Hawaii could soon require unannounced inspections of state-licensed care facilities for the elderly instead of giving the operators advance warning of when the Department of Health is coming.

The Senate is set to vote on a bill Tuesday that would bring adult residential care homes and community care foster family homes in line with hospitals and skilled nursing facilities, which are already subject to unannounced inspections.

Senate Bill 2384 is one of hundreds of bills that the full House and Senate will each be considering this week. Thursday is the deadline for legislation to pass out of its originating chamber and cross over to the other chamber for its consideration.

Sen Roslyn Baker gestures during meeting with Vice Chair / Sen Will Espero Chair and right, Clarence Nishihara, Public Safety, Intergovernmental Affairs and Military Affairs during committee hearing for bills.
Sen. Roz Baker said many of the care home operators’ concerns about unannounced inspections are “unfounded.” Cory Lum/Civil Beat

There are more than 1,600 adult residential care homes and community care foster family homes around the state providing over 5,600 beds for people who need care ranging from help eating and getting ready in the morning to a level equivalent to that provided in large nursing facilities.

More people are seeking these smaller types of homes that each have space for just a few residents, preferring to age in a neighborhood setting instead of an institutional facility.

Many states have already imposed unannounced inspections on this burgeoning industry, but Hawaii’s care home operators have lobbied hard and repeatedly beaten back efforts to require them.

Hawaii laws and state regulations allow the state Department of Health to inspect care homes without notice, but it’s not required to do so. The practice has long been to give the operators a heads up that they will be coming.

Keith Ridley, who leads the department’s Office of Health Care Assurance, which oversees the care homes, said he supports the legislation mandating unannounced inspections for relicensing and recertification.

“The theory behind it is that they have to be ready at all times,” Ridley told the Senate Consumer Protection and Health Committee when it was considering the measure last month.

“This is a matter of ensuring the public that they can depend on the licensing process,” he added.

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. He supports unannounced inspections to help ensure care homes are always operating at a high level, not just when inspectors are coming. Cory Lum/Civil Beat

The committee, chaired by Sen. Roz Baker, unanimously passed the bill despite opposition from some in the care home industry.

Wannette Gaylord, president of the Alliance of Residential Care Administrators, which lobbies on behalf of care home operators, said the bill feels like a “personal attack on care homes.”

One of her biggest concerns, shared by many others who testified against the measure, was the operator being home when the inspectors come. She said the caregivers often need to run errands, such as picking up medicine or taking a resident to the doctor.

“Please put back the current language of the existing statute so I won’t feel that I am a prisoner to what I thought was my calling in life,” she said.

Ridley assured senators that it’s not a problem if the primary caregiver isn’t at the home because the law requires the residents to be left in the care of a secondary caregiver who could answer questions from inspectors and provide the required information. And even if they were unable to do so, he said, inspectors could just come back another day.

The inspectors examine dietary and other care records. They check to ensure CPR certifications are up to date, and look at the overall cleanliness of the home, among other things.

“From time to time we’ll even talk to the residents: How are you doing? How is the care? Is everything OK?” Ridley told lawmakers.

Vice Chair / Sen Will Espero Chair and right, Clarence Nishihara, Public Safety, Intergovernmental Affairs and Military Affairs during committee hearing for bills.
Sens. Will Espero and Clarence Nishihara voted in favor of the bill to mandate unannounced inspections, but with reservations. 

He explained to lawmakers that barring a truly egregious infraction, the department works with the care home operators to correct their deficiencies rather than shut them down.

“We do recognize that from time to time that the operators and the residents won’t be home when we go to do the unannounced visit,” Ridley said. “There is no dinging them for that. We just come again.”

Baker was persuaded, and noted in her Senate committee report that many of the care home operators’ concerns are “unfounded.”

Sen. Will Espero, whose family used to run care homes, voted in favor of the bill but with reservations. He said he considers the unannounced inspections to be a “sneak attack.”

“This is their livelihood,” he said. “It could make or break a home.”

Baker said Monday that she considers unannounced inspections to be one of the best ways to make sure inspectors see the home when the operators are not expecting it, which allows the state to make sure that the facilities caring for some of the most vulnerable citizens are held to a high standard.

“I know that some of the care home operators are concerned that this is sort of like a gotcha activity but it’s really not,” she said. “The department, unless it’s something really egregious, is not interested in shutting people down. They work with people to make it right. Their concern is with the health and safety of the folks residing in their care homes.”

The bill also would mandate unannounced inspections for medical marijuana dispensaries. The state is in the process of reviewing applicants for eight initial licenses; each licensee can operate up to two production centers and two retail-dispensing locations.

If the Senate passes the bill Tuesday, it crosses over to the House, which can approve it as is, amend it or kill it. Any disagreements over the final language in the bill would get worked out in a joint conference committee later next month.

Earlier this session, the House had considered a broad bill that also included a provision requiring the Department of Health to conduct unannounced visits at the various types of health care facilities it oversees, but that part was cut out of the amended version that passed in committee.

All that was left in that bill was a provision to allow two private-pay clients to live in one community care foster family home as long as they were married or in a civil union. Currently, the homes can have up to three clients but at least two have to be Medicaid recipients, the target group that type of home was created to serve.

Gov. David Ige’s administration opposed the measure last session and this one. The governor said last week that there are other options available for married couples to stay in a long-term care facility together and pay out of their own pocket, including adult residential care homes.

That bill cleared the House Health and Human Services committees, but stalled in the Finance Committee, chaired by Rep. Sylvia Luke.

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