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Elderly Residents Of Unlicensed Home Pay Up To $9,500 Per Month, State Says

A central Iowa nurse is accused of attempting to exploit a potential gap in state regulation by running an illegal, unlicensed care facility out of this house in Des Moines.
Clark Kauffman
Iowa Capital Dispatch
A central Iowa nurse is accused of attempting to exploit a potential gap in state regulation by running an illegal, unlicensed care facility out of this house in Des Moines.

An unlicensed home for the elderly on Des Moines’ southwest side has been admitting tenants since 2017, with the residents paying up to $9,500 per month, newly disclosed state records show.

The house, now home to five tenants, appears to have been generating up to $46,800 per month for its owner, the records show.

The Iowa Department of Inspections and Appeals and the City of Des Moines are alleging in court that the Sutton Senior Home and its owner, Anne Porter of Ankeny, are running an illegal, unlicensed care facility out of the single-family house, which is located just off Park Avenue at 3219 SW 39th St.

They allege DIA inspectors visited the house last fall, reviewed the level of care needed by the six people who were then living in the house, and concluded it was functioning as either a residential care facility or an assisted living program, both of which require state licensure or certification.

DIA alleges Porter is circumventing state laws requiring licensure and inspection of care facilities by using one corporate entity to provide housing, as a landlord would, and another company that she owns, A-Plus Home Care Services, to provide health care for residents.

In responding to those allegations, Porter’s attorneys have stated in court filings that by delivering housing and health care through two “separate and distinct legal entities,” Porter need not be licensed.

Porter, who is a registered nurse, is merely a “residential landlord in the business of leasing rooms to tenants,” according to filings by her attorneys. They acknowledge that the residents of the home are all elderly individuals “who need varying amounts” of care.

The findings of state investigators who visited the home last fall are detailed in records tied an upcoming administrative hearing at DIA.

They allege that one of the tenants was 77 years old at the time of the visit and had moved into the house in November 2017, paying Sutton $2,100 per month in rent, and paying A-Plus $5,800 per month. The woman required 24-hour supervision for her safety, was diagnosed with Alzheimer’s disease and glaucoma, and had issues with anxiety, paranoia, confusion and wandering.

The other residents of the home were in a similar situation, according to the state:

  • A 73-year-old woman with Alzheimer’s disease was receiving assistance with medication, showering, dressing, meals and transportation. She had been a resident of the home since March 2020, paying rent of $3,700 per month, plus $3,800 per month for services from A-Plus.
  • A 68-year-old woman was dealing with cancer, kidney failure, depression and other serious health issues and was receiving more than 20 different medications and supplements at the home. She moved there in 2019, paying $3,500 per month in rent, plus $200 per day — roughly $6,000 per month — for health care services.
  • A 97-year-old woman who used a walker and required 24-hour supervision was routinely receiving more than a dozen medications or supplements. She moved into the home last September, paying $3,750 per month in rent plus $3,700 per month for health care services.
  • A 95-year-old woman who moved into the home last September was suffering from memory loss, macular degeneration and confusion. She paid $3,750 per month in rent, plus $3,700 for health care services.
  • An 89-year-old woman who moved into the home in April 2018 was paying $3,500 in rent, plus $116 per day for health care services. In April 2020, she was admitted to a hospice program due to declining general health.

Porter’s attorneys are seeking a declaration from the court that the 39th Street house is neither an assisted living program nor a residential care facility. DIA’s position is that it has consistently required licenses of health care facilities and assisted living programs that are “operating in totality through the use of an associated home health agency.”

Porter declined to comment on the case when contacted Monday. On her website, she says she has been a registered nurse for more than 40 years and holds a master’s degree in health care administration. Court records show that in addition to running Sutton Senior Home and A-Plus, Porter also serves as a court-appointed guardian for several individuals in central Iowa.

The outcome of the Sutton case could have major implications for nursing facility regulation in Iowa. If the court rules that a company can bypass state licensing and inspections by having separate corporate entities handle the housing and the health care, other providers might take that same path.

“This case provides an opportunity for legislators to step in and provide better guidance to regulatory agencies like the Department of Inspections and Appeals,” said John Hale, an Ankeny-based consultant who works on issues facing older Iowans. He noted that smaller, single-family types of houses offer a more appealing home-like setting.

“Many refer to this as the “Golden Girls” model, where people share a residence and pay for the services and supports that may be needed at any given time,” he said. “Large facilities seem like warehouses to many individuals and families, and they are looking for something smaller and more comfortable to meet their needs — something that looks and feels like a home, not an institution … Who can own and operate them, and under what circumstances, are policy questions that call for legislative action.”

In 2009, Dubuque Retirement Community, then home to 116 seniors, attempted to avoid state oversight and regulation after being repeatedly penalized by inspectors for poor-quality care. The owners of the facility announced plans to give up their state license as an assisted living center so the property could operate as an apartment complex subject only to landlord-tenant laws, while health care services were delivered by a wholly owned subsidiary that functioned as a home health agency.

The company indicated that by separating the housing component from the health care services, it would be able to provide the same care to the same seniors in the same building, but without a license and all of the attendant regulations and inspections. The Dubuque facility is now a fully licensed assisted living center operating under new ownership.

This article was republished fromIowa Capital Dispatch.