E N Q U I R E R   S P E C I A L   I N V E S T I G A T I O N
Hamilton County reports a rare look at home care
Open-to-public inspections reveal lapses, help families choose providers for loved ones.

By Spencer Hunt
Enquirer Columbus Bureau

Families in Hamilton County have it better than most when it comes to finding help for a mentally retarded loved one.

That's because the Hamilton County Board of Mental Retardation prepares public reports that assess how well private companies work with mentally retarded Ohioans in their own homes. The reports, rare in Ohio counties, show which companies make the fewest mistakes and quickly fix problems.

Information contained in the reports can be alarming, however.

Compiled from inspections at the homes of 350 mentally retarded people over the past two years, the reports underscore the scope of problems plaguing home-care programs. In nearly half of all cases, home-care workers made more than four mistakes per person cared for, an error rate the county considers unacceptable.

Among findings from a Cincinnati Enquirer analysis of inspection reports:

Inspectors found 736 examples of poor medical care, including 444 instances in which at-home workers failed to take people to the doctor or didn't report that they did.

In 426 instances, workers either didn't perform services they were paid to provide or failed to prove that they did their jobs.

In 252 cases, workers either lacked necessary training to care for mentally retarded people, couldn't prove they were trained or had other staffing issues.

Hamilton County officials say the reports provide a crucial opportunity to crack down on private companies that provide poor care. Problems are discussed with providers, and mentally retarded people can switch to new caregivers when the situation warrants, says Charles Stenken, assistant director of quality assurance for the Hamilton County board.

The county started making summaries of its reports available to the public about three months ago. Now it's working on a way to post the information on the county board's website, www.hamilton-co.org/mrdd.

Gay Covell, director of the board's Community Resource Division, says giving statistics to families allows them to make better choices to determine who will care for a retarded child or sibling. That motivates companies to do good work.

"They are concerned about how they look to families and how they look to the public," Ms. Covell says. "This is a good thing, obviously."

Habilitation Opportunities of Ohio is one of the largest private agencies with the most problems - averaging 6.1 mistakes per person. Inspectors who visited 48 people getting care from Habilitation Opportunities over the past two years found 294 problems. Among them were 89 missed or unreported medical appointments and 68 instances where services either weren't provided or documented.

When inspectors returned to follow up, they discovered 42 problems hadn't been immediately fixed.

Liz Freeman, Habilitation Opportunities' operations manager, says the citations are not a true reflection of what's happening in the homes. She says records proving medical appointments are kept are filed at the company's central office, not in people's homes. Detailed plans for a person's care can be so complex that 4,800 errors are possible for just one person, she says.

Despite its objections, Ms. Freeman says Habilitation Opportunities is working hard to improve services, and she predicts future inspections will find fewer problems.

She says, "Now that we have a clear understanding of what's being requested, it's a lot easier to comply."

Inside the Report
Living alone
Many people don't get the help they need to live on their own.

At last, a decent home
Pete Angler lived in danger for years, but now he's safe.

Flexibility yields solutions
Some counties tailor programs to individuals who need help.

Hamilton County reports
Open-to-public inspections help families choose providers for loved ones.

Who's accountable
The agencies and departments charged with prosecuting crimes against the mentally retarded.

What's been done
Find out what's changed since the first two installments of Ohio's Secret Shame

Photographer's album
A visual journey into the lives of Ohio's mentally retarded.

For Pete's Sake
A photo essay of Pete Angler and his advocates' 10-month struggle.

Ohio's Secret Shame

Part 1Part 2Part 3