In media reports of the Hawaii State Auditor’s findings of how adult residential care homes are licensed by the state, words such as “scathing,” “shameful,” “searing, “major problems” and “seriously flawed” are used to describe the findings.

The audit, released last week, found that many of the care homes operated without a valid license or with a license issued so quickly the requirements weren’t fully completed.

State oversight is so inadequate that the Department of Health’s agency in charge of ensuring care home safety doesn’t enforce its own rules. Online postings of inspection reports are incomplete and erratic. And there is no uniform system to track inspections and update information.

The most damning statement came from the state auditor himself.

“Assurance is part of OHCA’s name,” said Les Kondo, referring to the Office of Health Care Assurance. “Assurance assumes that the residents’ health, safety, and welfare are being protected. We found that this is not the case.”

Hawaii Gov. David Ige needs to immediately move to improve management at the Office of Health Care Assurance.

Anthony Quintano/Civil Beat

Are you paying attention, Gov. David Ige? This happened on your watch, under officials appointed by you.

You swore an oath, after all, to “safeguard the rights and freedoms of Hawaii residents and citizens.”

And yet, care homes, some of them large nursing homes (which weren’t part of the audit but have been dinged by the federal agencies in the past), house our most vulnerable residents. Hawaii is among the top 10 states for the percentage of its population considered elderly.

It’s not that the problems at adult care homes have gone unheralded. Civil Beat has published more than two dozen stories since 2013. One story explained how announced inspections failed to discover a resident who wasn’t properly being cared for and later died as a result.

In a Community Voices published Monday, State Long Term Care Ombudsman John McDermott points out that problems with the DOH’s supervision care homes go back two decades. He says it is wrong for the DOH to delay conducting unannounced annual inspections until July 1, 2021.

The audit confirms just how bad a job the state has done.

One of the most troubling sections of the audit lists “repeat deficiencies” in 2016 and 2017 that did not affect the relicense process nor result in sanctions, as they clearly should have. Here are just a few the auditor culled from OHCA files:

  • medication ordered but not reflected or recorded in the residents’ medication record
  • household members had no annual physical examination
  • no tuberculosis clearances for substitute caregiver and household members
  • no documentation of first aid certification for substitute caregiver
  • cobwebs in the corners and along hallway ceiling
  • unsecured toxic chemicals

Fortunately, the Hawaii Legislature has finally, if belatedly, acted. The governor signed into law Act 148 earlier this year that gives OHCA stronger and clearer enforcement tools over unlicensed care facilities. They include the power to have a court issue a search warrant to allow for a facility investigation, and financial penalties for compliance offenses.

The state auditor identified nine recommendations for OHCA that start with the agency completing its annual inspection process — including acceptance of a care home’s Plan of Correction and confirmation that deficiencies have been corrected — before renewing a care home’s license.

The governor will soon be sworn in for a second term, deliver his annual state of the state address early next year and inform the Senate of his appointments to run the DOH. Before then, he must move promptly to improve management at the Office of Health Care Assurance.

We urge him to prioritize the care of our seniors and disabled.

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