Hawaii may soon implement what’s become standard practice elsewhere in the country — mandatory unannounced inspections of state-licensed care facilities for the elderly and disabled.

The House Health and Judiciary committees jointly heard Senate Bill 2384 on Wednesday, passing the legislation over objections from industry groups representing home operators and caregivers.

Rep. Della Au Belatti, who chairs the Health Committee, said she had her staff call around to other states to learn more about mandating unannounced inspections.

“We found that it is indeed what most states are doing,” she said. “Hawaii really is on the outside of this, even for the family care home situation.”

Rep. Della Au Belatti leads a panel discussion of the Women's Caucus Thursday at the YWCA on Richards Street.
Rep. Della Au Belatti, seen here during a panel discussion in January, said Wednesday that Hawaii needs to join other states requiring unannounced inspections of care homes. Cory Lum/Civil Beat

It was somewhat of a change in course. In February, her committee stripped a provision of a broader House bill that would have required unannounced inspections, and what was left of that legislation died.

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, which are already subject to unannounced inspections.

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 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, usually a day of the week in a given month.

“The Department prefers that relicensing or recertification surveys be unannounced in order to maximize the readiness of the care homes or dispensaries for an inspection by the Department,” DOH Office of Health Care Assurance Chief Keith Ridley said in his written testimony.

Senate Bill 2384 also mandates 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.

Lawmakers chided the Department of Health for not having a representative to answer questions at the hearing. When asked, Ridley didn’t explain why he wasn’t there other than to say he had submitted written testimony. 

In that testimony, he said requiring unannounced inspections for care homes “is seen as an improved safeguard for the public.”

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.

The department gives operators flexibility in terms of correcting deficiencies that inspectors find, as opposed to just shutting them down.

Lawmakers said if that practice continues, they feel that unannounced inspections are a reasonable compromise.

Caregivers often say they like how the department currently gives them a head’s up about when the inspectors are coming so they can be sure they are home and ready. But lawmakers shot down that argument by saying the inspectors can just reschedule, plus a substitute caregiver is required to be home in the primary caregiver’s absence.

Rep. Joy San Buenaventura, who has a number of care homes in her Puna district, cast the lone vote against the bill.

She said it’s a 24-hour job for the care home providers and the prospect of regular unannounced inspections is just one more stressor. She questioned why this new requirement was needed.

Rep Joy San Buenaventura Vice Chair Legislature1
Rep. Joy San Buenaventura, vice chair of the House Judiciary Committee, voted against requiring unannounced inspections after noting she has many care homes in her Puna district. Cory Lum/Civil Beat

Wannette Gaylord, president of the Alliance of Residential Care Administrators and a care home operator, asked the committee to kill the bill.

“I humbly request that your committee, having the understanding of what it takes to provide 24 hour care, 365 days a year to our kupuna determine that the current regulations already in place are suitable,” she said in her written testimony.

Senate Bill 2384 cleared the full Senate on March 8, with only Sen. Russell Ruderman voting against it. He represents Puna and Kau.

After clearing the House Health and Judiciary committees Wednesday, the bill goes to the Finance Committee, chaired by Rep. Sylvia Luke, for its consideration.

Belatti said she expects the measure to ultimately be decided in a conference committee comprised of House and Senate lawmakers near the end of session next month.

The House bill that was stripped of the unannounced inspections requirement died a quiet death last month when the Finance Committee chose to not hear it. The remaining provision would have allowed a married couple to pay out of their own pocket to live in a community care foster family home.

A push to allow two private-pay clients in one CCFFH died last year as well over concerns about displacing low-income residents.

CCFFHs can each have up to three clients with the proper certification from the Department of Health, but at least two have to be on Medicaid. If it’s just a two-client home, one must be on Medicaid. This type of care facility was created specifically to serve Medicaid beneficiaries, and the department came out against the measure this year on those grounds.

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