Fear, uncertainty follow abrupt closure of Healdsburg skilled nursing facility

Karen Tovani has done about everything she can think of to find a new home for her life partner, Peter Bantowsky.

Bantowsky has been living at Healdsburg Senior Living Community for a little over two years.

But federal investigators have accused the facility’s owner, Pacifica Senior Living, of infractions like chilly room temperatures, issues with cleanliness, broken equipment, rough handling by at least one employee — and other problems more systemic.

Pacifica cites factors outside of its control, but that’s of little concern to Tovani. Just three days ahead of the impending closure, she saw her options narrowing.

“I’m actually feeling sick to my stomach,” said Tovani, 75. “I have two jobs. I’m supposed to be at one of them Friday morning. But I’m thinking I may have to cancel. I may have to lie in front of a bus.”

On Dec. 29, family members who had loved ones living in the 38-bed skilled nursing unit at the facility were told they had until Jan. 15 to find new accommodations. Most of them were able to do so. But five people, including Bantowsky, remain in the skilled nursing wing of the home. The state says they will be moved Friday. No one knows where, though officials have mentioned sites as far away as Sacramento and Oakland.

“To me, this is a question of the state failing its most vulnerable constituents, the ones they should be taking most care of,” said Bantowsky’s daughter, Jeanne Peregrine. “How can we call ourselves civilized when we treat our elderly this way? We can’t.”

Practically everything about this case has exasperated observers, from the apparent abdication of care by the owner of the facility to the abrupt announcement of closure; from the lack of state intervention to perceived reluctance on the part of other local elder care providers to absorb displaced Medi-Cal patients.

“I think it’s been completely botched,” said Tony Chicotel, a lawyer for the nonprofit California Advocates for Nursing Home Reform. “I just feel terrible for the residents. The feds decertified (Healdsburg Senior Living). It seems pretty irresponsible to not take some sort of ownership in what’s happening.”

Circumstances weren’t always so dire at the long-term care home near Highway 101 in Healdsburg, which offered skilled nursing, assisted living and memory care.

“It was a gem in our community,” said Marie Butler.

Butler’s husband, Richard Pellegrini, entered the memory care unit in 2012, and was transferred to the skilled nursing section a few years later. They enjoyed the amenities. The home sponsored quilt shows, casino nights and holiday boutiques.

“I have nothing to say about the prior owners or administrators, at all,” Butler said. “They were always available.”

New ownership

According to Butler and others, it began to unravel under the management of Pacifica Senior Living, which bought the property four years ago. Pacifica is one of the largest elder care providers in the country, with 88 “communities,” including 46 in California.

Most of the Healdsburg senior staff stayed after the transition, and morale remained high. But the environment started to deteriorate rapidly about a year ago, several people told The Press Democrat.

Healdsburg Senior Living’s shortcomings are documented in 33 allegations substantiated by the state Community Care Licensing Division in 2021.

Even more damning is a 180-page report issued by the federal Centers for Medicare & Medicaid Services (CMS) on Jan. 5. Chicotel, who has worked for the senior advocacy nonprofit for 15 years, called it “an investigative report like I’ve never read before.”

CMS noted two instances of what it calls “immediate jeopardy” to residents found by investigators during visits on Nov. 18-19. One instance involved a male resident whom staff failed to deter from a pattern of inappropriate sexual behavior that, investigators said, could have left female residents unsafe.

The second instance was under the heading of Administration, or leadership.

“I’ve seen reports where day-to-day conditions were worse,” Chicotel said. “I’ve seen the worst there is. But I’ve never seen such a complete leadership vacuum, almost to the point where no one was in charge. There’s no way the day-to-day quality could not have been affected by the vacuum in leadership.”

According to family members, Pacifica started purging employees about a year ago.

“It was like a domino effect,” Butler said. “Staff either quit, or were pressured to leave or were fired. Until there was basically no one in charge.”

Perhaps most disturbing, the facility began operating without a consistent director of nursing, a situation that Crista Barnett Nelson, executive director of Senior Advocacy Services for Sonoma County, likened to “not having a pilot for your airplane.”

Nursing directors started to come and go quickly, with gaps between stints, Butler said. And with the disruption in oversight came a general decline in medical care. Many skilled nursing residents had no up-to-date care plans. Barnett Nelson said several went months without seeing a doctor.

Pacifica Senior Living acknowledges it had staffing issues in Healdsburg, but says much of the difficulty was beyond its control.

