The owners of community-based care homes for the elderly and disabled are pressing state lawmakers, government officials and others to address what they say is a growing trend of illegal care facilities in neighborhoods throughout Hawaii.
They are concerned about the quality of care the clients inside these unlicensed or uncertified homes may be receiving, the broader implications to the long-term care industry and the state’s failure to adequately respond despite years of complaints.
“We just want to put a stop to this,” said Robert Tabaniag, owner of Hokulaki Senior Care Home in Kaneohe. “But it seems like the people following the rules sometimes get the wrong end of the stick.”
The Department of Health’s Office of Health Care Assurance, headed by Keith Ridley, oversees more than 12,300 residents who live in roughly 1,700 long-term care facilities. These range from smaller homes in residential settings with one or two clients per facility to larger institutions with dozens or more beds.
Tabaniag and the owners of other care homes said they have tried to get health inspectors to crack down on the unlicensed facilities but have been rebuffed, often told the department lacks the policing powers necessary to investigate.
They said cases have been referred to the Adult Protective Services division of the Department of Human Services and the Attorney General’s office but they have still seen a growing number of homes operating without the required license or certification that helps ensure the facility complies with health and safety regulations and that the caregivers meet the minimum standards of training and experience.
“They don’t even turn their heads,” Tabaniag said. “They just inspect the home next to it.”
Ridley and a spokeswoman for the Department of Health did not respond to requests for comment. The Attorney General’s office did not respond to an email seeking comment last week. Messages were also left with Adult Protective Services and Community Ties of America, which licenses foster homes.
It’s difficult if not impossible to know just how many care facilities may be operating under the radar. Several care home operators estimated there were dozens on Oahu alone, and a state lawmaker who works closely with the industry, Rep. John Mizuno, said a conservative estimate would be as many as 200 statewide.
“I would have to say 10 percent of that industry is now illegally run,” Mizuno said. “It’s a consumer protection issue.”
Mizuno, who serves as House vice speaker, wrote legislation trying to force the unlicensed homes to come into compliance but it died in the Human Services and Health committees, chaired by Reps. Dee Morikawa and Della Au Belatti, respectively.
“I support the chairs’ decisions, however, this is an issue that has percolated to the top of the minds of the caregivers,” Mizuno said. “You’re getting a cottage industry now that’s not being regulated.”
House Bill 833, which never received a hearing, would have required adult family boarding homes and private homes that provide healthcare to the elderly or disabled to be licensed by the Department of Health.
It also would have established fines for operating an adult residential care home, adult family boarding home or private home that provides healthcare to elderly or disabled individuals who are unrelated to the caregiver family by blood, marriage, or adoption or hospice home without a license.
Mizuno also put forward a caregiver omnibus bill, House Bill 1510, that included a section aimed at illegal care facilities. It would have required any community-based care home or day care center providing healthcare to the elderly or disabled who are unrelated to the caregiver family to be “licensed or certified and subject to the purview of the department to ensure the health, safety, and welfare of the individuals placed therein.”
Morikawa and Belatti gave the omnibus bill a hearing but deferred it indefinitely despite dozens of pages of testimony in support.
The bill was deferred because of its broadness, Morikawa said, and because much of it was contained in other bills.
When asked why HB 833, which focused on the illegal care home issue exclusively, did not receive a hearing, Morikawa said that decision was up to Belatti because she had the lead on it.
“I didn’t even look at it,” Morikawa said.
Belatti did not return a message seeking comment Tuesday.
Morikawa said there was concern about the difficulty in getting these illegal facilities to be licensed, such as having to obtain approvals from various agencies, so the plan is to work on a policy to streamline that process during the interim once the legislative session ends in May.
“I don’t see it as a problem here in Hawaii right now,” Morikawa said of the unlicensed care homes. “It’s already being regulated. If you’re caught you’re going to have to pay the consequences.”
The Department of Health was one of the few entities to oppose the measure but it did not take issue with the section relating to illegal facilities in its written testimony.
Linda Beechinor, who’s been a family nurse practitioner in Honolulu for the past 20 years and a nurse for the past 35 years, was among those who testified in support of the bill.
“It is widely known that there are many, many unlicensed and unregulated care facilities for the elderly in our community,” she said. “The fact is that elderly persons are placed in homes with lay (not professional) caregivers willing to care for them for remuneration, when family cannot or is not willing to provide ongoing care to the aged.”
She pointed to professional research literature that strongly indicates that the elderly and disabled are at an escalating risk for abuse and neglect as they become more dependent on others for their care.
“We go after someone who serves bad shrimp so why aren’t we going after these with the same vigilance?” said John McDermott, the state’s only long-term care ombudsman.
He has fielded complaints about illegal care facilities ever since he took the position 18 years ago.
“If the Department of Health is not going after them because they don’t have enough staff, or the will or the legislation that allows them to do that, it looks likes we have some homes that have called their bluff,” McDermott said.
“You’re strictly at the mercy of that caregiver,” he added. “They may be good, they may be bad. But there’s no inspection, there’s no one you can complain to and it’s unfair to those following the rules.”
Tabaniag serves on the board of directors of the Alliance of Residential Care Administrators, which represents a couple hundred licensed adult residential care homes.
He said the board is working with an attorney on a letter to state Health Director Virginia Pressler, Attorney General Doug Chin, advocates for the elderly and all 76 members of the Legislature that points out the problems with this burgeoning underground industry.
A draft of the letter notes how operating an unlicensed care home may be “lucrative and attractive,” given the avoidance of costs and time to comply with state licensing requirements. The letter also notes that some licensed care home and foster home operators have “jumped ship” and started operating illegally instead.
Ramon Sumibcay, a care home operator in Makakilo, said a death due to neglect or abuse in an unlicensed facility would be devastating to those running care homes legally.
“If we don’t do anything now it will destroy us later,” he said. “It’s a growing trend. Are we just going to close our eyes and look the other way and let them operate as we hear stories?”
He encouraged anyone looking to place an elderly or disabled member of their family into a care facility to make sure the operator is licensed by the state.
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