STEVE INSKEEP, host:
The state of Florida has almost 3,000 assisted living facilities and the state was among the first to regulate assisted living and to adopt a bill of rights for patients. But an investigation by the Miami Herald and our member station WLRN found that regulators are failing to protect some residents. They uncovered dozens of questionable deaths in Florida assisted living facilities.
Kenny Malone reports.
KENNY MALONE: Aurora Navas spent her life terrified of water. Yet in 1962 she put her three kids by themselves on a Pan-Am flight out of Fidel Castro's Cuba. She sent her husband by a boat a year later. It took five more years before she could get her flight over the Straits of Florida and reunite the family in Chicago.
Aurora Navas worked 13 years on an assembly line at a transistor factory there. She helped pay for a vacation to Miami Beach, where she watched from the sand in fear as her kids played in the ocean. She never forgot those six years she lost with her kids.
Mr. ALFREDO NAVAS: As a matter of fact, she still referred to me as baby, the baby, nene.
MALONE: Alfredo Navas is the youngest of Aurora's three children.
After Aurora's husband died in 1983, she retired to Tampa to be near Alfredo. He visited every day, but as his mom got older, he had to hire extra help.
Mr. NAVAS: Just to keep an eye on her and make sure she took her medication, she didn't leave the stove on. She was still cooking. She was a strong bird.
MALONE: When she was 83, doctors diagnosed Aurora with Alzheimer's disease. She wound up at Isabel Adult Care III, a six-bed assisted living facility in Southern Miami-Dade County. Isabel Adult Care has fancy sconces, a covered walkway, and an elegant stone fa�ade, and sits right on a lake. The first time Alfredo Navas visited he noticed the lake.
Mr. NAVAS: They had like a little chain-link fence. I did see a surveillance camera. You could see the alarm on the door. And there's always a person there. Everything seemed fine.
MALONE: A Miami-Dade police report describes what happened on January 27, 2008. Around 3:45 in the morning, Aurora Navas got out of bed. She put on her light-blue house slippers and shuffled out of her room. She walked past an unplugged surveillance camera. She wandered out a back door with an improperly set alarm. She shuffled through the unlocked back gate. Two on-duty caretakers failed to stop her.
That night, Alfredo Navas woke up to the phone ringing. It was his older sister.
Mr. NAVAS: She she told me that there had been an accident at the nursing home and that mom had passed away.
MALONE: Police found Aurora Navas's left slipper lying next to the lake. They found Aurora Navas drowned in around 18 inches of water.
It's one of 70 questionable deaths uncovered during a year-long investigation by The Miami Herald and WLRN into the state of Florida's assisted living facilities.
Mr. MIKE SALLAH (Reporter, Miami Herald): Angel Joglar, 71, killed when left in a bathtub of scalding water.
MALONE: Herald investigative reporter Mike Sallah reads from a list of deaths culled from thousands of state documents.
Mr. SALLAH: Gladys Horta, 74 years old, strapped so tightly, the restraints ripped into her skin, causing a blood clot that killed her.
MALONE: We found deaths from residents being deprived medications and from residents being over-medicated, deaths from Miami to the Florida Panhandle, deaths in 100-bed facilities and in six-bed facilities.
Mr. SALLAH: Walter Cox, 75 years old, Alzheimer's patient. Wandered away from a facility for the fourth time. His body was found torn apart by an alligator.
MALONE: In almost all 70 cases, there were few or no consequences for caretakers. Florida once a national leader in legislation policing assisted living facilities, but our investigation shows the state has fallen behind in enforcement.
As the U.S. population ages, Florida is a case study for how the country protects some of its most vulnerable citizens.
Unidentified Man #1: Isabel Tirdo(ph)?
MALONE: Our reporting team showed up at one of five facilities owned by Isabel Lopez. She owned the place where Aurora Navas drowned.
Unidentified Man #2: (Unintelligible)
Unidentified Man #3: Alright.
