For 18 years, Hawaii Long-Term Care Ombudsman John McDermott has pushed for a requirement that inspections of care facilities be unannounced.

He may not have to wait much longer, thanks to a bill that the House Finance Committee passed Tuesday.

Senate Bill 2384 would require the Department of Health to conduct unannounced inspections of state-licensed care facilities that are up for relicensing or recertification. The rules would cover such facilities as residential care homes, foster homes and adult day care centers.

House Finance Committee meeting wide view at the Capitol, Room 308. 5 april 2015.
Nine of the 16 committee members present voted with reservations on the bill. Cory Lum/Civil Beat

Adopting The National Standard

Such unannounced inspections are required by the vast majority of U.S. states.

In written testimony, McDermott said that over the past 18 years he’s seen “numerous accounts of abuse and neglect, even death, in (Hawaii’s) long term care facilities,” as a result of abusive or neglectful caregivers. He said families have been asked to refrain from visiting on the day of an inspection, which means they can’t tell inspectors directly about any concerns they may have about the treatment of their loved ones.

When former Gov. Linda Lingle was running for governor, McDermott noted that she voiced her support for surprise care home visits. But as a compromise when she took office, Lingle allowed announced visits to continue alongside unannounced visits.

“If you tell someone when you are coming, you can’t really call that an inspection,” he wrote. “It’s strictly paper compliance, pro forma, an illusion.”

Current state law allows surprise inspections, but doesn’t make them mandatory.

The DOH also supported SB 2384, and wrote in testimony that the bill likely would cause care homes and dispensaries to be better prepared for an inspection around the clock.

Industry Resistance

But Hawaii’s care home industry opposed the bill.

The Adult Foster Homecare Association of Hawaii said it welcomed unannounced visits, but took issue with requiring that the formal inspections for relicensing and recertification also be unannounced.

The association stated that if inspectors showed up to facilities unannounced, the operator might be absent, which could result in follow-up visits and additional taxpayer expense.

In earlier testimony, the DOH wrote that the bill would have no fiscal implications.

“Visit us unannounced anytime to ensure patient care and consumer protection,” association officials wrote. “But if you need us to get our mortgage, rental, budget, fingerprints, and over 50 other documents … you must give us some notice.”

Rep. Della Au Belatti, chair of the Health Committee, said Hawaii was lagging behind other states when it comes to surprise come care inspections at a March hearing.
Rep. Della Au Belatti, chair of the Health Committee, said Hawaii was lagging behind other states when it comes to surprise come care inspections at a March hearing. Cory Lum/Civil Beat

Others who opposed the bill said medical appointments could be affected by surprise visits.

At a March 23 hearing, lawmakers rebutted the argument that a facility’s primary caregiver needs time to prepare, by noting a substitute caregiver is required to be present when a primary caregiver is not.

Lawmakers also said that as long as inspectors can be flexible in rescheduling or in giving care residences a chance to correct errors before shutting a facility down, the bill was a fair compromise.

Rep. Joy San Buenaventura and Sen. Russell Ruderman have been the only lawmakers to vote against the bill so far — both represent the Puna district, which has several care homes.

“This is already a 24-hour job for the care home providers and this adds more stressors,” Buenaventura said at the March hearing.

In addition to mandating unannounced visits for care facilities, the bill also would require the DOH to conduct surprise inspections for medical marijuana dispensary license renewals.

Dispensaries would be required to have security measures including an alarm system, video monitoring and fencing to surround the facility. Marijuana dispensaries can open in July under Hawaii law.

The bill already cleared a Senate floor vote and one other House committee — now, SB 2384 faces a House floor vote.

Half of the committee members present voted in favor with reservations.

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