Watch out for the watchdog

By Cynthia Hubert - Published August 18, 2003 in The Sacramento Bee
Carole Herman minces no words as she advocates for the elderly

It has been two decades since Carole Herman turned her rage about the death of her beloved Aunt Millie into a crusade. Twenty years, and Herman is still seething.

"Our elderly people are abused and neglected in nursing homes every single day," Herman says, her eyes narrowing, her manicured fingers flailing, her words spewing out like venom. Homes are dangerously understaffed, she continues. The industry is in cahoots with regulators. Reform has not happened fast enough.

"Things never change," Herman laments, shaking her head. "I want to quit every week."

Nursing home resident Lucille Williams gets a goodbye kiss from her daughter-in-law, Carol Williams. With them is Carole Herman, an advocate for the elderly.

Many in the industry, and those charged with monitoring it, no doubt wish she would. Even some of Herman's supporters admit that her public pronouncements that nursing homes routinely "kill" people and "steal" from them, her relentless stream of formal complaints on behalf of residents and their families, and her occasionally confrontational meetings with administrators and regulators can be over the top. Some of her detractors call her egotistical and overzealous.

"I would describe her as a flamethrower," says Mark Reagan, a San Francisco lawyer who defends nursing homes and their corporate owners.

"It's almost impossible to work with her toward collaborative solutions. I don't see her as a particularly positive force in advocating for the elderly."

But since setting aside her work as a computer software executive to start the nonprofit Foundation Aiding the Elderly in 1983, Herman's commitment to her cause has only deepened.

"I have made plenty of enemies, and they will do just about anything to shut me up," she says, juggling a steadily ringing phone and stacks of files labeled with the names of her frail clients.

"But I won't shut up. I know too much."

Her learning curve has been steep.

FATE was born about a year after Matilda Anticevich died at a Sacramento nursing home in 1982.

Aunt Millie was "like a second mother to me," says Herman, 61, looking at a framed picture of Anticevich on her desk. Eighteen months after Aunt Millie moved into the nursing home at age 77, she died following surgery to repair infected bedsores.

Anticevich's relatives were outraged, and Herman, then vice president of a software marketing company, filed her first complaint against a nursing home with the California Department of Health Services. Investigators deemed the complaint "unsubstantiated," a term with which Herman would soon become frustratingly familiar.

The next year, Herman and her husband, Harris, who in 1974 founded Software Module Marketing with an investment of $1,000, made an initial public offering on the company, which had grown to $10 million in annual sales. The couple, the parents of four grown children, got out of the software business for awhile. Harris began spending more time on the golf course. Carole, a Sacramento native who, like her husband, became wildly successful despite never having earned a college degree, launched FATE in a mission to improve care in nursing homes and help families navigate a complex web of rules, regulations and resources.

She schooled herself on the agencies charged with overseeing nursing homes and learned how to navigate the bureaucracy. She studied regulations and patient rights. She began trolling nursing homes, talking to residents and their families, noting the number of staffers on the floors, questioning workers about why some patients were soiled or had empty water pitchers. She contacted the news media and hounded state and federal officials about inadequate staffing and poor care, occasionally using shock tactics to drive home her points. Once, Herman made members of the Little Hoover Commission wince with a poster of an elderly woman's dead body.

Carol Williams says her longtime friend, Carole Herman, left, can make one phone call and get results when there's a concern about a patient's care in a nursing home.

To the dismay of some in the industry, Herman also began cultivating lawyers willing to file suits charging homes with abuse and neglect. Among regulators, whom she bombarded with complaints, the stylish and articulate former businesswoman gained a reputation as a snarling bulldog.

"Before I met Carole, I thought she had to be the devil herself," recalls Helen Garcia, who for 10 years surveyed nursing homes for the Department of Health Services. "People in the licensing office referred to her as a witch. They told me not to tell her anything if she came around."

Garcia later began contacting Herman "on the q.t.," urging her to file complaints on certain cases that her department superiors declined to act upon. "Every day, I saw incidents of malnutrition, physical abuse, people sitting in their wheelchairs in dripping wet diapers, and in a lot of cases nothing was happening," Garcia says. In 1998, Garcia, shrouded in black to hide her identity, told her story to a congressional panel investigating nursing-home abuse. Garcia later quit working for the state and now is a medical consultant.

"The system doesn't protect people unless they have an advocate," Garcia says. "Carole is a great advocate."

