Wendy Silverthorne walked out of Castle Medical Center two years ago with a huge decision to make in less than 24 hours.
The Kailua native, who now lives in Washington, needed to find a place where her mother could get the care she needed to recover from a serious fall. Doctors said her mother was stable enough that she had to leave the hospital the next day, but not well enough to return home.
There are almost 2,000 facilities in Hawaii that provide long-term care for the elderly and disabled. Deciding which one is the best fit for a loved one’s needs can be a daunting task, especially when information is hard to get.
Hawaii’s 51 nursing homes post their inspection reports — which show if there’s a history of violations and what corrective action has been taken — on the Internet because they are federally regulated.
But Silverthorne’s mother didn’t need that high level of care, nor the higher bill that comes with it. She required something a step down — an adult care home.
Silverthorne scoured the Web, trying to learn which of these facilities would be best for her mother. She soon found out that Hawaii doesn’t require adult care homes to post their inspection reports online.
Although less convenient, Silverthorne tried calling the state Department of Health, which regulates adult care homes, to learn more about individual facilities. But she ran into a wall there, too.
Silverthorne was told to submit her request for information in writing and someone would get back to her within 10 days. Time was not a luxury she had.
Her story, which is hardly a lone example, has inspired a handful of legislators to try to pass a law this session that would require inspection reports to be posted online starting Jan. 1, 2015.
It’s not the first time such a bill has been introduced.
As expected, the adult care home industry is out in force trying to get it shelved again. The people who run these facilities say it’s an invasion of privacy and would cost the state a lot of money.
But changes in House leadership and strong support from senior advocacy groups could make its passage possible this year.
John McDermott, state long-term care ombudsman, said the bill is much needed.
“Hawaii’s senior and disabled populations are rapidly increasing while our nursing home bed capacity has remained approximately the same,” he said in his testimony. “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.”
By 2030, one in four Hawaii residents will be over 60 years old, according to a state plan for the elderly.
McDermott said finding information on nursing homes is easy. Just type www.medicare.gov and click on “Nursing Home Compare” to view annual inspections for every nursing home in the country.
“But if someone prefers an adult residential care home or community care foster family home or assisted living facility, where is that website? Nowhere,” he said, noting that 27 other states have an online site.
The inspections are already being done, so why not have convenient access so the public can benefit, McDermott said.
“The current requirement is that a person must write a letter to the Ofﬁce of Health Care
Assurance, specify the home or facility, and then wait for some state worker to manually pull the ﬁle, redact the names, make a copy, charge for the copying and you will get the information you need now in 10 to 15 days,” he said.
Lilia Fajotina, president of the Alliance of Residential Care Administrators, strongly opposes the bill. She said it would be better to have the actual citation from DOH posted in the care homes.
The citations are vague and confusion could arise, Fajotina said. She noted as an example a citation for accidentally not including the word “lean” on a lunch menu. She said a citation for not writing “lean luncheon meat” ends up posted as “Menu does not meet the nutritional needs of the resident.”
“Posting our violations on the website I believe is violating my privacy and it may be against my civil rights,” she said in her testimony. “Not everyone would open up his/her home to strangers and lose his/her privacy to save the state millions of dollars.”
Esther Pascual is president of the United Group of Home Operators, a member of the Hawaii Coalition of Care Home Administrators which represents 500 adult residential care homes caring for about 2,500 of Hawaii’s elderly and disabled.
“The overregulation and extraordinary oversight of this industry has beaten it in the ground and has driven many legitimate operators out of business while driving up the costs of operations to the state,” she said in her testimony. “This does a great disservice to the aged and elder who prefer the comfortable and relaxed setting of a private home instead of being institutionalized in a huge nursing home.”
Pascual called the measure “extreme” and said care homes shouldn’t be held to the same regulations as hospitals and nursing homes.
State senators are working with the care home industry to find a compromise.
