I am a Registered Nurse in Hawaii and owner of Maile Case Management, LLC. I have been in business for 8 years now and have worked as a nurse in Hawaii for approximately 20 years. Additionally, my husband is a well-respected physician in the Central Oahu area. I am currently finishing the remaining two years of my Ph.D. program and have a desire to write academic articles, especially those pertaining to health care, the elderly, and community care facilities.

As a nurse who case manages patients in the Department of Health (DOH) care homes, in private homes, and for home care companies, I feel that I have a lot of offer the public in the way of experience and knowledge of this business. The reason I am writing you today is because I feel frustrated by the recent attack on what has been called “illegal care homes in Hawaii.

First of all, I am one of the original nurses involved in the model of care that is currently under attack, and I want to say that this model was born out of necessity! The aging-in-place model is something that I’m proud to be involved with here in Hawaii, and I believe it will continue to grow.

As many people know, the DOH is tremendously overloaded with their responsibilities, and I believe this is a contributing factor to the extremely long wait periods in order to secure a care home license. The long waiting period is what has led many people to look for answers elsewhere.

Walkers and wheel chairs at Hokulaki Senior Living LLC. care home elderly. 14 aug 2015. photograph Cory Lum/Civil Beat

I remember when I was first approached by a care home operator for help. I was shocked by her story (but I also knew many other people in her same situation). She had been a care home operator who unfortunately was given notice by her landlord. The care home operator called her DOH inspector telling her of what happened and was advised to rent a new home and fill out the DOH application paperwork. She was also told that they would rush the application through.

After months of waiting, and almost having to claim bankruptcy for a home she could not afford, this former care home operator was devastated and needed help. The DOH claimed to have not received the first application packet that she submitted, and even when the care home operator drove the paperwork to the DOH in person, there were continuous obstacles keeping her from getting the new license.

Her story is something that I’m hearing everyday now. People are calling me in desperate need of help, and unless a care home operator goes through this, he/she cannot understand how stressful this event is.

Sadly, when landlords know that a home is going to be used as a care facility, they charge very high monthly rates. It is nearly impossible for someone who is not bringing in any income to pay the high rate month after month, for years!

So now that I’ve established that there are problems related to obtaining a DOH care home license, let’s look at this new model-of-care (that many are attacking) closer. Many people are calling it an “illegal or unlicensed care home.”

The new model of care is simply not illegal, and I’m getting tired of hearing this. As stated in the recent article in Honolulu Civil Beat, care home operators are worried about the safety of the elderly in the “illegal care homes.” Besides this complaint, I have heard other care home operators complain about a lack of supervision and oversight of the patients in the aging-in-place facilities. I have also heard people say that this model of care is “stealing all of the patients.”

Although I do believe that some care home operators feel worried about the safety of the elderly in the community, I do not believe this is the driving factor for all of the many complaints. I feel that there is a lot of competition in this industry and the anger is the result of jealousy.

Why do I say this? I get calls all the time from care home operators and foster home operators begging me to open an aging-in-place facility with them. They say things like, “I know I can get patients if I work with you,” and “I know I can make a lot more money.”

This theme runs through most of the comments I hear. I have also heard people say that the aging-in-place facilities are stealing all of the patients. All of these comments have obvious undertones of jealousy.

The fact is, these homes are not care homes at all. If they are not care homes, than how can they be “illegal care homes?”

We have never claimed to be a care home, and we never tell our clients we are running care homes. We simply tell them the truth! Our clients are simply renters who are getting home care services. If someone can prove that it is illegal to be a renter in Hawaii, I’d love to see that. Also, if someone can prove that it’s illegal to get home care services, I’d love to see that as well.

By trying to close down this model of care, people would be basically taking away a patient’s right to choose where he/she can live. Does a person have a right to live anywhere they want to? Yes!

Before I finish this letter, I’d like to say that even though many people are turning us in to the DOH, APS, and the attorney general, we are still thriving and growing! Not only do the aging-in-place facilities that I case manage provide great care, we also have nursing oversight for every patient getting home care services, and have much positive feedback from the patients and family members.

I personally ask everyone to stop judging something you know nothing about. If you want to run a care home, run it well. If you want to run an aging-in-place facility, run that well. Keep providing excellent care for our elderly and disabled. This is what we all want!

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