This Mother’s Day Evelyn Castaneda’s phone rang. Her son broke the news: Castaneda’s mother, Vera Kaneshiro, was dead.

Officially, Vera died of natural causes, which might seem logical given that she had lived 86 long years.

But Castaneda believes the death was anything but natural.

She blames the caregiver, and Hawaii’s foster home system more generally. With proper care, she is convinced, her mother would still be alive.

“They took her to nothingness,” Castaneda said.

“This is an epic failure,” she said, before homing in on her mother’s caregiver at the time of her death. “I feel like slapping that lady and kicking her in the okole.”

The caregiver at the adult foster care home in Waipahu found Vera unresponsive in bed. Vera had a history of malnourishment over the past several years, and starting in 2011 she was fed through a feeding tube.

The emaciated octogenarian was transported to the hospital, where she declined for 12 days before succumbing to what the death certificate listed as cardiac arrest, acute respiratory failure and staph infection. The document also lists “severe dehydration,” “severe hypernatremia” and “acute renal failure” as secondary causes.

In the living room of her house in the Mililani neighborhood, Castaneda grabbed a thick stack of medical records from the end of the couch. Flipping through page after page, she stopped and pointed out references that doctors made to dehydration and abnormally high sodium levels when Vera arrived at the emergency room on May 1.

It all marked a striking contrast to the woman that Vera had been. In her prime, she was a sociable former ballroom dancer and avid karaoke singer with a fondness for dinner parties.

In the living room of her modest two-story house, Castaneda showed me photographs of Vera, who she described as a “daughter of thunder” with a fiery temperament.

Nathan Eagle/Honolulu Civil Beat

Evelyn Castaneda reviews her mother’s medical records at her Mililani home, June 3, 2013.

Through tears, Evelyn pointed to one picture, in black and white, of her beautiful young mother on the beach, in a lei and a bathing suit, alongside a chiseled young man. Her mother’s vivaciousness came across in other photos, as well, like the gathering of family and friends in which she carries a young girl in her arms.

But in another photo, taken decades later, she had changed dramatically. It shows three lively silver-haired sisters standing with Vera who by that time suffered from Alzheimer’s. She is expressionless in a wheelchair, disconnected from her sisters and the events happening around her.

Her mother’s declining health had led Castaneda to care for her for four years on Guam. After a few months of trying to continue caring for her mother in a makeshift room at her new home in Mililani, Casteneda decided it was too much to handle and found an adult foster care home in Wahiawa that would accept her in March 2007.

The caregivers were “nice people,” Castaneda said, but after noticing some scratches on her mother’s arm she decided to find a new place. The caregiver said the marks were from the door jamb, but Casteneda’s gut told her otherwise.

Castaneda moved Vera to a foster home near Ewa Beach. That went well until one day, Castaneda said, she came back from a visit to Guam and noticed her mother had lost 50 pounds.

That spurred Castaneda to search for yet another home for her mom. She found one while Vera was in the hospital for a long list of ailments, including dehydration. It was the second of three times she was hospitalized in 2011. Hawaii Medical Center West released Vera to the Waipahu care home in June 2011, where she stayed until her final trip to Pali Momi in May.

“My mom was so strong,” Castaneda said. “But her mind and body wouldn’t have been as bad as it was if they didn’t do this.”

Dehydration kills brain cells and causes organ failure.

Castaneda reached for another tissue as she remembered the phone call announcing Vera’s death on Mother’s Day.

In her effort to uncover more about her mother’s medical history, Castaneda has requested the records from Vera’s stay at Hawaii Medical Center West and Kaiser Hospital.

As Castaneda waits for a response to her medical records request, she has been playing phone tag with Community Ties of America, the the Tennessee-based company that the Hawaii Department of Human Services contracts with to license the case management agencies that place residents in adult foster care homes and certifies the homes.

Vera’s primary caregiver deferred comment to a case manager. A message seeking comment from the case manager was not returned last week.

Nathan Eagle/Honolulu Civil Beat

A portrait of Vera Kaneshiro.

John McDermott, Hawaii’s long-term care ombudsman, emphasized that the whole system depends on the case manager doing their job of monitoring.

While some care home residents have children who live in Hawaii, others live on the mainland and rely almost entirely on case managers.

McDermott noted that Vera’s last foster home had routinely passed inspection, but he said that doesn’t necessarily mean much because caregivers are given advance warning.

The state is reviewing the criteria that is used to evaluate care homes after the Legislature passing a bill this past session requiring the Department of Health to post the inspection reports online as of 2015. The bill, if Gov. Neil Abercrombie signs it or allows it to become law, says the reports must be fair to the care homes and to the public that depends on them.

This move came as lawmakers quietly passed a bill during the last session to extend a law that allows less-trained nurses to substitute as the primary caregivers in foster homes like the one Vera stayed at. McDermott has said the law compromises the care of Hawaii’s elderly and disabled.

Meanwhile, Castaneda has concerns about the care home system in general, and she specifically wonders how many elderly people die due to substandard care.

Castaneda hopes others learn from her lessons. In particular, she hopes they will learn to recognize signs of dehydration and other medical problems, and that they will not hesitate to change caregivers if they suspect something is off.

“Let it be a wake-up call,” she said. “It certainly was for me, but it’s too late. I feel like I failed my mom.”

A fan in front of the TV hummed as she sifted through more old photos and Vera’s medical records.

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