When Hawaii lawmakers decided last year to require unannounced inspections of state-licensed care facilities for the elderly and disabled — a policy most states adopted years ago to hold the growing industry more accountable — they also chose to delay doing so until July 1, 2019.

Rep. Della Au Belatti, who inserted the last-minute amendment, said it was necessary to first gain a better sense of health inspectors’ workload and understand the outcome of the unannounced visits and inspections they conduct.

The same bill required unannounced inspections of medical marijuana dispensaries to start almost immediately.

The amended bill included a provision requiring the Department of Health to submit annual reports about the inspections it does for the roughly 1,700 care facilities it oversees.

The first report was filed earlier this month with the Legislature. It was all of four pages, including a cover page, a blank page and a page citing the law that set out everything the report was legally required to have in it.

State long-term care ombudsman John McDermott called the department’s report “terrible,” questioning how the information it contained would justify the decision to not change the policy immediately.

“Why it takes three years to do this is a mystery,” McDermott said.

Specifically, the report was to include: the annual aggregate numbers of announced and unannounced visits conducted by the department; the annual aggregate numbers of unannounced inspections as follow-up visits, visits to confirm corrections or deficiencies, or visits to investigate complaints or suspicions of abuse or neglect; and the general outcomes and corrective actions taken by the department as a result of the visits and investigations.

The report answers the first part in a table that shows 350 of the 2,154 inspections and visits last year were unannounced, about 16 percent. There were 67 unannounced inspections of nursing homes, which is required by federal law for Medicare and Medicaid certified facilities.

It ignores the second requirement for a breakdown of why the visits and inspections were made. And it provides a single sentence to address the third requirement about general outcomes and corrective actions:

“Overall, most inspections result in citations for non-compliance with regulations and all citations are required to be corrected by the facility before the facility receives their renewed license or certification,” the report states.

McDermott said he was concerned that “most” inspections, even announced, result in citations.

“That’s not good,” he said.

Belatti did not respond to requests for comment about the report. Neither did Keith Ridley, who heads the department’s Office of Health Care Assurance, with oversees the care facilities.

A department spokeswoman also did not respond.

Belatti has said that “everyone is concerned about patient safety” and that’s why she worked so hard to get the amendment in the bill delaying the requirement for unannounced inspections. She negotiated the final version in April with Sen. Roz Baker, who also did not respond to requests for comment.

“If they are understaffed, it will become very clear to us because of the number of inspections that they are doing,” Belatti said in an interview after the full House voted to pass the bill last year.

Ridley has said he wants unannounced inspections and his boss, Health Department Director Virginia Pressler, has called them a “good idea.”

To health inspectors, “visits” are different from “inspections.” Inspections can last for several hours, and surveyors file written reports on the conditions they find that become publicly available. Visits are typically much shorter, sometimes lasting half an hour or less.

Some care home operators have said they are fine with the state doing unannounced visits, but for decades industry groups have fought moves to require unannounced inspections as part of the licensing or certification process.

In testimony on bills before the Legislature, industry groups representing the care facilities have said the operators need to know when the inspectors are coming so they can get their paperwork in order to make sure they are home with their clients and not out running errands, such as picking up medicine or taking someone to the doctor. They’ve also cited privacy concerns.

But critics have maintained that an unannounced inspection is the only way to get an honest snapshot of how the facility is running. They say when the operators know the inspectors are coming, they are able to quickly shore up any deficiencies in preparation for the visit.

Richard Mallot, executive director of the New York-based Long Term Care Community Coalition, has said announced inspections are “just an empty shell when it comes to accountability.”

Read the full report below: