ARLINGTON, Texas — Cara Jefferson couldn’t believe her eyes when she arrived at the boarding home.
Her mom always prided herself on always dressing well. Now, she lay on a too-small bed with no bed sheet at the unlicensed Arlington boarding home, Jefferson said. The smell of urine permeated the air.
When she turned her mom over, she saw blood and a wound on her mother’s buttocks that took her breath away, Jefferson said. Her mother moaned in pain and told her she hadn’t had anything to eat in days.
“She just kept saying, ‘I’m hurting. My body hurts. I’m hurting. I’m hurting,’” Jefferson said.
She tried to understand how this could have happened. Her mother, Ella Sanders, 68, who had dementia, only lived in the boarding home for a few months. Jefferson said she knew she had to get her mother out of that house immediately.
Her mom died 13 days later. The death certificate said she died of sepsis caused by a urinary tract infection.
“She didn’t deserve this,” Jefferson said. “Nobody deserved that.”
Other families told WFAA about what they said happened to loved ones in other unlicensed boarding homes.
Jacqueline Thomas died after she got “sores on her buttocks … so badly inflamed that [she] could not lay on her back,” police records show. And Ellen Johnston said she suffered neglect in a boarding home – but she lived to talk about it.
A WFAA investigation found the operators of those boarding homes had been on the state’s radar for years. The operators had been sued by the state for running unlicensed facilities that violated state laws, but it was no deterrent.
The issues surrounding boarding homes made headlines this spring following the arrest of Regla Becquer, who ran homes in Tarrant County. She has since been indicted for murder in the death of a man in her care, and Arlington police are looking into other client deaths and how she and her relatives came to own property belonging to some of them.
“The reason you see so many of these unscrupulous owners popping up again and again and again is because that financial incentive is pretty strong,” said DJ Maughan, a public health expert and professor at Oklahoma State University.
Nearly 300 houses in violation
Loopholes in state law allow boarding homes to operate often without licenses and oversight.
If a boarding home has more than three residents, and caretakers help with needs like bathing or eating or taking medication, Texas requires the operator get an assisted living license. To get that license, the fire marshal and regulators inspect to ensure it’s safe for people to live there.
But WFAA found some operators ignore the law and avoid oversight by concealing how many clients live in their homes – which advocates and experts say puts vulnerable people at risk.
A WFAA analysis found regulators discovered nearly 300 houses statewide in violation of licensing requirements from 2021 to 2023.
“The way they get around it is to say they're not providing any services,” such as bathing or feeding assistance, said Catherine Hawes, a retired Texas A&M professor of health policy and management and an expert on long-term care. “The state agencies don't have enough staff to check on it, and they only check on it when there's a problem.”
For more than a decade, regulators have made repeated visits to a tidy brick home on Olympia Drive in Grand Prairie.
Over the years, it has been operated by different people, and repeatedly found to be an unlicensed assisted living facility in violation of the law.
In September 2018, records show, Tiffany Brown was in charge when they cited the facility. Over the following year, inspectors found her violating the law three more times.
But the home continued to operate illegally. Twice in 2020, Brown falsely told an inspector that one of the residents was a relative to get around licensing requirements, state records say. In 2021, after Brown wouldn’t let an inspector inside the home, the state sued and got a court order. When inspectors got in the house, they found her – again -- running an unlicensed assisted living facility.
“The consequences of defying the licensure standards are so relatively minimal compared to the gain to be had, that if you do a simple cost benefit analysis it’s worth the risk over and over again,” Maughan said.
Brown was still in business last September of 2023 when Stacey Sifert needed a place for her mother, Jacqueline Thomas, a dementia patient.
Sifert said she didn’t know Brown’s history with regulators when she chose her as her mother’s caretaker.
“My mom was in skilled nursing, and I needed a place for her to go,” Sifert said.
Sifert agreed to pay Brown $1,200 a month for 24-hour care, according to text messages between her and Sifert.
About six months later, a 911 call brought paramedics to the home.
“The paramedics told me that they found her on the floor covered in her own fecal matter,” Sifert said.
Brown told police that an employee hadn’t shown up for work and that she was “unaware the patients were alone,” court records state.
Sifert’s mother was hospitalized and then later moved to a nursing facility.
“She wasn't eating,” Sifert said. “She wasn't drinking. She never walked again.”
Sifert said Brown asked her to pay the $600 that remained for her mother’s housing bill. Sifert refused. Brown wrote in a text, “I guess you’re not paying me. ... I pray God has mercy on you."
Later, on April 17, Thomas died.
A second client at another Grand Prairie boarding home run by Brown ended up in the hospital in March. The wheelchair-bound client had developed “bed sores to the point where a bone in her back” was exposed, court records state.
Brown now faces felony charges in connection with Thomas and the other client.
She declined to comment.
Thomas’ case reveals another problem: the lack of accountability among the people that help families find housing.
Sifert says before her mother went to live in Brown’s boarding home, a nursing facility put her in touch with a consultant who helps seniors find housing. He recommended Brown.