“Due to the tremendous burden and stress of running a health care facility during a pandemic, we lost our long time Executive Director and several other tenured department heads,” the company said in a statement. “The leadership team that had been so successful for so many years simply could not find and hire enough qualified staff in the local market to operate the building.”

Pacifica says it employed temporary staff, ran job fairs and hired consultants to plug the holes in its workforce, to no avail.

Finally, on Dec. 13, CMS fined Pacifica more than $325,000 and said it would no longer pay for skilled nursing care at Healdsburg Senior Living with Medicare/Medicaid funds, effectively closing the unit. The state brought in Sycamore Healthcare to manage the unit through the end stage.

This type of action is a rarity, insiders say.

Closures are rare

There are generally fewer than five nursing home closures each year in California, Chicotel noted, and the majority of those are voluntarily exits from unprofitable sites. Federal decertification, he said, is even more rare.

Barnett Nelson said this is only the second instance she has seen in 10 years of elder advocacy in Sonoma County. The first was four years ago, when CMS terminated an agreement with Fircrest Convalescent Hospital in Sebastopol.

It incenses her, and others, to know that Pacifica is thriving, despite its mishandling of the Healdsburg facility. In fact, the company has plans to open a new elder care facility in Santa Rosa, off Airway Drive.

“They seem to put building infrastructure (new Memory Care facilities) and renovating the premises over resident care,” said an email from Burton Barnes, who has been in assisted living at Healdsburg Senior Living with his wife, Patricia, for nearly a decade. “They really look to the bottom line first.”

Leslie Quintanar, regional director of operations for Pacifica, said Santa Rosa’s larger population will make it easier to hire workers.

“Most of our staff can’t afford to live in Healdsburg,” Quintanar said. “Santa Rosa is a little more accessible. Also, this was complicated by the fact that this was skilled nursing. Santa Rosa will be just assisted living and memory care. And that’s in our wheelhouse.”

When relatives of Healdsburg Senior Living residents found out the government was getting involved, they believed the California Department of Public Health would restore conditions to pre-Pacifica levels.

But on Dec. 29, they learned through a flyer posted in the lobby that they had 17 days to find alternate arrangements. They would get no help from the state in doing so. And most have had trouble finding new homes, even as the initial deadline passed.

That, Barnett Nelson said, is because most of the skilled nursing residents at Healdsburg Senior Living were Medi-Cal patients, and facilities don’t receive as much money from Medi-Cal as they do from residents who pay independently or are funded by Medicare. So managers tell authorities their beds are full.

“We’re down to five people left at the site. We have 16 facilities (that take skilled nursing patients on Medi-Cal) in Sonoma County,” Barnett Nelson said. “You’re telling me we can’t find five beds in this county?”

Soaring anxiety

With no clear destination for their relatives, the Healdsburg Senior Living families have seen their anxiety soar over the past month.

Sycamore first offered Barry Bunte space in Lake County or Oakland for his mother, Beverly, who is 94.

“We see my Mom at least 4 days a week,” Bunte wrote in an email last Friday. “If they move her there, we won’t be able to make that happen. This would increase the isolation of our loved ones and I know this would kill my Mom, eventually.”

Bunte said he has located a bed for Beverly, at Apple Valley Post-Acute Rehab in Sebastopol. As of Tuesday, Tovani still hadn’t found one for Bantowsky.

“They mentioned East Oakland at one point,” she said. “I’m 75. I don’t drive at night. I’d probably kill someone driving home. I can’t be going to Sacramento or Oakland or Vacaville. I’d never see him again.”

Remembering real people

She and other worried relatives want everyone to remember these seniors are real people, with life histories, loves and accomplishments.

Klaus-Peter Bantowsky, for example, was born in Hamburg, Germany, in 1938. His family was anti-Nazi, Tovani said, but the Allied bomb that fell on his house in 1943 didn’t know that. Homeless, his parents hustled the kids into a truck bedded with straw, for a long, uncertain drive to southern Germany. Where will we sleep? Bantowsky remembered asking his mother.

It became a trigger point, Tovani said. Anytime Bantowsky had to change rooms at Healdsburg Senior Living, he’d become agitated.

“The crazy thing is, on Friday it’s going to be, ‘Where is he gonna sleep?’” Tovani said. “He’s 83 years old, and now he’s asking the same question he asked when he was 4.”

You can reach Phil Barber at 707-521-5263 or phil.barber@pressdemocrat.com. On Twitter @Skinny_Post.