Although nursing homes are more familiar to most Americans, nearly half of all elderly residents of institutions live in adult care homes. Often housed in converted residences, adult care homes usually provide personal care, supervision and activities for a small group of residents. Care in such facilities is often excellent, and may be more personal and comfortable than a larger, medically-oriented nursing home. Sometimes, though, the care can be horrific—as Chiyeko Tanouye’s case attests.

Ms. Tanouye was placed in an adult care home operated by Raquel Bermisa in mid-1999. At age 79, the Pearl City, Hawaii resident was completely unable to provide for her own care, and was confined to her bed.

One common problem experienced by bedridden patients is the development of bedsores—more properly referred to as pressure sores or decubitus ulcers. Ms. Tanouye began to suffer from such sores within a short period of her placement.

Treatment for pressure sores is normally straightforward. Patients must be turned regularly to relieve the pressure on affected areas, and the sores must be cleaned, protected and treated with salves. Regular nursing and medical review is essential to help in the reduction of pressure sores.

Unfortunately for Ms. Tanouye, her caretakers did not follow up with the prescribed medical care. By the time Ms. Bermisa took her to the emergency room last August, she was beyond treatment. Ms. Tanouye died shortly thereafter.

Hospital personnel reported the death to prosecutors, who ultimately charged Bermisa with manslaughter. As operator of the care home, Bermisa was responsible for seeing to the care of Ms. Tanouye, and she failed in that duty, prosecutors argued. Ms. Tanouye’s death from sepsis caused by inflammation of her open wounds could have been avoided, and Bermisa had a duty to provide the care necessary to prevent that death.

Last month Bermisa plead guilty to manslaughter, and she is awaiting sentencing. She is facing a one-year jail term for her failure. Prosecutors believe that hers may be the first such conviction in the country.

Most adult care homes provide good care. Despite that, neglect is unfortunately all too common. Such total disregard for patient care is not common, but it is difficult to estimate how frequently such incidents occur.

Under Arizona law a person can be charged with manslaughter for "recklessly" causing the death of another. That standard is met when the defendant is aware of the risk of injury and consciously disregards that risk. An Arizona conviction for manslaughter will lead to imprisonment for 6 to 18.5 years.
 
  

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