INDEPENDENCE, La. — More residents and workers who spent three-plus days inside a nursing home evacuation warehouse in Tangipahoa Parish for Hurricane Ida describe horrific conditions in a bare-bones facility, yet records show the nursing homes had been paying tens of thousands for use of the site for several years.
Evacuation plans and Medicare cost data indicate the homes paid thousands of dollars for a facility that relied on camping stoves and portable toilets that were lined up in the gymnasium-like warehouse, separated from residents’ air mattresses on the floor by a moveable curtain.
Nursing home advocates and experts question whether the payments for the possible use of the site were part of a corporate structure aimed at hiding profits from government oversight.
But an attorney for Bob Dean Jr., the owner of the nursing homes and the warehouse, denies any motivation for the payments beyond cost sharing for the expense of the warehouse.
Problems nearly from the start
“We knew from the time we walked up in there that this was going to be tragic,” said a worker for one of the nursing homes who asked not to be identified.
The hurricane tore a path straight for Tangipahoa Parish, straight for the three-building warehouse complex holding 843 residents. The owner of the nursing homes and the warehouse, Bob Dean Jr., decided to move the residents into two of the buildings on site because the third had metal walls and he said he feared it would not withstand Ida’s ferocious winds.
But hurricane event summaries written by Dean’s nursing home administrators indicate a second building started to flood as the rainwater poured down, so all the residents were put into the main warehouse building air mattress-to-air mattress.
An evacuation center that should have been a safe haven for the residents was anything but, the worker said.
"They suffered"
They decided to tell their story after weeks of sleepless nights about the conditions at the warehouse.
“All this was weighing on my heart that these patients suffer. They suffered,” the worker said.
Never-before-seen videos taken inside the warehouse shed more light on the conditions. At 1:25 a.m. on August 30, the power is out for more than thirty minutes when the generator failed. The worker said the same thing happened three or four more times.
In the early hours of the morning, more than a dozen residents can be seen in wheelchairs with others trying to sleep in folding chairs. Air mattresses fill the floor with at least one resident using the foot of another’s air mattress as a pillow laying on the cold, hard concrete.
Tube-fed patients are on hospital beds, but they’re in the minority. Bariatric patients are on mattresses laying flat on top of wooden cots.
Psychiatric patients yell periodically, interrupting the hushed chaos as workers try to help the hundreds in the room.
“Patients had been in wheelchairs for two days straight.”
Resident Lisa Renard told WWL-TV she was one of those patients, spending three days in a wheelchair at the site.
“The way I knew I was in trouble because I smelled decaying flesh. My leg had an odor, it was really bad,” Renard said.
She is a diabetic and she lost much of her left leg after an amputation following the evacuation because gangrene had taken hold.
An attorney for Dean, the owner of the nursing homes and the warehouse, John McLindon, said staff members he consulted did not recall Renard spending days in her chair.
But Renard said she was forced to sleep in it, to use the bathroom on herself in it, without enough help to get to the portable toilets.
Using water pitchers as urinals
The worker WWL-TV interviewed said other residents were stuck on their mattresses using water pitchers for urinals.
“We were on our knees in that filth. We were on our knees trying to clean and change people,” they said.
The conditions deteriorated rapidly after Dean’s seven homes evacuated all their residents to the site. Inspectors from the Louisiana Department of Health inspected the site for the first time as the busses and ambulances were already on their way and Hurricane Ida was churning in the Gulf of Mexico.
Nursing homes paid tens of thousands for warehouse
Evacuation plans dating back to 2019 include a one-page contract that indicates one of Dean’s real estate holding companies, Plaquemine Plaza Holdings LLC was to be paid $20,000 a month by the nursing homes for the warehouse, whether they used it or not.
“It seems rather shocking that they would be paying for something like that monthly. But this is a way to funnel money from the operating company through to another company that's owned by the same owner. So, it's a way to make money,” said UC San Francisco Professor Emeritus and nursing home expert Charlene Harrington.
She said it's a common practice for nursing homeowners to pay themselves through other businesses they own, where one company's cost is another's revenue, but they're both owned by the same people.
According to Harrington’s research, the nursing homeowners often do it to avoid litigation and regulation and to hide profits.
“If they show that they're operating with a very low profit margin or even a loss, then it gives them a better argument with the government to say we need higher payment rates,” she said.
The government, Medicaid and Medicare are the largest source of funding of patient care revenue for nursing homes. A Kaiser Family Foundation study from 2017 found state Medicaid money alone pays for 62% of nursing home residents.
Attorney says costs for warehouse were justified
But McLindon said Dean’s corporate structure for the nursing homes and his holding companies is aimed at sharing the costs, not hiding profits.
“When you buy a building of that size and it's big, you know you've got a mortgage payment, you've got taxes, you've got insurance, you've got monthly maintenance. So, what he did was all seven of the nursing homes would pay towards that monthly expense, and it was not $20,000 for a nursing home. I think the total of the seven,” McLindon said.
While the attorney admits he did not know the specifics, if they all paid equal amounts, that would total $34,285 per nursing home per year whether they used the evacuation site or not.
WWL-TV reviewed cost data the seven homes submitted in recent fiscal years to Medicare and identified possible payments made for the evacuation lease site.
For example, the cost report for 2019 submitted by Maison De’Ville of Harvey indicates $64,536 was paid for an evacuation site building lease.
The exact amount all seven paid is unclear in the data we reviewed.
Whatever the total, the money paid by the nursing homes to help fund the evacuation site fell short of providing a facility that could fully withstand a storm.
The worker said even the main building started taking on rainwater in spots.
“You had the more patients from the wall because the water was coming through and you know, all of the floor was, I mean, in some spots, the patients still laid in the water. They just was on a mattress in the water,” they said.
And the area where the workers were heating up canned food and making sandwiches for the residents was outside the main building.
“The area where they were cooking outside, it was not even five feet from all the trash. It was nothing but dirty diapers. And oh my God. Any anything that had feces on it was you was cooking right by it,” they said.
When asked about the lack of amenities for the money spent on the facility, McLindon, Dean’s attorney, said, “Well, so if you did that, I imagine that twenty thousand dollars would be thirty or forty thousand dollars a month for a building that you only use very rarely, hopefully only very rarely, when a Category 4 hurricane is headed towards you.”
Harrington said Medicare has few regulations about what payments to nursing homes have to be used for, but state Medicaid rules are more strict.
The Louisiana Department of Health said Medicaid does allow nursing homes to pay lease payments to companies with a shared owner, however there are guidelines for how much.
While the department’s multi-agency review of what happened at the warehouse and beyond is expected to continue to the end of the year, the memories of the warehouse keep playing over and over again in the worker’s mind.
“I felt so bad for them because they couldn't do for themselves, and all they could do is just lay there and cry like, oh my God,” they said.
The worker was one of more than 800 laid off because the Louisiana Department of Health took the unusual step of revoking all 7 nursing home licenses that belong to Dean. He has appealed to try and get them back. That process is also still ongoing.