A sprawling two-story home stands at the end of a driveway on a quiet residential street in Kaneohe.
In front of it on the long, narrow property, a second residence is under construction. With more than 6,000 square feet of living space, it will more than match the first in grandeur with its yellow concrete walls, white pillars and green Spanish roof tiles.
These are not your typical care homes.
In their home at the back of the property on William Henry Road, Myriam and Robert Tabaniag provide care for eight elderly residents, three of whom require nursing-home level services because they are unable to walk or eat on their own.
The Hawaii Department of Health licensed Hokulaki Senior Living as an expanded adult residential care home, or E-ARCH. The Tabaniags hope to do the same with the home they’re building at the front of the property. They also operate a five-bed ARCH nearby, which they plan to sell when construction is finished on the other home.
“If you come in for the money you can only fake it so long. And if you do, you’re going to hurt someone. You’re going to hurt the industry. You’re going to hurt people trying to do noble work.” — Robert Tabaniag
State Rep. John Mizuno, who regularly advocates at the Legislature on behalf of care home operators, asked the Tabaniags to open their home to demonstrate what a good care home looks like.
Civil Beat has been examining the care home industry from a number of angles including the state’s posting of inspection reports online, unannounced versus announced inspections, and the restrictions that certain types of homes have when it comes to clients paying privately or through Medicaid.
Sue Cornish, a registered nurse and certified care manager at Eldercare Resources, has worked in the industry for 20 years.
As an independent case manager, she checks on the Tabaniags home and others as required by state law, popping in once a month to provide a certain degree of oversight and create care plans for the residents that the home operators must follow.
Cornish, who happened to stop by Friday during the tour of the Tabaniags home, described the facility as a “10,” saying she wished more in the industry strove to deliver such good services.
For the Tabaniags, it’s all about “safety, safety, safety.” The home is equipped with alarms, door-open alerts and a sprinkler system in case of fire.
But it’s also about comfort. In the entryway is a space dedicated to Jesus and a sitting area with comfortable and ornate chairs and couches. A chandelier hangs over the kitchen table, which has a bowl of fresh fruit and avocados on it.
“We will make you feel like a king or a queen,” Myriam said.
All eight clients, ages 86 to 99, including one married couple, were seated in the living room in wheelchairs and recliners watching “The People’s Court.” Later in the afternoon, they took turns singing karaoke with the help of staff nurses.
“They are our bosses,” Robert said. “This house is theirs. They are paying for it.”
All of the Tabaniags’ residents pay for the care out of their own pocket, an average of $6,000 per month per person.
“I feel rich from the 1st to the 5th of the month but by the 10th we’re broke,” Myriam said, explaining the additional costs she pays for liability insurance, workman’s compensation and utilities, in addition to the mortgage.
“It’s a very big overhead for a small company,” Robert added.
The Tabaniags are the relatively rare care home operators who welcome unannounced visits by DOH’s Office of Health Care Assurance, which usually happen once a year.
“I love it,” Myriam said, noting that the possibility of a visit keeps her on her toes and gives her assurance that the staff is doing its job if she’s on vacation.
These visits are generally around 20 minutes long. The inspectors talk to the residents and may ask if they’ve eaten recently, look for medication lying around or any blatant problems.
“When they come they are so stern,” Myriam said. “We are not buddy-buddy with them.”
In the same vein, she said it should be a “red flag” if a care home operator tells a prospective client or the family of someone who wants to check out a care home to “call before you come.”
This is separate from the announced annual state licensing inspection. The Tabaniags, like many care home operators, have opposed efforts to make these inspections unannounced.
They also oppose posting these inspection reports online, which the state is now required to do thanks to a bill the Legislature passed in 2013 over strong objections from industry representatives who said the forms could be misinterpreted by the public.
Like others, the Tabianiags say it’s just too cumbersome to have an inspector come without notice because the licensing surveys take hours to complete.
The inspectors not only check with the residents and scrutinize physical aspects of the home, but they also review all the necessary paperwork to ensure fire drills are being conducted regularly, tuberculosis clearances are up to date and background checks for staff are complete, among many other requirements.
“I’ve got things to do,” Myriam said, adding that’s why she thinks it’s fair the state at least gives care home operators a day of the week and what month the inspectors will be coming.
Her biggest concern is not being home for the inspection, given that so much of the day is spent taking the residents to doctors, shopping or other activities.
“We are out all the time,” she said.
Robert Tabaniag, a military veteran who was stationed at Pearl Harbor, used to be a tug boat captain. He retired 15 years ago to start a care home business with his wife of 47 years, a registered nurse who was then working in the Neonatal Intensive Care Unit at Kapiolani Medical Center.
“I think I had more fun in the Army,” Robert said with a laugh. “But this has given me a better perspective of what it is to be old.”
When the couple was looking to get into the industry, Raquel Bermisa was making headlines.
The Hawaii Attorney General’s Office had just prosecuted the 40-year-old care home operator for manslaughter in the death of Chiyeko Tanouye, who died from bed sores in 1999 at age 79. Bermisa was sentenced to 20 years in prison in 2001, but then-Gov. Ben Cayetano commuted her sentence to four years.
Bermisa, who had operated a five-client home, failed to implement a treatment plan.
Robert, now a certified nurse aide, recalled asking his wife if she was crazy to want to get into the care home business with this in the news, but Myriam assured him that they would be nothing like Bermisa and that they would operate a home that provides, as Mizuno describes it, “Cadillac care.”
“If you come in for the money you can only fake it so long,” Robert said. “And if you do, you’re going to hurt someone. You’re going to hurt the industry. You’re going to hurt people trying to do noble work.”
The Tabaniags said they are the first to say bad care homes need to be weeded out and shut down.
“If they are devastated, we are more devastated,” Myriam said. “They give the whole industry a bad name.”