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Challenges Of Care

Sandwich generation faces some tough times
by: , Elvera Stephan and son James, sit together as she holds her granddaughter Valerie. The photo was taken two weeks after Valerie Stephans’ birth in December 2006.

First of two parts

Like many baby boomers, Jim Stephan was caught in the middle. His two oldest children were playing six sports. His aging parents, meanwhile, were struggling to keep up with chores at their house in Bend.

With his only sibling living in Virginia, the task of helping his aging parents was mostly his. When emergencies came up, he would get in the car on Friday after a week's work running a small construction firm and drive to Bend to spend his weekend trying to fix things.

Wanting his parents, Elvera and James, closer to his Lake Oswego home, Stephan - with help from his sister and wife - began navigating a list of senior care facilities provided by the state.

'Where do you even start?,' Stephan said. 'You just start driving around.'

Now 50, Stephan fits the profile of what's nationally known as the sandwich generation: A growing set of adults who care not only for their kids but also for their parents.

'The guilt you feel as your parents are aging and you have your children and you're trying to squeeze everything in … that's a big part of it. You can't fit everything in in a 24-hour day,' he said. 'You feel like you can't do anybody justice. Somewhere, you've got to sacrifice.'

'It's difficult because you're sort of sailing in uncharted waters,' Stephan said. 'You just have to rely on people.'

He ultimately settled on Spring Ridge, a Wilsonville retirement home where his parents enjoyed a small apartment that allowed them to live independently. He later moved them to Spring Ridge Court, an assisted living facility with private rooms and full-time employees to help with daily needs.

But his reliance on Spring Ridge could only go so far. When Stephan's mother began suffering from dementia and his father's body became frail, care options dwindled and they began receiving care in separate facilities. Stephan again began the long drives, this time chaperoning his parents as they visited.

Again the search began. And after looking at about a dozen new care homes, Stephan found what he thought was a solution. In the spring of 2006, he placed his parents at The Pearl at Kruse Way, a combined nursing home and dementia care facility in Lake Oswego. The Pearl was managed by Avamere Health Services, an Oregon company which advertised as a facility to 'assist individuals reclaim their independence' on the Web site of Avamere Health Services.

Stephan's parents moved in spring 2006. They planned to live out their last days together.

Stephan remembers thinking that the center, with its new interior and unique services was a great fit.

He knew the days ahead would be hard. He recognized that his 86-year-old mother, Elvera, would soon be outliving his father.

He hoped The Pearl's 'Best Friends' approach - an intimate program to help his mother with her dementia - would also help her in her grief.

'Avamere told me that they could do this and I believed them that they could take care of her. I trusted them,' said Stephan.

But five days after she moved in, his mother, during a bout of dementia, was handcuffed and left on the floor of the facility. Avamere employees never told Stephan what happened. Instead, he learned the details through the family of another patient.

He felt his trust in Avamere was violated.

In May, a Multnomah County jury agreed, awarding his mother's estate more than $900,000, believed to be the largest punitive verdict ever handed to an Oregon care facility for compromising the safety and dignity of an elderly person. Elvera died at the beginning of the trial; James died last June.

Stephan's experience is unusual. Most residents who live at The Pearl at Kruse Way or the state's other 141 nursing facilities haven't reported any problems.

But as more Baby Boomers age and senior care sees its own boom, companies launching inventive programs risk missteps that can take a human toll.

Health care officials such as those who head Avamere say they too are sailing in uncharted waters, simply trying to build a senior care system that provides a variety of services, allowing seniors to get the care they need where and when they need it.

Among the state's largest senior care corporations, Avamere Health Services was founded 13 years ago by Rick Miller and his business partner Rick Dillon. The Wilsonville-based company last year reported $250 million in revenues, according to an article in American Executive magazine.

With eight facilities in Washington and 30 in Oregon, the company's holdings include a rehab facility each in unincorporated Clackamas County and Oregon City, both built in 1983, and The Pearl at Kruse Way, built in 2005.

Miller said the learning curve was particularly steep at The Pearl, which features unique side-by-side nursing homes - one for dementia patients and the other for rehabilitation.

The Pearl garnered 44 of the 251 citations that the state issued to Avamere facilities in the last two years.

The problems ranged from failing to communicate and follow care plans, to numerous medication errors, multiple violations of state hiring rules and failing to report suspected abuse, provide pain control to patients and properly feed and hydrate clients.

'There was just a combination of things that have gone on to cloud all of the intent, all of the good,' said Miller. 'I've always tried to find the right way to run the business. Long term care is a challenging business at best.'

Unlike most other senior care corporations that focus on a specific service, for example nursing homes, Avamere's offerings run the gamut of elder-care services, including home health care, independent living, assisted living, dementia care, skilled nursing and hospice.

Founder Miller is chairman this year of the American Health Care Association, representing the long-term care industry in Washington, DC. Dillon is the current president of the Washington Health Care Association. Both spend considerable time lobbying for better government reimbursement rates for senior care as well as other industry issues.

Miller said Avamere, meanwhile, reinvests much of its profits in growth and believes strongly in its unparalleled vision that seniors can and should have access to multiple care options without relocating or waiting.

'We're focused on building a business that we want to have when we need this level of care,' Miller said. 'And one thing we know about seniors is they don't want to be in nursing homes.'

But the growing company has had growing pains, said Miller. In 2006, the same year Elvera Stephan was handcuffed at The Pearl and the facility itself was faltering, all of Avamere's facilities fell below state averages on quality surveys for the second year in a row. Aware of the quality control problems and wide fluctuations in facility performance, Avamere's top executives began an ambitious restructuring aimed at improvement.

As that new model emerges - with a chief operating officer, strategist and quality control expert taking direction from a volunteer board of professionals - some problems persist, most minor.

But some, like Stephan's, have been dramatic and life-changing experiences.

During the trial, he had his doubts, said Stephan. His mother's health was at its worst. People accused him of being greedy, a gold digger. But as the stress mounted, he stayed the course, wanting to do the right thing by his mother. And wanting to hold Avamere accountable.

'How did I feel? Like an enormous weight was lifted off my shoulders. It was just a huge relief. And happiness in one sense, like I did do the right thing,' said Stephan.