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The city’s code enforcement division sticker reads: “DO NOT ENTER. UNSAFE TO OCCUPY.�

Three weeks ago, authorities rescued nine residents from the house that served as Angelique’s Adult Care Home at 5101 E. Eighth St., near East Broadway and North Rosemont Boulevard. The licensed business cared for seniors, including some under hospice care. They were removed because the air conditioner was broken for days and the residents were in distress from the 100-degree heat inside the house, requiring five to be taken to the hospital, authorities said.

This situation brings to light a difficult decision many families have to make as our population gets older — how to best take care of an elderly relative, especially if they need to be placed in some type of care facility.

ÃÛèÖÖ±²¥ requires adult care homes, assisted living centers and skilled nursing homes to be licensed. However, the state does not require licensing of boarding and care group homes, which provide residents with housing, food and no medical care, said Kathleen Kuczynski, the Pima Council on Aging’s long-term-care ombudsman.

Advocates for seniors say families who need to place an older relative into a care home must research licensed facilities, and once they are placed in a facility, families should visit or have someone check on their loved ones regularly to help prevent problems or elder abuse.

If possible, plan ahead

Family members have to be advocates for their elderly loved ones and learn to navigate their care, said registered nurse Debbie Waring, the Pima Council on Aging’s family caregiver support program coordinator.

Inquiries and research into a residential adult care home, an assisted living facility or a skilled nursing home should start a year or two in advance of the need, Waring advises.

“Planning ahead and looking at facilities before you need them will allow you to make better choices. When you are doing things in a crisis mode, it is hard to make good decisions,� she said. “Planning will also allow you to involve other family members because it can be an overwhelming task.�

The Pima Council on Aging, a nonprofit agency that advocates for the well-being of older adults, can assist families in need of care-home information, including the type of facility, determining the health care and costs, and research tips on the business and employees.

Council staff can also explain the importance of a care home or facility having Medicare certification.

“Medicare does not cover the cost of assisted living facilities or long-term care facilities. But, Medicare will cover qualified health-care costs more often used to pay for a skilled nursing facility, or home health care, which includes physical therapy, part-time or intermittent skilled nursing care or home health aide care,� said Adina Wingate, a council spokeswoman.

Staff can also explain the importance of a facility participating in the ÃÛèÖÖ±²¥ Long-Term Care System, which is designed to help fixed-income seniors and those who are disabled afford care.

The council offers a list of referral agencies that help families find care homes or facilities.

Seek information

Waring said about 300 people a month seek information about a care home or facility for a loved one, and the need to make a plan for finding home care services.

“Most want to keep their family members at home and independent as long as possible,� said Waring. “Our goal is to give them information and consult with them about what they need.�

Added Wingate: “There are many different elements to the conversations. There may be seniors who are very active and want to live in an assisted living community that offers numerous activities. Some may need hospice or end-of-life care. Others may need skilled nursing care.�

Said Waring: “Coming from a nursing perspective, I would question caregivers about different situations, including how they would handle falls, or if they could identify signs of a stroke. I’d question them to see if they could think on their feet and would be able to keep my family member safe.

“If my loved one had dementia and refused to take a shower, I’d question them about how they would handle that situation without escalating it, and see what their alternative solution would be.�

Waring said researching employees’ skills, certifications and education is important, along with the history of the facility through ÃÛèÖÖ±²¥ Department of Health Services records.

The state agency licenses the homes and records citations, deficiencies, monetary fines and when the failings were corrected. It also completes a survey of the facilities once a year.

“Unannounced visits to a care home are always a good thing, and so is visiting during different workers’ shifts,� said Waring.

A facility that has a stable workforce can show the business is taking care of their employees, said Waring, adding that a high turnover in employees may indicate subpar working conditions.

“A high turnover in workers can lead to stressful conditions among residents because they do not have someone who is consistent in their lives,� Waring said.

Kuczynski also advised a review of the facility’s buildings and upkeep, food services section and its emergency readiness plans, including the response times for paramedics, firefighters or law enforcement. She said the state’s annual inspection, which is available to the public, includes the information.