MALONE: Isabel Lopez walks into the driveway with her three-legged dog named Ron, or Rum in Spanish. I ask her in broken Spanish if she remembers Aurora Navas. (Spanish spoken)
Ms. ISABEL LOPEZ: (Spanish spoken)
MALONE: (Spanish spoken)
Ms. LOPEZ: (Spanish spoken)
MALONE: (Spanish spoken)
Ms. LOPEZ: (Spanish spoken)
MALONE: Lopez maintains the death was an accident. She says she doesn't know why the alarm didn't work the night Navas died. We have more questions, but the language barrier makes it too difficult.
Ms. LOPEZ: (Spanish spoken)
MALONE: Lopez asks me to call back the next day with an interpreter. When I do, she declines through the interpreter to answer any more questions.
There's one Florida agency charged explicitly with overseeing assisted living facilities and investigating deaths like that of Aurora Navas - the Agency for Health Care Administration, or AHCA.
Two weeks after Aurora Navas drowned, Isabel Lopez reported: We found that all procedures were followed; the facility has door alarms, proper door locks, and a fenced backyard.
An AHCA spokesperson said the agency has no records of the case and refuses to comment on whether it pulled the police report. If it did, the agency would have read what we saw about the surveillance camera, the mis-set set alarm, and the unlocked back gate.
The Navas family sued Isabel Lopez in civil court for wrongful death and settled for an undisclosed amount. Their attorney was Michael Feiler, who specializes in bringing cases against assisted living facilities in Florida.
Mr. MICHAEL FEILER (Attorney): On close examination, you see facilities with clearly inadequate living conditions, or improperly trained staff, or improper oversight. And essentially what you end up with is basically a bunch of small warehouses for the elderly. And that - I find that troubling.
MALONE: As the industry has expanded, AHCA's staffing has stayed the same and has faced its own budget issues. Our investigation found AHCA is doing fewer inspections, taking longer to follow up on complaints, and rarely punishes facilities to the full extent of the law.
In 2008 and 2009, AHCA found enough violations that according to its own rules would have let the agency strip licenses from at least 70 facilities. The state closed just seven.
State Senator NAN RICH (Democrat, Florida): Well, my first reaction is that AHCA is not doing their job.
MALONE: Nan Rich is the Democratic Minority Leader of the Florida Senate. She says our investigation shows that the state is headed in the wrong direction.
Ms. RICH: So we need to go back and figure out how to make sure that the statutes are actually followed and enforced and maybe there need to be stronger ones.
MALONE: AHCA declined a request for an in-person interview. In an email, the agency said shutting down a facility is, quote, "a very harsh penalty." In each case, AHCA says, it considers the gravity of the violation, actions taken by the owner to correct violations, and the potential emotional and physiological harm created by removing residents from their home.
AHCA would not comment specifically on the death of Aurora Navas, but it did add: We are sympathetic to Mr. Navas regarding the loss of his mother.
Nearly every facility owned by Isabel Lopez has a documented history of problems. The police have had to use bloodhounds and a helicopter to search for runaways from Lopez's facilities. AHCA itself has found 119 different violations over the past decade. But the only disciplinary action AHCA has ever taken against Isabel Lopez was in 2009 - a $1,500 fine for not complying with Medicaid laws.
Alfredo Navas can't understand why AHCA never followed up on his mother's death.
Mr. NAVAS: So what does AHCA do? It's just a paper-pusher. Somebody just died, you know, and if they're not applying the laws and fining or closing these people down, then what are they there for?
MALONE: In her original incident report to AHCA, Isabel Lopez wrote: All precautions were taken so that an occurrence like this would not happen.
But it did happen. And without AHCA enforcing its own rules, there's no governing body to prevent deaths, like the death of Aurora Navas, from happening again.
For NPR News, I'm Kenny Malone in Miami.
INSKEEP: And you can see how Aurora Navas might have eluded security measure intended to keep her safe by going to NPR.org.