“I asked if she has had any problems and any complaints, and they said, ‘No, she's great. Everybody that goes stays for a long time. They’re all happy,’” Sifert said.
Sifert thought the boarding home was licensed.
“I thought it was a 24-hour care facility, not a boarding home,” Sifert said.
When WFAA reached out to the consultant, he told us that operators like Brown pay him a fee – usually a percentage of that first month’s housing – to refer clients.
He said he heard complaints from clients that Brown verbally abused them and wouldn’t let them use the phone, so he had stopped referring clients to him.
But the consultant said he recommended Brown to Sifert anyway. He said it fit Thomas’ budget.
“She couldn't afford my standard licensed facilities,” he said.
He said he never disclosed the complaints that he had heard about Brown to Sifert.
Inspectors 'felt threatened'
There’s another boarding home operator that’s been on the state’s radar, too.
Her name is Ireka Hamilton. She has run several homes in Tarrant County over the years.
Records show state regulators began investigating Hamilton and her business partner more than a decade ago. They found them operating unlicensed assisted living facilities at two locations.
The state filed a lawsuit in 2014 and got a court order barring Hamilton from operating assisted living facilities. But she wasn’t barred from running boarding homes which, again, don’t require a license in most parts of Texas.
Still, she remained on the radar of regulators – particularly, one of her houses on Saddleback Drive in Arlington.
Inspectors documented what happened when they visited there in June 2019. Hamilton was “yelling at a caregiver” when they arrived, shouted at a state director on the phone, and told surveyors they were “stupid” and “this was harassment,” inspectors wrote.
She did agree to let them in, but the inspectors wrote that they cut the inspection short because they “felt threatened.” As a result, inspectors couldn’t determine if Hamilton was operating in violation of the law.
It is not clear what regulators did next, if anything.
The following year, in 2020, Cara Jefferson moved her mother, Ella Sanders, into that same home on Saddleback. Because they’re not regulated by the state, there’s no such thing as a statewide database or inspections or enforcement actions against boarding homes.
She’d lived there about four months when Jefferson said she found her mother near death and smelling of feces.
Jefferson said she spoke with Hamilton a day after mother was removed from the home.
“I asked her, ‘What happened to my mom?’ I said, ‘When she stopped eating and stopped drinking, that wasn’t alarming to you?’” Jefferson recalled. “I can’t remember the answer that she even gave me.”
'We were told all the right things'
More than a year after Sanders died, retired nurse Ellen Johnston moved into a different Arlington home run by Hamilton. Johnston suffers from Parkinson’s Disease and her family could no longer care for her.
“We were told all the right things” by Hamilton, her daughter, Tanya Winn said, adding that she thought it was a licensed facility. “I absolutely felt safe and protected sending her there.”
Over a four-month period, Johnston lived in two of Hamilton’s homes. Both of them, Winn said, housed six to eight people and they offered the services of an assisted living facility. Neither house was licensed, records show.
In January 2022, an ambulance took Johnston to the hospital with an infected pressure wound.
“I’ve never seen something so disturbing,” Winn said. “You could see the bone and raw flesh.”
As her mom fought for her life, Winn said she spoke to Hamilton. She said Hamilton wanted to know when she would be paid.
“She asked me if she could go to the hospital and pick up payment for my mom,” Winn said. “I dared her at that point because I was a little mad.”
State regulators have continued to have Hamilton on their radar.
Twice in 2022 at two different homes in Arlington, state records show, inspectors cited Hamilton for operating unlicensed assisted living facilities.
“That is so frightening to know that she was still doing this years later,” Winn said.
Unlike Jacqueline Thomas and Ella Sanders, Ellen Johnston survived her time in an unlicensed boarding home.
She now lives in a nursing home. Her wound is still healing, two and half years later.
“I went through hell,” she said. “She should have been taking better care of me.”
Johnston and the family of Ella Sanders sued Hamilton and her company over allegations of mistreatment. Both lawsuits were settled.
WFAA tried repeatedly to speak to Hamilton prior to the lawsuits being settled. Her attorney said in a statement that those settlements prevent Hamilton from “addressing those allegations.”
The families of the three women say laws need to change to protect vulnerable Texans who live in boarding homes. Currently, cities can choose whether to require boarding homes to obtain licenses and submit to regular inspections, but only handful actually do. Also, the families say consultants who are paid to recommend problem operators to families also should be held accountable.
“There’s people out there referring people to places like this without any kind of fact checks,” Winn said. “It is incredible that people are allowed to take care of individuals, no matter their age, without any inkling of concern.”
The Texas Department of Human Services Department told WFAA in a statement that it’s not a crime to operate an unlicensed assisted living facility. A spokeswoman said if an “individual continues to operate an unlicensed facility,” the state can seek a court order to stop them.
However, WFAA found examples in state records of operators who ignored those court orders and kept on operating.
Tiffany Brown is out of business and out on bond. Someone else is operating the house on Olympia Drive.
Hamilton is still operating the house on Saddleback, where Sanders lived.
WFAA spoke to a caretaker who said the people living there have dementia. Asked what they do for them, he replied, “Everything.”
Email investigates@wfaa.com