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Hawaii lawmakers were fed a familiar love story on Valentine’s Eve at the Capitol, a true tale of an elderly couple separated by a state law regulating care homes.
If the Legislature would just tweak the statute, lawmakers were told, the two could live out the rest of their days together at a home in Kaneohe with the help of nurses who live on site.
A similar tale was told five years ago. A loving couple, separated by legal restrictions on the composition of care homes, needed a legislative fix. They got it, despite objections from state agencies responsible for regulating the industry.
Care home operators are trying to pull off the same feat this legislative session. They’ve found their anecdotal couple, lined up friendly lawmakers and are working to change regulations over opposition from state health officials who are worried about the industry turning its back on those most in need in order to make more money.
The industry targeted one bill in particular last week, but several pieces of legislation have been introduced that would benefit care home operators by loosening existing regulations.
There are more than 12,000 long-term care residents statewide in roughly 1,600 homes that provide different levels of care. And the numbers are growing as Hawaii’s population rapidly ages.
The facilities help people age in community-based settings instead of institutions, saving the state millions of dollars in health care costs and fulfilling a desire of many residents. But there are concerns over just how far the state should bend to accommodate the providers who continue to demand more concessions and fight efforts to improve transparency and accountability.
The law the industry pushed through in 2010 didn’t just help an old loving couple. Hundreds of care home operators stood to benefit financially from the change, which let them accept three people in each adult residential care home, or ARCH, instead of two.
It’s a similar situation this year. The industry is using an elderly couple as the impetus for the state to relax restrictions on community care family foster homes, or CCFFHs, that could mean thousands of extra dollars a month for each operator.
The state currently lets this type of home have up to three clients. Two must be on Medicaid and one can pay out of his or her own pocket.
House Bill 600 would flip this by allowing two private-pay clients and one Medicaid recipient, which could leave the poor with fewer places to go for long-term care — something health officials highlighted and supporters of the legislation acknowledged.
The Department of Health called the proposed change “problematic.”
“Please don’t place the burden on DOH to begin to redefine licensed or certified beds based on how clients pay for services at those beds,” the department said in its written testimony opposing the bill. “This would be a bad precedent and will lead to confusion and unfairness.”
The Department of Human Services stopped short of opposing the bill, but aired concerns.
“While we recognize the need for the CCFFH operator to be able to have sufficient income and the desire to keep individuals such as spouses and parents and their adult children together, the DHS must ensure the availability of CCFFHs for all Medicaid recipients who do not have the means to privately pay for housing,” DHS wrote in its testimony.
The department noted that care home operators could just apply for a different type of license, called an expanded ARCH, that would let them increase the number of residents in their homes.
The care home industry doesn’t want to go that route though, insisting there be more options for private-pay clients.
Jonathan Hanks, who runs an adult foster home with his wife Arlene, brought one of their clients, Noboru Kawamoto, to the Capitol on Friday.
Kawamoto is the perfect poster child to get the bill passed. For starters, he is a veteran who served in the 442nd Regimental Combat Team in World War II. He’s also been married to his wife Elaine for the past 67 years.
Like other aging couples, they want to live together in a home where they can receive the nursing-facility level of services they need without being in a big institution.
“The additional private pay client will help us not to struggle to make ends meet.” — Elma Tierra, Waipahu care home operator
But since the Kawamotos would both be private-pay clients, Hanks can only have Noboru at his home, which has reduced the couple’s time together to weekend visits.
Hanks pushed Kawamoto in his wheelchair through the Capitol rotunda Friday morning, up the elevator and into a small conference room where the House Health and Human Services committees were taking public testimony on several bills related to aging and regulations for care homes.
When it was his turn, Hanks wheeled Kawamoto up to the table across from the committee chairs, Reps. Della Au Belatti and Dee Morikawa.
Hanks underscored the need for the Legislature to pass the bill so the Kawamotos could live together again.
Kawamoto sat in his wheelchair, seeming a bit confused. He shook his head at first when asked if he wanted to say anything.
That’s when Hanks leaned over and, speaking directly in his ear, told him to tell the House committees that they should pass the bill — the one “we’ve been working on.” Kawamoto obliged and they returned to their spots in the crowded room.
Other care home operators went up to testify in support, explaining how the bill would give them extra income to help them afford their own medical needs and avoid having to find second jobs outside their homes.
“Due to the increasing and significant rise of our standard of living, we need extra income to support out daily needs,” said Elma Tierra, president of Adult Foster Home of the Pacific, one of many facilities in Waipahu. “The additional private pay client will help us not to struggle to make ends meet.”
Many more care home operators signed their names to pre-written testimony supporting the bill, explaining that “there are many vacancies in our home” and the needs of Medicaid clients have been met.
Keith Ridley, who heads the DOH Office of Health Care Assurance, the state agency that oversees the vast majority of long-term care facilities, told the House committees why the bill was flawed.
The department says the bill changes the intended purpose of the CCFFH program, which was specifically designed and established to save the state money while ensuring quality health care in an approved setting.
House Vice Speaker John Mizuno followed up later that day with a news release, trying to cement the story line. The headline was “HB600 Attempts To Allow Couple To Remain Together.”
“I understand the need to provide long-term housing for Medicaid patients,” Mizuno said in the release. “However, allowing couples who have spent their whole lives with each other, to live out their final years together has to take precedent over the State’s need to provide for Medicaid clients. It’s just the right thing to do.”
Media outlets picked it up and regurgitated it for care home operators to proudly pass around on Facebook.
While passing House Bill 600 is the primary focus of the care home industry so far this session, other bills have been introduced that could loosen regulations.
House Bill 1116 would change how old the primary and substitute caregivers must be and how many hours of continuing education they have to complete.
The legislation has left blanks where all the numbers would go, causing some health officials to worry that the age, for instance, might be lowered from 21. A hearing has yet to be scheduled.
House Bill 1195 would let adult residential care homes have three clients instead of two.
The care home industry fought for this change in 2010 and succeeded in getting the bill passed over the concerns of health officials. The law was supposed to sunset in 2013, but the Department of Health has allowed the practice to continue, making this more of a housekeeping measure.
The bill is up for decision-making Wednesday morning before the House Health and Human Services committees along with House Bill 600. Both were introduced by Mizuno and other lawmakers, including Morikawa and Rep. Tom Brower.
Mizuno has been behind frequent efforts in recent years — often successful — to help care home operators, many of whom are Filipino and live in his Kalihi Valley district.
He has received thousands of dollars in campaign contributions from care home operators. He’s received thousands more from groups representing the care homes, such as the Alliance of Adult Residential Care Administrators, or ARCA.
ARCA, headed by Lilia Fajotina, who runs a Waipahu care home, has in turn spent thousands of dollars to hire two of the best lobbyists in the state, George Morris and John Radcliffe, to help persuade lawmakers. Those lobbyists also donated to Mizuno’s campaign.
John McDermott, the state long-term care ombudsman, has repeatedly cautioned against relaxing regulations of care homes. The death of 88-year-old Nona Mosman and subsequent prosecution of her caregiver has only reinforced his position.
Mosman died in May 2013 while living in a Waipahu foster care home ran by Jennifer Polintan. In January, Polintan was sentenced to a year in prison for manslaughter after it was revealed that she had another full-time job and had left the care up to her unqualified relatives.