In 2013, the Hawaii Legislature unanimously passed a bill requiring the state Department of Health to post online the inspection reports for care homes so members of the public could easily check out the history of a facility before placing a loved one there.

Prior to the law, accessing the reports started with a written request to the department and then a wait of two weeks or longer for the agency to track down the records and black out parts it considered confidential. Then requesters were charged for the copies and time it took to produce the documents.

Since the law requiring online posting was passed, the department’s Office of Health Care Assurance, headed by Keith Ridley, has taken turns ignoring it and fighting it, only posting batches of inspection reports after media pressure, letters from lawmakers and Gov. David Ige’s intervention. 

The agency was back at it Thursday, voicing “strong support” for Senate Bill 1114 that would let the department wiggle out of compliance altogether.

Sen Laura Thielen questions Dept of Health Keith Ridley in Capitol Room 16 on care home reports being made public with up to 2 month delay.
Sen. Laura Thielen questions Keith Ridley of the Department of Health during a hearing Thursday at the Capitol. Cory Lum/Civil Beat

“I’m just astounded,” said Sen. Laura Thielen, who put together the original bill in 2013 requiring the online posting. She called the department’s care home overseers “jerks” in a blog post Tuesday.

“These are public records. I don’t understand the mentality,” she said to Civil Beat on Thursday. “At the end of the day, there’s no reason why they aren’t embracing this.”

Last year, the department introduced legislation that would have given it the option of posting the inspection reports instead of being mandated to do it. And when it did feel like doing so, the proposal would have given the department 30 days to post the report instead of five.

The legislation also would have eliminated two of the most important types of facilities — adult residential care homes and assisted living facilities — from the list of those whose inspections must be posted.

Dept of Health Keith Ridley listens as Sen Thielen questions him in Capitol Room 16 on care home reports being made public with up to 2 month delay.
Keith Ridley, head of the Office of Health Care Assurance, responds to a question from the Senate Human Services Committee on Thursday. Cory Lum/Civil Beat

There are nearly 500 ARCH facilities statewide, with about 2,700 beds. It’s the second-most-common type of long-term care facility in a home-based setting after community care foster family homes, of which there are 1,145 that provided almost 2,900 beds. There are 14 assisted living facilities that provide 2,230 beds.

Legislators killed the effort in the House, but its companion bill in the Senate was revived this year.

The Human Services Committee, chaired by Sen. Suzanne Chun Oakland, deferred Senate Bill 1114 on Thursday after several people testified against it and Ridley awkwardly explained the department’s support. That means the proposal is likely dead — again.

Chun Oakland had been among the lawmakers who urged Ige to force the department to comply with the law, which he did. But as chair of the committee, it took her action to bring back the bill for the reconsideration it got Thursday.

Chair Suzanne Chun Oakland questions during carehome bill discussions room 16, Capitol.
Sen. Suzanne Chun Oakland, chair of the Human Services Committee, listens to testimony. Cory Lum/Civil Beat

Thielen pressed Ridley as to why the department wanted to make compliance optional instead of mandatory.

He said his agency did not ask for the bill to be considered again this session, and didn’t know who did. He said the department didn’t check with the governor’s office before testifying on the bill.

Ridley said he wasn’t necessarily opposed to the mandatory posting requirement, even though his written testimony didn’t reflect that. He said the aspect of the bill the department did strongly support was providing more time from the point an inspection is completed to when it must be posted online.

Lawmakers gave the department an 18-month lead time and $148,000 to hire two people to implement it when they passed the initial bill in 2013. No one was hired and the Jan. 1, 2015, deadline to start posting the reports came and went.

Larry Geller from Kokua listens to Sen Thielen questioning.
Larry Geller tells senators why they should reject the Department of Health’s efforts to undo a law requiring care home inspection reports to be posted online. Cory Lum/Civil Beat

Advocates for the elderly, who fought for years to get the bill passed in the first place, emphasized their continued support for the state to post the inspection reports online.

“When a spouse or parent is about to be discharged from a hospital, many families need to quickly choose which permanent or temporary care home placement is best,” said Marc Delorme, president of Kokua Council, an advocacy group for seniors.

“Online posting of all inspection reports fulfills the need for information, and that is why the Legislature passed the law in 2013 requiring the prompt posting of all reports,” he said.

Larry Geller said the bill would neuter the current law, “leaving families in the dark at a time when they need information the most.”

Mark Delorme President of Kokua Council after he testified during carehome bill. Sen Chun Oakland chair room 16 Capitol..
Mark Delorme, president of Kokua Council, listens to testimony before explaining why it’s critical to have the inspection reports easily accessible online. Cory Lum/Civil Beat

Notably absent were the many care home operators who year after year have lobbied against the online posting of inspection reports. They have said the public is not equipped to understand the nuances of any deficiencies that may be noted in reports and that posting them may violate their privacy.

The Office of Health Care Assurance had posted 1,181 inspections for 2015 and 2016 as of Thursday on its website.

Some of those deficiencies can be insignificant, as caregivers have been quick to point out.

The Heart to Heart Care Home in Waipahu, an ARCH, was dinged for using blue ink on a medication record for a resident in September, the inspection report says. The rules require the records to be written in black ink or typewritten.

Significant portions of the findings are redacted in the inspection reports, as in this one for Pearl City Nursing Home.
Significant portions of the findings are redacted in the inspection reports, as in this one for Pearl City Nursing Home. 

Others are a bigger deal. Norma Santos’ Jan. 14 inspection of her Honolulu ARCH says she did not report certain incidents, properly store iodine prep pads or obtain a physician level of care certification prior to admitting a resident.

It’s unclear what the problem was with a “physical environment” issue concerning fire prevention protection because the findings are completely redacted.

The department blacks out significant chunks of each report, ranging from medicines and patient names all the way to the names of caregivers, compliance managers, licensees and the findings themselves.

Reports for some types of homes, particularly the community care foster family homes, offer little information.

Violeta Fiesta’s is typical. On Jan. 11, she received an OK to upgrade to a three-client certification for her home in Ewa Beach. The three-sentence report simply says: “All requirements met at time of review.” The compliance manager’s name is blacked out, as is the primary caregiver’s.

Community care foster family home inspections are generally just a couple lines, like this one for Violeta Fiesta.
Community care foster family home inspections are generally just a couple lines, like this one for Violeta Fiesta. 

Some of the most significant findings are for skilled nursing facilities. However, that may not be a reflection on the care that type of facility provides as a whole so much as the fact that their inspections are unannounced while the other types of care homes receive advance warning.

The November inspection of the 115-resident Pearl City Nursing Home found a patient who was restrained for too long, and a failure to ensure mail was delivered unopened and timely, among a list of other deficiencies.

Unlike in many other states, Hawaii does not mandate unannounced inspections as part of its annual certification process for community care foster family homes, adult residential care homes and other less institutional facilities. Officials have the authority to make unannounced visits, but say limited resources often prevent them.

By contrast, the state’s skilled nursing facilities face unannounced inspections, whether it’s prompted by complaints or their license renewal. That’s because federal law requires it and the state typically conducts its license surveys in conjunction with the Medicare review. This includes the 49 nursing homes in Hawaii.

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