State health officials want the Hawaii Legislature to delay by two years a law requiring unannounced inspections of care facilities for the elderly and disabled, saying they may disrupt the lives of the residents and home operators.

Advocates for the elderly slammed the recommendation, which the Department of Health submitted in its annual report to lawmakers.

“It’s amazing how often the Department of Health puts the safety of our kupuna somewhere at the bottom of their priority list,” state long-term care ombudsman John McDermott said Thursday. “This is a very depressing report.”

Keith Ridley, who heads the state Office of Health Care Assurance, said a few of his inspectors have been denied entry into a home while trying to determine if the facility was licensed.
Keith Ridley, who heads the state Office of Health Care Assurance, said the department believes in the philosophy of unannounced inspections, but the practicality is another thing. Cory Lum/Civil Beat

McDermott and others fought for nearly two decades to get the law requiring unannounced inspections passed, which finally happened in 2016. Most other states already have this mandate.

A last-minute amendment inserted by Rep. Della Au Belatti, who chaired the House health committee at the time, delayed the start date for three years, making it effective July 1, 2019. The rationale was that this would give the department time to collect additional data and better understand how this would actually work.

Belatti did not respond to messages seeking comment about the latest proposed delay.

Keith Ridley, who heads the department’s Office of Health Care Assurance, handles licensing and inspections for 1,699 facilities that provide 12,657 beds. Some are larger nursing homes, providing care for dozens of residents, but many are smaller facilities serving just a few clients.

He said he continues to believe unannounced inspections are a “good philosophy,” but that the practicality of conducting the time-consuming inspections without disrupting the routines of the elderly and the operators may be challenging.

“The situation is different for care homes than other larger facilities or institutional facilities because the care home operators do tend to take residents out on doctors’ visits and excursions,” Ridley said.

No bills appear to be moving forward this session that would further delay unannounced inspections. But the Legislature, if so inclined, would still have time to take up the issue next year.

John McDermott unlicensed carehome.
John McDermott, state longterm care ombudsman, called the department’s recommendation to delay unannounced inspections “depressing.” Cory Lum/Civil Beat/2018

Sen. Josh Green, a medical doctor from Hawaii Island, said the Legislature should give the health department several new positions to help with the inspections.

“They are way understaffed and underfunded,”Greene said. “Eventually lawsuits will change that, I predict.”

Ridley, who has advocated for additional inspector positions in the past, noted the distinction between “unannounced visits” and “unannounced inspections.”

Visits are brief events designed to quickly ascertain the status of specific target concerns, the report says. Inspections, on the other hand, are more robust for purposes of license renewals and can take a few hours.

The department is required by federal law to conduct unannounced inspections of nursing homes and intermediate care facilities. There were 84 unannounced inspections of these types of facilities last year, according to the report.

The smaller facilities, such as adult residential care homes (ARCHs) and community care foster family homes, do not have that mandate yet but there are unannounced visits. The department conducted 911 unannounced visits last year and 1,498 announced inspections, the report says.

Overall, the report says, “most inspections result in citations for non-compliance with regulations and all citations are required to be corrected by the facility before the facility receives their renewed license or certification.”

The most egregious violations noted in the report came from unannounced visits, including four care homes that were cited for leaving residents unsupervised. In three of those cases, no caregiver was present. And in the fourth case, the primary caregiver was asleep upstairs and the substitute was not in the room.

“The department suspects there are more homes that are leaving residents unsupervised or in the hands of unqualified persons.” — Department of Health annual inspections report

The report says the number of care homes cited was small “but the department suspects there are more homes that are leaving residents unsupervised or in the hands of unqualified persons.” That, the report adds, “is a very unsafe practice with potential for great harm to the residents.”

The department recommended increasing its frequency of unannounced visits, which may require additional staff, while delaying for two years the unannounced inspections.

Jim Shon, head of the Kokua Council, a senior advocacy group, said the argument that it’s impractical or inconvenient to conduct unannounced inspections is “weak.”

“Too often legislators do not look beyond their noses to notice that what an agency says is impossible, is actually being implemented many other places,” Shon said. “The Department of Health has been consistent in not wanting — and resisting — change and more effective oversight. They have consistently taken the side of care home operators and not the care home residents.”

Ridley said the department continues to believe that any licensed facility should be ready for an inspection at any time.

“Whether we announce or don’t announce those inspections, they ought to be ready,” he said.

Read the full report below.

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