“Unbelievable.”

That was Wendy Silverthorne’s first reaction when she learned this week that the Hawaii Department of Health has blown its deadline to start posting online the inspection reports of more than 1,600 long-term care facilities.

The Kailua native inadvertently became the poster child for the issue two years ago when a handful of state lawmakers, government officials and advocates for the elderly began their uphill battle to force the department to change its longstanding policy of requiring the public to file a formal written request to view the violation histories of the care homes.

photograph Cory Lum/Civil Beat

Elderly residents receive help at a long-term care facility. Hawaii passed a law in 2013 requiring the Health Department to start posting the inspection reports for care homes online beginning Jan. 1, but officials are not ready to do so yet.

Cory Lum/Civil Beat

The process can take up to 15 days and the department charges for the time it takes to gather the records, redact names and make copies. That’s too long and costly for people in situations like Silverthorne’s. She only had a few hours to find a place for her mother who was getting discharged from a hospital but wasn’t well enough to return home.

“We’ve been waiting for this a long time. We’ve got a law. It was signed. Don’t you have to follow the law?” — John McDermott, the state’s long-term care ombudsman

“It’s just so scary to think about putting someone you love in a place that you basically have no information about other than what they tell you, and unfortunately that may or may not be accurate,” she said.

Her mother died Dec. 4, 2013, but Silverthorne continued the fight for others who are bound to find themselves in a similar situation — especially in Hawaii, one of the fastest-aging states in the country.

Wes Lum, the former director of the state’s Executive Office on Aging, explained the need for the law in his testimony on the legislation.

“This bill is about transparency, consumer education and consumer protection,” he said.

“Hawaii’s senior and disabled populations are rapidly increasing while our nursing home bed capacity has remained approximately the same. When there are no nursing home beds available, people have to consider community-based options — but there is currently no quick or easy way for the public to attain information on the quality of care of these facilities.”

Care Home Industry Fought the Bill

After years of yielding to the powerful lobbying force of the adult care home industry, the Legislature finally passed a bill that made Hawaii the 28th state to require the inspection reports to be posted online. Then-Gov. Neil Abercrombie signed Act 213 during a special ceremony in July 2013.

It was more than just a suggestion for the Health Department to consider. It was a legal mandate that says, beginning with inspections occurring on Jan. 1, 2015, the department must post on its website electronic copies of the reports for all the inspections it performs for several types of state-licensed long-term care facilities, which together house more than 12,000 residents.

Despite the 18-month lead time and receiving all of the money and positions the department said it would need to implement it, there is scant evidence that the state is anywhere closer to posting the inspection reports online now than it was in 2013. 

The department’s annual report to the Legislature, filed in December, suggests the department doesn’t understand when the deadline was.

“We didn’t have enough time to put a system up that made sense to the public.” — Janice Okubo, spokeswoman, state Department of Health

In a description updating lawmakers on Act 213, the report says the law requires the department to start posting the inspection reports online “beginning July, 2015.”

Another sign of impending delay came last September during a meeting of the Policy Advisory Board for Elder Affairs.

Keith Ridley, a board member and head of the department’s Office of Health Care Assurance, which oversee the vast majority of the state’s long-term care facilities, said at the meeting that the posting of the inspection reports “will depend on the priorities of the new governor to clarify the language relating to what has to be posted and the timing of the postings,” according to the meeting minutes.

Ridley could not be reached for comment this week.

Last July, he told Civil Beat that he wasn’t sure the Jan. 1 deadline was realistic. He said his office was still in the process of establishing a position and deciding which inspection form would be posted online.

The law created a task force of stakeholders to recommend a new inspection form that was fair to the care home operators and useful to the public. The group recommended using the same form that the federal government uses for nursing homes — all of those reports have been available online for years.

Candidate Ige Lauded New Law

Gov. David Ige, who took office Dec. 1, has appointed Dr. Ginny Pressler to head the Department of Health, replacing Director Linda Rosen.

Department spokeswoman Janice Okubo said Thursday that she was unsure if there have been any inspections since Jan. 1 or if the department had the capability yet to post them.

The department needs clarification over what the law means by “completed inspection,” she said, and whether the report should be posted right after the initial inspection or wait until the care home operator submits a plan of corrective action to include with it.