During FATE's first 16 years, Herman never paid herself a salary, and she says she poured more than $150,000 of her own money into the organization. As the group's only full-time employee, she now earns $2,500 a month. Today, FATE has a national following and has intervened in cases from Texas to South Carolina. From her home office, Herman typically works until late into the night, doing research and talking with clients.

"I don't know what I would have done without Carole," says Sylvia Bellew of Carmichael, who sought Herman's help several times for her late husband, Rick, who had Alzheimer's disease.

Herman intervened after Rick Bellew was seriously injured by another patient at a nursing home, and again when he suffered a broken hip. In the first case, she arranged a hearing with state officials after nursing home staffers blamed Bellew for his injuries and tried to bar him from the home. The state ruled in his favor. In the second case, while visiting Rick Bellew, Herman noticed bruises on his lower body and demanded he go to a hospital. Doctors determined Bellew had suffered a broken hip two days earlier. He died shortly after Herman filed a complaint on the matter.

"Carole always took the time to talk to me, to help me sort things out," Sylvia Bellew says. "She never asked me for a thing. She just did what she had to do."

Carol Williams, a longtime friend who has approached Herman with concerns about the care of her mother-in-law, Lucille, in nursing homes, called FATE's mission "God's work."

"If we had to go through some of these things ourselves, it would take us years," she says. "Carole makes one phone call and gets things done."

Herman takes pride in small victories but says she is fighting an uphill battle. She accuses the Department of Health Services and the Attorney General's office of being soft on an industry that has deep pockets and is politically powerful.

"No one wants to hear the truth, which is that politicians fall victim to financial concerns," Herman declares. "Nursing homes are abusing people and killing people, and no one wants to know about it."

Industry groups and regulators take issue with Herman's harsh words.

Reagan, who represents the California Association of Health Facilities, calls many of the lawsuits backed by FATE frivolous and questions Herman's motivations. "I wonder how much she uses these lawsuits as a platform to make a name for her organization," he says.

State regulators are reluctant to talk about Herman.

"We are not comfortable with giving our personal opinion about her," says DHS spokeswoman

Carole Herman of the Foundation Aiding the Elderly visits with client Lucille Williams, right, at Asbury Park nursing home. Herman began working with Williams when her family raised concerns about her care in a previous facility.

Lea Brooks. But Brooks says Herman's "sweeping allegations" about the agency's lack of aggressiveness in enforcing rules on nursing-home care are off the mark.

At the Attorney General's office, Collin Wong also questions Herman's charges of lax attention to nursing homes, arguing that authorities have become far more aggressive in prosecuting abuse and neglect cases.

In 1993, the office filed just one criminal complaint against a nursing home, says Wong, director of the agency's Elder Abuse bureau. Under Bill Lockyer's leadership, he points out, the numbers have climbed dramatically. Last year, the office filed 131 such actions and got 81 convictions for crimes ranging from sexual assault to theft.

"We're talking about a lot of progress in a very short period of time," Wong says. More than 10 percent of the state's 1,400 licensed nursing homes, including some owned by the biggest fish in the industry, now operate under a court injunction ordering them to improve care.

"We're proud of what we have done," Wong says. "Of course, we know that we're only in the first stage of a longer journey. We have a lot of work still to do."

He gets no argument from Herman.

"I have 1,600 active cases in my database," she says. "I have cases filed five months ago with DHS that have not even been investigated. So, yes, we have a lot of work to do."

Subtlety, says friend and nonprofit colleague Dave Lukenbill, is not Herman's strong point. She is a scrapper who rarely is intimidated, and can be less than diplomatic at times, he admits. Recently, a county commission studying issues related to aging kicked her off the panel, calling her disruptive. Herman says she was guilty of nothing but unbridled honesty.

"Carol is a true believer," says Lukenbill, a consultant to grass-roots organizations. "Like many true believers, she is driven to a degree that she turns some people off."

Herman, who moves nimbly on two artificial knees, has no intention of treading lightly.

"I'm not running for public office, and I'm not in a personality contest," she says, climbing into her car after a visit with a client at a local nursing home. "So if certain people don't like me, that's just fine.

"The important thing is that I know who I am, and my family and friends know that I am pure of heart and telling the truth. Nothing else matters."

Foundation Aiding the Elderly can be reached at (916) 481-8558 or www.4fate.org.

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