Girl Injured as Group Home Scrambled to Care for Relocated Hacienda Patients

The closure of a wing at the now-infamous Hacienda HealthCare earlier this year resulted indirectly in a new victim — a 4-year-old who girl was hospitalized with burns after being moved to a different facility.

The child was one of the many patients who were rapidly relocated to other facilities when Hacienda HealthCare in south Phoenix shut down its skilled nursing facility earlier this year, after a resident with disabilities in the care of its IFC wing, located in the same building, was raped by a nurse and gave birth to his child.

Healthcare Alternatives, Inc., became the 4-year-old's new home in July 2019. She was unable to speak, and had a type of brain damage that made it impossible for her to regulate her own body temperature.

The Mesa company, which receives funding from the state to provide for Arizona residents under the state's Medicaid program, primarily cares for babies with severe developmental disabilities. Its six group homes usually receive young, medically fragile patients directly from the hospital, but stepped up to welcome two former Hacienda patients after the skilled nursing facility announced its voluntary closure in late July.

The girl arrived at Healthcare Alternatives with a hypo-hyperthermia blanket, a medical device for her condition that assists with maintaining steady body temperature, from the previous facility.

At the time, the state's Department of Economic Security's Developmental Disability Division (DDD) was still scrambling to find alternative placements that were equipped to handle the Hacienda patients' complex medical needs. Many were transferred with little warning, leaving new facilities scant time to prepare for their arrival.

"We thought we were doing the DDD a favor," Don Savino, who co-owns the facility with his wife, Elizabeth, told Phoenix New Times on October 22. "And we were trying to help the patients, and protect them — Hacienda implied that the last two patients in the nursing facility needed to get out of there right away."

When relocating a member from one facility to another, according to DES, a caseworker completes an assessment detailing the needs of the transferred patient to ensure that the proper equipment is available, and that staff at the new facility are trained to provide proper ongoing care.

"Typically, in that meeting between DDD, us, and Hacienda, we would have developed a discharge plan that included ordering needed equipment, and getting it delivered to us [before the girl arrived]," Savino said. "But this was such a rush that Hacienda had to give us the equipment that they had, and let us use it, until we could get new equipment provided by a patient's insurance, which requires a physician's orders."

Savino said they received the hypo-hyperthermia blanket without instruction or training, and were instead scheduled to replace it a few days after the child came into their care.

But before the replacement day, a nurse who no longer works at Healthcare Alternatives incorrectly used the inherited device on the disabled toddler, resulting in minor burns and hospitalization.

On October 21, ABC15 News (KNXV-TV) reported that the facility has been under investigation since the incident, meaning the DES had temporarily suspended its ability to enroll new clients. However, while the Savinos were speaking with New Times, they received an email from the state informing them that they were back in compliance. 

"This has been incredibly upsetting for us," Savino said. "It's been nerve-wracking. We did everything we possibly could to get back to where we should be, and have done everything requested of us."

The providers' owners are not aware of the status of the child, as they have not been able to get any information on her condition since the incident. The DES declined to comment, citing the privacy and confidentiality of members’ health information.

Healthcare Alternatives, whose website refers to the company as The Bodgen House, is a state-licensed provider with no previous investigations or history of malpractice.

"The DDD is our largest income source for sure," Savino said. "We bend over backwards to help them, and that's all we thought we were doing. It all seemed above-board."

Group homes that contract with the state have come under heavy scrutiny in the last year following the rape at Hacienda. The care facilities rely heavily on the decisions of the state Legislature, which allocates money to the DDD. A recent DES study of reimbursement rates showed many of these providers only receive about 70 percent of the recommended state funding needed to adequately provide care to patients.

"The rates have not kept up with the increased costs of services and the increased costs of wages," said Wendy Shaw, the chairperson of Arizona Association of Providers for People with Disabilities, who noted that many providers are paid minimum wage. "When you're hiring people at a rate they can make making tacos — and even for nurses, we can't afford to pay the same as you would be able to pay nurses at a hospital — it stands to reason that the folks we are recruiting might not be as experienced as folks who work in some of those settings, where wages can be more competitive. It's going to have an impact on the health and safety of the people we support."

However, The Bogden House is a bit different — it's a nursing-supported group home, which means it receives almost all of the recommended funding for its medical professionals, according to the same DES study. The Savinos pay their nurses a competitive wage to hospitals, the couple said, and most of the provider's original staff has been retained since its founding in 2008. Savino described the blanket accident as unique and horrific for their facility, and the result of an emergency response to Hacienda's situation.

As of October 22, the group home will be able to accept new patients, Savino said.

The DES confirmed that it had lifted the enrollment suspension.

"The health and safety of all members is a top priority of the Department of Economic Security," said Brett Bezio, a DES spokesperson. "DES will continue to monitor the health and safety of all members."