Particularly if the latter holds true, Okubo said the department may need more than the five days the law allots to post the report online after an inspection is completed.

She also said the department doesn’t want to post the reports without including explanations of the terminology used within them and other information to help the public properly understand them.

“As governor, I will ensure the law is executed immediately because seniors in adult care must be ensured a safe environment when they may be entering vulnerable years.” — David Ige, campaigning for governor last October

That was the concern of care home operators like Lilia Fajotina, who was president of the Alliance of Residential Care Administrators when the bill was under consideration. She objected to posting the reports online, saying the citations are vague and confusion would arise from letting the public try to make sense of them.

The task force, which officially dissolved June 30, 2014, had recommended that the Legislature take up many of these issues last session and extend the work the group was doing for another year. But lawmakers didn’t address the concerns detailed in the task force’s report.

Okubo said the department is still working with the task force on recommendations to amend the law “to make it a little more doable for us.”

“We didn’t have enough time to put a system up that made sense to the public,” she said.

In the days leading up to his Nov. 4 election win, Ige told Civil Beat that he fully supports the law requiring the inspection reports to be posted online. He voted for it as a state senator in 2013.

“I believe in honesty, openness and transparency, especially when it comes to such an important issue like the care and safety of our kupuna,” Ige said in October. “As governor, I will ensure the law is executed immediately because seniors in adult care must be ensured a safe environment when they may be entering vulnerable years.”

Ige said that he would work closely with the Health Department to make sure it is compliance with the law and has sufficient resources to follow it.

If needed, he said he’d also work with his former colleagues in the Legislature, which starts its next session Wednesday, to immediately address any issues that may arise when the law is implemented.

On Thursday, Ige spokeswoman Cindy McMillan said Ige’s position hasn’t changed. She said she didn’t know why health department officials aren’t moving more quickly.

‘Eighteen Months Is a Lot of Time’

House Vice Speaker John Mizuno said Wednesday that the fact that the Health Department isn’t ready to comply with the law should not necessarily be considered a major setback.

“This could actually be a good thing,” he said, noting that lawmakers could use the opportunity to improve the law.

“I’ve come full circle,” Mizuno said. “The website posting of any violations is not bad, but it should be expanded to recognize care homes that do a stupendous job — like with a four- or five-star rating.”

He acknowledged the inherent problem of the Legislature making laws that aren’t followed.

Mizuno said lawmakers should demand an explanation from the Health Department.

“There is no excuse,” he said. “The public deserves to have an answer. I can understand why some people will be disappointed.”

The law appropriated $148,000 over two years to fund two full-time positions and buy the necessary computer equipment.

“The website posting of any violations is not bad, but it should be expanded to recognize care homes that do a stupendous job — like with a four- or five-star rating.” — House Vice Speaker John Mizuno

John McDermott, the state’s long-term care ombudsman, said posting the reports online is more than just the government becoming more transparent; it could save lives.

“There were a lot of people who testified in favor of this,” he said. “We’ve been waiting for this a long time. We’ve got a law. It was signed. Don’t you have to follow the law?”

The public’s ability to access free, timely online inspection reports can make the difference in placing a loved one in a good care home or one of the “rotten apples,” as Mizuno has said.

Earlier this month, Jennifer Polintan, a Waipahu foster care home operator, was sentenced to a year in prison for manslaughter in the death of 88-year-old Nona Mosman, who was living at the home in her care.

The case revealed that Polintan had another full-time job and left the care up to her unqualified relatives. Mosman died in May 2013.

Silverthorne, who now lives in Washington, said she was lucky. She had the means to travel back to Hawaii multiple times to help find a good home for her mother. She also had friends and family on Oahu who personally checked out some of the homes and were able to weed out bad ones.

“There’s a lot of us who grew up in Hawaii and still have parents there and you just don’t know you need this information until that day comes when your loved one’s circumstances change,” she said.

Kailua resident Bruce Bolos, who helped Silverthorne find a quality care home for her mother, was frustrated that the state isn’t on track to start posting the reports online.

“Eighteen months is a lot of time to figure out what you’re doing,” he said.

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