“We want to make sure the public information is available,” said Sen. Laura Thielen, who introduced the bill after being inspired by Silverthorne’s story and recalling her own similar experience. “Hopefully there’s ways to work with the care home industry to address their problems.”
Lawmakers changed the legislation so the inspection reports include the positive things care homes do, not just the violations. The bill was also amended to require the departments of health and human services to remove the negative inspection reports online if the facility has no violations for three straight years.
Green said the discussion has revolved around being fair and safe.
“We want to reward facilities who are doing a good job as well as alert individuals who may have a concern,” he said. “What would be safe for people is a good reporting system so consumers can make a good educated choice about where their loved one might stay.”
The bill heads to the Senate Ways and Means Committee next, but no hearing has been set.
The companion legislation in the House isn’t faring as well.
It cleared the Health and Human Services committees, but the effective date has been pushed back years. It’s a tactic to keep the bill alive, while making it meaningless if passed. Other committees could change it back to 2015 though.
“We’re early in the legislative process and we want to continue the discussion,” said Rep. Della Au Belatti, who chairs the Health Committee. “We want to get more input from the affected departments as well the industry and consumer advocates and patients.”
The bill heads to the House Consumer Protection Committee next, but no hearing has been set. It will also have to make it through the Finance Committee.
The Senate and House money committees will be looking at how much it would cost the state to put the inspection reports online and maintain the system.
The Department of Health, which supports the proposal with reservations, says it will need to hire one extra person to do it, at $46,000 a year. Thielen doesn’t think it will require that much funding though.
The state Department of Human Services, which oversees some of the care homes, isn’t so much concerned with having to post the records online as it is in clarifying the legislation to reflect which department oversees which care homes.
Lawmakers and others familiar with the history of the bill say the testimony from DOH and DHS reflects a changed position after years of opposing the legislation. Supporters of the bill are reassured by this new stance.
Sen. Suzanne Chun Oakland, who chairs the Human Services Committee, said she has also noticed a change in the tone of the care home industry. She said industry professionals normally just oppose the bill, but this session marks the first time she can remember in which they are making suggested amendments.
Lawmakers said they think part of the reason for the bill’s optimistic outlook is just that times are changing.
“We live in the Internet Age,” Green said. “Hospitals and nursing homes are already going through this process.”
Chun Oakland and Thielen said it’s important for the public to have Web-based access to information on care homes. They cited Silverthorne’s story as an example of someone who lives on the mainland but has to find a care home for their loved one in need.
McDermott, the ombudsman, agreed. He said the current process is too slow and costly.
“We need to move into the 21st Century,” he said. “Hawaii can do better.”
But the increased likelihood of the bill passing this session compared to previous attempts may also reflect a change in House leadership.
Mizuno repeatedly shelved the bill. But the committee’s new chair, Rep. Mele Carroll, apparently felt otherwise. The bill passed out of her committee with amendments Friday. Neither could be reached for comment.
Mizuno has received thousands of dollars in campaign contributions over the past several years from adult foster home groups, long-term care agencies and the providers themselves. Not to mention their lobbyists, including John Radcliffe, one of the biggest political players in the state.
Mizuno also represents District 28, which includes Kalihi, where 55 adult residential care homes are located.
Silverthorne no longer has anything to gain if the bill passes or fails. She and her family have made arrangements for her mother.
Nonetheless, Silverthorne said she is pushing for this legislation to become law so others don’t have to endure the same thing.
“It’s been quite a journey,” she said.
Silverthorne recounted some of the horror stories she went through.
For instance, her father asked some of the homes what they would do, hypothetically, if his wife fell again one night. She said he was told that they would put a pillow under her head until the nurse arrived in the morning and could get her back in bed.
“Speaking as an adult child living on the mainland, even though I grew up there, it’s very difficult trying to support my dad making a huge family decision while not having access to information,” Silverthorne said. “The DOH has to make inspections, as required by law. It’s paid for by taxpayer dollars. So why isn’t that information available, especially given the timeline families are dealing with?”