHS and McDowell County initiated new inspections and took new actions against the facility in October, a few days after CPP’s story on the settled case was published. Cedarbrook’s appeal of this new state regulatory action could have a broad impact on the state’s ability to regulate adult care homes effectively.

The Nebo-based facility has asked the Office of Administrative Hearings to set aside a DHHS-imposed ban on new admissions to the facility, claiming an undue financial burden and that state and county surveyors conspired in a malicious and capricious way to shut Cedarbrook down. State witnesses disputed this, saying their actions came because of serious red flags they identified at Cedarbrook. A administrative law judge has temporarily allowed new admissions again while considering Cedarbrook’s and the state’s arguments and is expected to rule in mid-February.

If the judge permanently prevents DHHS from halting admissions at Cedarbrook, it could set a precedent that would erode a key tool the state has used to bring troubled facilities into compliance.

Perhaps the biggest potential change could come in either a new settlement or a federal court decision in the federal case against North Carolina’s housing options for mentally ill adults. Lawmakers could offer legislative reforms as part of a settlement that would allay federal concerns. So far, there’s been little movement publicly on that front.