Only a fraction of America’s worst-performing nursing homes, including Legacy Hilo Rehabilitation & Nursing Center on the Big Island, get increased oversight even though hundreds of homes nationwide qualify for more scrutiny as a measure to better protect residents.

But there are hundreds more nursing homes, including five others in Hawaii, that have the same troubling pattern of serious problems yet aren’t getting the same attention from health and safety inspectors. Until now, the names of these facilities have been kept secret.

U.S. Sens. Bob Casey and Pat Toomey from Pennsylvania have released a list provided to them by the Centers for Medicare and Medicaid Services of nursing homes that health inspectors flagged for having established a troubling pattern of providing residents unsafe or substandard care.

Although these facilities “substantially fail” to meet the care standards established by Medicare and Medicaid, they are not subject to more frequent surveying and progressive enforcement actions.

“The trouble is, it’s a loved one who’s needing to live perhaps the rest of their life in a nursing home,” said Larry Geller, a local activist on senior care issues. “But for many people living in a nursing home is purgatory. It’s depending on the specific nursing home and in many cases the specific staff. Even one staff member can make a difference.”

In Hawaii, there are six nursing homes flagged by the CMS as having a history of serious quality issues: Kulana Malama, Kuakini Geriatric Care and Wahiawa General Hospital on Oahu, Legacy and Kohala Hospital on the Big Island and Samuel Mahelona Memorial Hospital on Kauai.

Federal regulators say they have only enough resources to keep a closer eye on about 80 troubled nursing homes nationwide. Facilities subject to this added scrutiny face termination from participation in the Medicare and Medicaid programs if they don’t correct their violations, or qualify for a time extension, within 18 to 24 months.

20 Poor Care Citations

Only Legacy Hilo faces more severe oversight and accountability actions for its history of violations. Those violations have in recent years included a failure to adopt a quality assurance program to monitor areas including meal service, resident quality of life and infection control; an absence of policies that prohibit mistreatment, neglect and abuse of residents; and failure to return personal funds of deceased residents to their representative or family member.   

In 2016, Legacy Hilo racked up more than two dozen poor care citations and paid tens of thousands of dollars in fines. In one incident, a resident with dementia wandered out the front door. Health inspectors documented another incident in which a resident with mobility issues was seated by a staff member too far from the dinner table and left struggling to eat and spilling food in his lap.

In February, after more than two years of extra oversight, Legacy Hilo logged 20 health citations. Hawaii nursing homes have an average of seven citations per year.

A spokesperson for Legacy Hilo could not be reached by phone on Tuesday.

The CMS lists Hawaii’s five other facilities that have a history of serious safety and compliance problems as candidates for the increased oversight program. The names of these nursing homes, and their status as troubling status, had not previously been published by the government.

Inspection reports available online show a history of problems at these facilities.

Examples of abuse and neglect include an insect infestation at Kuakini Geriatric Care in Honolulu that the facility failed to correct, resulting in ants and cockroaches crawling on top of residents, countertops and medical charts. 

Inspectors also documented a record of health citations for violations including a shortage of nursing staff and failure to properly determine whether a resident is able to self-administer his medication.

As of last month, the facility had an overall rating of two stars and a quality rating of five stars.

Kulana Malama paid a fine of $64,558 in December 2017 when inspectors discovered 22 health citations, including violations for failing to provide safe respiratory care to a resident who needed it and failing to provide enough nursing staff to meet the everyday needs of residents.

On Kauai, Samuel Mahelona Memorial Hospital paid fines of $33,676 in October 2016 and $43,544 in April 2018 after incurring citations for health violations for failing to clear the nursing home of accident hazards and failing to provide necessary care to residents.

Jim Shon, president of the senior advocacy group Kokua Council, said the state has an obligation to ensure that nursing homes are safe.

“If they’ve been flagged for having extra problems, that means our system of inspections and corrections has broken down,” Shon said.

In 2016, Kokua Council sued the state over its failure to post inspection reports of state-licensed care facilities online.

A judge ruled the department violated the state open records law by redacting information to the point that the reports are worthless to those who rely on them to help make decisions about placing a family member or loved one in a long-term care facility.