A Miami-Dade nursing home is closing its much-maligned pediatric unit, amid a controversy
over the shunting of disabled children into institutions.
Carol Marbin Miller, [email protected]

A Miami Gardens nursing home linked to the deaths of two youngsters is closing its 60-bed children’s unit, the epicenter of a bitter dispute over Florida’s system of care for profoundly sick and disabled children.

About a week ago, Golden Glades Nursing & Rehabilitation Center informed state health administrators of its plan to shut down the harshly criticized pediatric unit. The facility was housing about 30 children late last year, although the number had since dropped to 19, said Lori Weems, a lawyer for Golden Glades’ owners.

“We have been aware of the facility’s plan to close the pediatric wing for a few weeks. Various staff from the agency have been assisting them and our nurse care coordinators are working with families,” said Michelle Dahnke, spokeswoman for the state’s Agency for Health Care Administration (ACHA). “Ultimately the transition location for the child will be determined by the parent and we want to ensure they are fully informed.”

Florida’s decision to house hundreds of profoundly disabled children in institutions designed for elders has drawn fire of late, both from children’s advocates and the U.S. Justice Department, which has accused the state of cutting in-home care for frail children so deeply that parents often have no choice but to institutionalize their loved ones.

Golden Glades is one of six nursing homes in the state licensed to care for children. Its problems, highlighted in a series of Miami Herald stories, included two deaths and a series of state and federal fines totaling over $300,000.

The home, which changed ownership last June, has sought to streamline the transfer of children by donating a special bed with protective netting to the family of one child, allowing the boy to return home to his parents. The child, who suffered from frequent spasms and movements, requires the netting to prevent him from falling out of bed or injuring himself against metal railing.

“That child,” Weems said, “is getting to go home.”

The nursing home also is “raising private funds to construct a wheelchair ramp” — which was, like the special bed, not covered by Medicaid — “so that a wheelchair-bound child whose parents very much want to care for him can go home,” Weems said. Medicaid is the state’s insurer for needy and disabled people.

For several days, Weems said, social workers and administrators at the home have been working with ACHA to provide options to the parents or other caregivers of the children who had been living there. They arranged tours of group homes, medical foster homes and other nursing homes, and offered to help find services for families that wanted to bring their children home.

The state Department of Children & Families had several foster kids who were living at the nursing home, said Joe Follick, a spokesman for the agency. As of Monday, three of the DCF kids remained at Golden Glades; one was moved to a medical foster home Wednesday, another is scheduled to move to a medical foster home “shortly,” and a third will be moved under the oversight of a sister department, the Agency for Persons with Disabilities.

“We have been diligently working to find a different home for them, and every child in a skilled nursing facility,” Follick said.

“We have created a new system to help ensure that every child in our care — except in extremely sensitive medical situations — can live in a home setting where they can receive the same attention and love that every child deserves,” he added.

The lion’s share of Golden Glades’ children, however, are headed to other nursing homes. Of the 19 who remained on Thursday, Weems said the parents of 15 of the “child patients have chosen continuing residential pediatric care for their children.”

Gwen Wurm, a University of Miami pediatrician who has been working with child welfare administrators to recruit foster parents who are willing to care for severely disabled children in home settings, called the transfer of the children into yet another nursing home unfortunate.

“This is an absolute missed opportunity,” said Wurm, who heads the medical foster care program for Jackson Health Systems. “They should have . . . met with every parent and every family to come up with an array of services that made it possible to allow more of those children to be in a home. It is best for children to be in a home setting, with a loving family — if that’s possible. It also is possible to save money that way.”

Durell Peaden Jr., a Panhandle doctor who served in the Florida Senate from 2000 to 2010, most of them spearheading issues related to medical care, said the state needed to “redesign” its system of care for medically fragile children to promote greater use of community-like settings.

“You can’t keep just cutting the budget so that children are sequestered away and deposited in
institutions,” said Peaden, who is a Republican from Crestview. “That’s just from the standpoint
of a country doctor.”

Golden Glades had hoped to make its pediatric wing a model for the treatment of medically fragile children, Weems said.

“Our primary goal was to make substantial improvements to the facilities and to the care in the pediatric unit so that the extremely ill children had a much higher quality of care, a safe environment, and a place where they were easily accessible to their families,” Weems said. “When they approached me initially, they wanted to make massive structural improvements, to add a playground, and to change the facilities dramatically so that it was much more fun and age-appropriate.”

Weems declined to specify why the new owners opted, instead, to close the unit, except to say that it was “due to changing circumstances and policy decisions, and after extensive cooperation and input from policy-makers and key agencies.”

In business for only about a half-year, the ownership group, Kabirhu Associates, confronted a litany of problems, many of which began long before they took over.

In September 2011, federal health regulators imposed the largest Florida nursing home fine in recent memory, $300,000, in connection with the death of a severely disabled 14-year girl, Marie Freyre, who perished only hours after being admitted to the home when caregivers neglected to give her life-sustaining anti-seizure drugs. Her story was highlighted in a series of Miami Herald stories.

Teenager Bryan Louzada, who died at the home in July 2010, also was the subject of a Herald story on the state’s warehousing of disabled children in nursing homes.

Late last month, ACHA imposed at least $7,500 in additional fines as part of a settlement agreement over Marie’s death.