MINNEAPOLIS - At the Edgewood Vista senior home in Hermantown, Minn., elderly residents were stunned, even incredulous, over the recent revelation that an 89-year-old fellow resident was drugged and raped in her bed last year by a young caregiver.
But the rape, which prompted widespread outrage and calls for a state investigation, is just the latest incident to occur at homes operated by Edgewood Management Group, a North Dakota company that has been cited more than 50 times over the past four years for cases of abuse or neglect.
The incident also opens a window onto broader issues of maltreatment at assisted-living homes - a fast-growing and lightly regulated industry that now serves thousands of frail older Americans.
At Edgewood Vista, a review of hundreds of pages of inspection records suggests that maltreatment and neglect have been persistent issues. A Star Tribune analysis found a history of incidents from the seven states where Edgewood operates:
• Three aides at an Edgewood Vista senior home in Virginia, Minn., slapped, pinched and taunted residents over a period of months. One dressed an elderly man up in a clown wig for a social event while others threw balls at residents.
• Residents at Edgewood homes in South Dakota and Minnesota wandered away unnoticed; one was found two blocks away in cold weather without a coat, while another was discovered outside on the pavement in a pool of blood.
• Staff at an Edgewood home in Cheyenne, Wyo., failed to conduct required health assessments of six residents despite "significant declines" in their physical and mental abilities. One resident was not reassessed even after she hit another resident with a knife.
Yet Edgewood, which is based in Grand Forks and has 50 assisted-living communities in the Midwest, was not sanctioned or fined for these and dozens of other violations.
The lack of sanctions is emblematic of assisted-living homes, a sector of senior care that has escaped much of the regulatory scrutiny directed toward traditional nursing homes.
Assisted living, also known as "independent living," operates in a regulatory gray zone between senior housing and nursing care. Hundreds of facilities across the country are governed by a patchwork of state rules that vary widely and have failed to keep pace with the increasingly acute diseases of the aging people they serve, say elderly care advocates.
"This is a systemic problem," said Dr. Robert Kane, chairman of long-term care and aging at the University Minnesota's School of Public Health. "The more we have these national (assisted-living) companies, the more we need to hold them accountable ... and not just treat these as isolated incidents."
Each day, they come to share stories about their families or play cribbage over coffee. But in recent weeks, the elderly women who gather in the spacious lobby of the Edgewood Vista home in Hermantown have found themselves revisiting a chilling incident.
On Jan. 18, 2013, an 89-year-old resident was drugged and raped in her bed by a 30-year-old caregiver. A nurse examiner later said the vaginal tear from the rape was the worst she'd seen in her six years in the field.
It was all the more stunning that the rape occurred at Edgewood, a company that prides itself on creating a social atmosphere in its homes, complete with live music, ballroom dances and private theaters.
In an interview, Edgewood Executive Vice President Russ Kubik said the company takes pains to train its staff and provide top-notch care. Kubik used the word "devastating" four times to describe the Hermantown rape and called it the worst incident in his 27 years in the senior care industry.
"A sexual assault like that is a nightmare," Kubik said, fighting tears as he spoke. "It's just a very ugly thing, and I can only hope and pray that I never see it again."
Attorneys for the elderly woman have alleged that administrators at Edgewood impeded an investigation by local health professionals who treated her, and even suggested the sex was consensual.
In addition, another resident at the home, Carol Johnson, said staff threatened her with eviction recently when she tried to inform neighbors who were unaware of the incident.
Kubik denied that Edgewood threatened Johnson with eviction - "We don't do that," he said - and said the facility did not want to create unnecessary anxiety by telling residents about the assault after the rapist had been removed from the building. Administrators also had to weigh the privacy concerns of the elderly survivor and her family, he said.
"Do they want to have (information about the rape) hung out there and to have everybody know what happened?" Kubik said. "It's a horrible situation but a delicate situation. ... We thought that we were doing the best that we could."
Safety record not unusual
Edgewood's handling of the case was by no means unique. Indeed, state regulators and elder-care watchdogs say the company's safety record does not stand out as unusual.
"There is a lot worse than Edgewood," said Deb Holtz, the Minnesota ombudsman for long-term care.
However, there is no national database of abuse records at assisted-living centers, so comparing companies is difficult. Despite its explosive growth, the assisted-living industry - which now serves 750,000 people in about 2,500 facilities nationwide - is still known for a lack of accountability.
Because nursing homes are regulated by the federal government, licensing records are aggregated in one place easily accessible to consumers. Assisted-living homes, by contrast, operate under widely varying state laws and enforcement philosophies. Even a consumer who obtains licensing records may be frustrated to find inscrutable handwritten comments and blank columns.
"The rape in Hermantown may have been the tip of the iceberg, but we wouldn't even know if there is an iceberg below it," said Dr. Kane of the University of Minnesota.
Incidents of abuse
Jean Hill, 82, wakes each morning to the image of her late husband. Black-and-white photos of Clyde Phillip Hill, standing proudly in a U.S. Coast Guard uniform, grace the walls and bed stand of Jean's home in Virginia, Minn.
In a voice barely louder than a whisper, Hill describes the shock of learning, in 2009, that a staff member at the Edgewood Vista facility in Virginia dressed up her husband in a clown wig and then posted the images on Facebook. The elderly man was also put in a sun room "for a time out period for punishment," according to a 2009 police report.
The abuse didn't end there. One caregiver hit a resident in the chest with the back of her hand, while another slapped an elderly woman and pinched the side of her breast. An employee told investigators that the abuse "went on for months."
"It was shameful, just shameful what happened," said Hill, a former schoolteacher.
The state Department of Health cited the Virginia facility for failing to report the maltreatment and failing to ensure that residents were free from physical and verbal abuse. One caregiver was charged with fifth-degree assault and disorderly conduct.
Today, such care lapses are starting to get the attention of state legislators. In 2013, the Department of Health worked with the Legislature to pass better protections for patients who have home-care providers. The law increased the frequency of inspections and called for a system of increased fines based on the severity of violations. The law also requires on-site inspections of assisted-living centers every three years.
A number of large senior care companies, including Edgewood Management, supported the tougher rules.
Even so, Deb Holtz said Minnesota needs heftier fines: "If you increase financial consequences, you will often see systems changing as a result."
As for Carol Johnson, she simply wants Edgewood to guarantee that it will inform residents when a crime occurs. But her health is waning, and she is not preparing for a long fight with the company.
"I came here to live out whatever days I have left in peace," she said. "Unfortunately, they have not been peaceful."