We in the Utah Department of Health and Human Services (DHHS) are committed to ensuring that Utah’s most vulnerable citizens — older adults, people with disabilities, those with mental illness, adolescents and children — are cared for in settings where their health and safety needs are paramount. We are dedicated to ensuring this occurs through reforming the system that licenses private providers who serve these individuals.
Last week, the Disability Law Center (DLC) released a report about mistreatment of individuals at the hands of people who were supposed to care for them and keep them safe. We are grateful to the DLC and its advocacy for vulnerable Utahns. We share the DLC’s concerns regarding the programs in the report and their ability to provide safe and healthy environments for those in their care.
The report raises questions about DHHS’s relationship with more than 7,700 private business owners, many of which operate 24/7 programs for these vulnerable populations. These programs, not the state, are largely responsible for providing critical care for individuals others turn their backs on. The overwhelming majority of these private sector partners care deeply for these people and provide high-quality services.
The state’s role is to set health and safety standards for providers and ensure these standards are being met. When a negative event or complaint occurs, our licensors perform a limited investigation to evaluate whether licensing standards are violated. They refer many incidents to law enforcement, or to Child Protective Services or Adult Protective Services as appropriate.
In the past six months, our 116 licensors conducted 1,477 unannounced and 2,998 announced inspections of these programs. While inspections may result in findings of noncompliance with licensing rules, we impose sanctions, or conditional licenses, on only the most severe licensing violations. Given that only 30 conditional licenses were issued during this time, it’s clear that the vast majority of these providers are ensuring the health and safety of the individuals within their care.
The DLC and The Salt Lake Tribune accused our department and its dedicated staff of treating these providers too gently. We know our department needs to do everything we can for the people living in these programs and those who love them. But these accusations fail to recognize the complex nature of the relationship between the state and these private providers.
The state must navigate a balance: Ensure there are safe places for individuals to be cared for and that enough private programs remain available for these individuals to live.
When our department fails to strike that balance, we risk reacting too quickly to close a program without a safe placement for individuals in that program to live. In many cases, they can’t simply go home. Who would care for these individuals? Where would they go? So, our department works with providers when possible to correct problems. Facility closures occur when corrective action plans fail to be implemented effectively.
When conditions in these facilities are so poor or when a resident suffers a serious injury or death, we need to move swiftly and effectively to address these issues and, yes, close programs. Unfortunately, the actions we took with respect to Mr. Chien Nguyen, the individual referenced in the DLC report, did not prevent his death, which occurred when the program in which he was placed failed to properly address his health needs.
DHHS is responsible for carrying out the balance established through law and its regulatory framework, and we recognize that we need to do more. We expect programs to take licensing standards seriously, and we have built an enhanced framework to enforce those standards.
Our new noncompliance process starts with the imposition of civil money penalties (fines), a new authority granted by the Utah Legislature that became effective last week. Penalties can increase with the severity of violations, including prohibiting new program admissions and program closures. In the last six months, we have imposed over 128 civil money penalties and issued 10 cease and desist orders on programs not operating with a license.
We are grateful to the Utah Legislature for providing our department with several new tools to increase our authority and transparency when regulating programs. But we aren’t just waiting for action by the Legislature. We are evaluating and revising our administrative rules and increasing the competencies of our licensing staff. Our public website will be enhanced to allow anyone to search any programs and see inspection reports.
While we continue to engage in reforms, we encourage individuals concerned about the conditions in a care facility to report those concerns to the DHHS at 1-833-353-3447.
(Tracy Gruber)
Tracy Gruber is the executive director of the Utah Department of Health and Human Services. Prior to her appointment by Gov. Spencer Cox, she was director of the Office of Child Care at the Utah Department of Workforce Services (DWS) and senior advisor for the Intergenerational Poverty Initiative.