Kuczynski is a trained advocate who has authority under federal and state laws to investigate and assist in resolving complaints on behalf of residents at long-term care, assisted living and skilled nursing facilities. She said she can check in on residents in care homes or facilities on behalf of the individual or their families who may live out of state.

If family members suspect wrongdoing toward their relatives, said Kuczynski, “they should contact us and we can reach out to Adult Protective Services or the state Department of Health Services� to report abuse or neglect. If a resident is in imminent danger, 911 is called.

She and her staff make unannounced visits to skilled nursing facilities every month, assisted living facilities every other month and adult care homes twice a year. There are more than 300 such facilities in Pima County.

Watch for red flags

ÃÛèÖÖ±²¥ police Sgt. Pete Dugan said many seniors who are living in care homes and facilities are widowed and their children live out of state. He said in addition to making sure their loved one’s physical needs are met, a family member or guardian must also monitor the senior’s bank accounts to make sure no one is financially exploiting them and withdrawing large amounts of cash.

Police say among the red flags are strangers or even a family member coercing an elderly person into making financial transactions. Another sign something is wrong is when an elder is not allowed to speak for themselves and are giving implausible explanations about what they are doing with their money. A third sign is when an elder is fearful that they will be evicted, or institutionalized if money is not given to a caregiver.

The National Institute on Aging says that about 1 in 10 adults over age 60 are abused, neglected or financially exploited. It can occur by “a loved one, a hired caregiver, or a stranger. Abuse can happen at home, at a relative’s home, or in an elder care facility.�

In fiscal year 2017, there were 13,056 reports of vulnerable adult abuse, neglect, self-neglect and financial exploitation investigated in ÃÛèÖÖ±²¥ by Adult Protective Services, according to the agency’s annual report. The reports were a 12 percent increase from fiscal year 2016. (See attached box for link to report.)

In Pima County, total reports received were 2,842 and total cases opened were 2,699. Investigations are conducted in both private residences and facilities. Adult Protective Services staff evaluate an alleged victim’s need for services and offer protective services when needed, according to the report.

Under state law, a vulnerable adult is someone age 18 and older who is unable to protect him/herself from abuse, neglect or exploitation by others because of a physical or mental impairment.

From 2016 to 2018, the ÃÛèÖÖ±²¥ Attorney General’s Office took on about 50 criminal cases of vulnerable adult abuse, financial exploitation and theft, said Katie Conner, an office spokeswoman. The cases were referred to the attorney general by law enforcement agencies or cases originated in the office.

Shut down over heat

At Angelique’s Adult Care Home, the seniors were helped by a nurse of one of the residents who went to check on her client. She found the residents — ages 64 to 86 — in distress from the heat that was recorded at 103.6 degrees inside the home.

ÃÛèÖÖ±²¥ Fire Department paramedics went to the home and police detectives learned the air conditioner was broken for days. Adult Protective Services and the ÃÛèÖÖ±²¥ Department of Health Services were alerted to the incident. The home was shut down.

Cynthia Hermann, 71, owner of the adult care home business was arrested on suspicion of five counts of vulnerable adult abuse and nine counts of endangerment. A search warrant return shows detectives seized documents, including five employee files and two cellphones from the home. Superior Court online records show Hermann has an arraignment scheduled for Aug. 22.

On Friday, a message was left for Hermann, but she did not return a telephone call for comment.

Prior to this latest incident, no enforcement actions were taken against Angelique’s Adult Care Home by the state Department of Health Services, according to the agency’s database .

However, in March 2018 during a health inspection by the state agency, Angelique’s was cited because the manager did not ensure medication for two of four residents was administered properly, posing a health risk to the residents. The problem was remedied the next day.

Another facility that lists Hermann as the principal of the business, ACL Adult Care Homes LLC, at 7622 E. Calle Cabo, received citations from 2015 up to June 2018, including re-occurring employee deficiencies. A total of three fines totaling $1,500 were levied against the business, according to state data.

The deficiencies, which have been corrected, included employees whose records lacked CPR training certification, first-aid training and valid fingerprint clearance cards.