The public will likely have to wait longer than promised before gaining free and easy access to the inspection reports of more than 1,600 long-term care facilities in Hawaii.

Despite an 18-month lead time and receiving all its requested funding, there are doubts that the state Health Department will be ready to start posting inspection reports online by Jan. 1 as required by law, according to government officials and lawmakers.

Complicating matters, a working group tasked with providing recommendations dissolved Monday after legislators ignored its request to remain on the job a second year.

After years of yielding to the powerful lobbying force of the adult care home industry, the Legislature in 2013 passed a bill that made Hawaii the 28th state to require the inspection reports to be posted online. Gov. Neil Abercrombie signed Act 213 last summer at a special ceremony in his executive office.

Easy access to inspection reports could assist families when it comes time to choose a care facility.

Vinoth Chandar via Flickr

The legislation included funding for the entire amount — $148,000 over two years — that the department had requested to implement the law, including two full-time positions and equipment. It also created a working group to recommend a new inspection form that is “fair to the care home operators and useful to the public.”

The law took effect July 1, 2013. As of Wednesday, the department has yet to settle on which form it will use or hire someone to post the reports online when they start coming in six months from now.

“I know there was pushback from the care homes and certain things got modified somewhat, but in the days of public disclosure this is absolutely essential,” said Rep. Cynthia Thielen, who was instrumental in the passage of the law.

“Families must be able to have access to this kind of information when they make decisions like this,” she told Civil Beat on Wednesday.

The inspection reports contain the facilities’ violation histories. They are public, but as of now to view them the department requires a formal request in writing. That process can take up to 15 days and the agency charges for the time it takes to gather the records, redact names and make copies.

Care home operators such as Lilia Fajotina, who was president of the Alliance of Residential Care Administrators when the bill was under consideration, said the citations are vague and confusion could arise from posting them online and letting the public try to make sense of them.

“Whether the date is realistic or not, that’s the date that the Legislature selected.” — Keith Ridley, Office of Health Care Assurance chief

The task of actually posting the inspection reports online will fall on two agencies under the Health Department — the Office of Health Care Assurance and the Developmentally Disabled Division.

OHCA Chief Keith Ridley said his agency, which has oversight over the vast majority of the state’s long-term care facilities, is in the process of establishing a position. He said he’s hopeful that when he starts hiring, one of the first candidates to apply will be well qualified and a good fit so the department can meets its deadline.

He said it’s hard to tell if the department will be ready in time, saying it depends on what form the agency ultimately chooses and if it can bring a person on board and trained quickly.

“Whether the date is realistic or not, that’s the date that the Legislature selected,” Ridley said.

Lawmakers Urged to Water Down Law

The 13-member working group was comprised of state health officials, an information technology specialist, care home industry representatives and advocates for the elderly. They met five times in the last half of 2013, not counting extra subgroup meetings, before submitting in December an eight-page report to the Legislature with their findings and recommendations.

The report identified a new inspection form — the group’s primary task — but it also called on lawmakers to water down the law and delay its full implementation.

The group recommended the Health Department use the same federal form that most other states are using to post inspection information online. It’s called a U.S. Centers for Medicare and Medicaid Services form 2567, the one used for nursing home inspections.

Here’s what the form looks like, as used in the May 29, 2013, inspection of a Hawaii nursing home:

Ridley said the form 2567 is used for a number of facilities, but it’s different than the survey report form used for adult residential care homes and other community-based facilities. He said the department may end up using the federal form, but it’s also looking at coming up with its own.

The working group also asked the Legislature to revise Act 213 to limit the initial online posting to just one type of facility for up to six months. The law mandates the reports be posted for seven types of facilities, ranging from adult day health centers and homes for the developmentally disabled to long-term care facilities and foster family homes.

The report included a request for a one-year extension of the working group to June 30, 2015, to allow for more time to help monitor the online posting implementation process.

The group also wanted lawmakers to extend the time frame for posting the reports from five working days after the inspection to within 30 calendar days so the facility can provide a plan of corrective action that could be posted online with the report.

“If there is anything that we would want to pursue — and we haven’t even given it thought at this point — we would have to discuss it with our leadership and submit it to the Legislature,” Ridley said.

Report’s Recommendations Disregarded

The Legislature did not revise Act 213 last session, which ended May 1, but lawmakers say they will look at making changes to it next year — especially if the department fails to start posting the inspection reports online in January.

House Vice Speaker John Mizuno said Tuesday that the Legislature and Health Department may have to face the reality that sufficient funds weren’t provided.  

“I have my doubts,” he said when asked if the Jan. 1 deadline would be met.

With Hawaii being among the fastest-graying states, Mizuno said, the website would be a great tool for people looking to find a care home.

By 2030, one in four Hawaii residents will be over 60, according to a state plan for the elderly.

Mizuno, whose predominantly Filipino district includes many care homes, views the online posting of inspection reports as a win-win. The care home operators essentially get free advertising, he said, and the consumers can easily see the violation histories and plans of corrective action for the care homes at no cost.

The vast majority of long-term care facilities operate above-board, he added, but there are a few “bad apples.”

“We need to find out what we need to do and how much it’s going to cost.”
— Rep. John Mizuno

“We’ve got to vet them out,” he said. “We need to locate, suspend and stop them from operating if they’re not providing proper care.”

As of January, there were 12,074 long-term care residents statewide, according to the most recent data available from John McDermott, state long-term care ombudsman.

There are roughly 4,300 beds in 50 nursing homes, he said, but all of those already have to post their inspection reports online because they are federally regulated. (These reports can be found at Nursing Home Compare, a federal website, or Nursing Home Inspect, an app ProPublica created.)

That leaves almost 7,800 beds at just over 1,600 state-regulated care homes that don’t have to post their inspection reports online — until next year.

“If it’s not up and running by January, that’s something that the 2015 Legislature needs to take into consideration,” Mizuno said. “We need to find out what we need to do and how much it’s going to cost.”

Sen. Suzanne Chun Oakland, who helped get the bill passed in the first place by pulling the stakeholders together in search of a compromise, said in an email Tuesday that she was aware of the working group’s report. She said she’d be happy to review it and have her research office draft something next year.

Doubts about the Health Department’s ability to post the reports online, starting with any inspection after Jan. 1, come at a time when the agency is failing to conduct annual inspections for more than a third of the nursing homes in the state.

Hawaii is facing a fine of up to $121,000 if it doesn’t get its act together by September, the Honolulu Star-Advertiser reported Sunday. The Health Department says it lacks the resources to meet the inspection deadlines for nursing homes.

Thielen said the department needs to be ready by January to start posting the inspection reports for care homes. 

“It’s to the benefit of all the families who have to all of a sudden look for a care home for their loved ones,” she said. “That’s terribly important.”