Inspector shortage, inefficiencies create care crisis for Hawaii’s elderly

Always Investigating

A lack of inspectors. A whole sector unregulated. A long wait to license more facilities.

Those are just some of the problems plaguing long-term care in Hawaii’s long-term care industry, and it could be putting Hawaii’s kupuna at risk.

When Always Investigating started digging into what many have called an elder-care crisis, we found a slew of problems with regulating the industry. So we asked what it will take to fix it, and found out some things are in the works to address the issues.

Nearly 12,000 people in Hawaii have found long-term care in the face of a severe shortage, but thousands more need it still.

“They can’t find a bed available. They need home care immediately,” said Shelley Wilson, CEO of the Wilson Care Group, which operates a licensed home health-care agency, as well as a licensed residential care home in Kailua that is full, as are many such facilities across Hawaii. “I think for the majority of the public, they don’t realize until it’s too late.”

“Far more than that are needed,” said Larry Geller of the Kokua Council, which advocates on behalf of critical senior issues such as long-term care, “and the Department of Health is in the middle of all this. They have to license and they have to inspect.”

Yet despite long waitlists for more care facilities, the state agency that regulates the industry puts new inventory on the backburner.

“Those brand-new facilities (that) require an initial survey are the lowest priority,” said Keith Ridley, chief of the Hawaii Department of Health’s Office of Health Care Assurance, “and unfortunately, as a result, those facilities will have to wait until we have the resources available.”

It’s a wait Ridley says that can be a year or more. As for the hundreds of existing locations with a license, a severe shortage of inspectors has them triaging those inspection and re-licensing visits too. Only places like skilled nursing facilities stay absolutely within their annual licensing visit timeline.

“Other facilities that aren’t high on Medicare’s list get lower on the list and get done when we are able to get to them,” Ridley said.

That leaves a gap for many places, like Hawaii’s nearly 500 adult residential care homes.

“Those are in the scores, 60 to 80, in that neighborhood, where we are behind, and it equates to approximately 10-15 percent of the facilities,” Ridley said.

Always Investigating asked, what happens when they hit an expiration date?

“We don’t revoke or cancel a license. What we do is we get out as soon as we can. If necessary, we’ll extend a license,” Ridley said. “We don’t want them to have to kick out mom and dad, and grandma and grandpa.”

“If you can’t get your inspections done and you’re way behind, there could be a gap in time where maybe somebody did have a bad outcome and they shouldn’t be providing care any longer,” said Sen. Josh Green, also an emergency room physician. “It’s another reason why we want them to be caught up in almost real-time. … It would probably take a year to catch up.”

The state is filling one inspector vacancy at the end of this month, and recruiting for a handful of new positions that could start as soon as January. But that’s half the battle; the other is knowing exactly where to start.

We asked the state for a list of which facilities are on expired licenses, and it’s something they could not provide. It’s not easily accessible to the public, or even to the agency itself.

“It’s not a list that we necessarily maintain,” Ridley said. “It’s a paper log, essentially, and not even a log. It’s just a file where we’ve kept copies of licenses that we’ve issued, and we go through and see when the license is due for renewal. We need to create a management information system where we have databases of providers and we can query reports.”

“We can’t get safe services to people if we don’t get these certifications done,” Green said. As an emergency room doctor, he sees the problem up close.

“An elderly woman cracked her pelvis. She came into my ER late at night on the neighbor islands,” Green said. “We had nowhere to send her. We would love to have home nurses, but we’re short of all of these services.”

Short partially because the regulatory backup goes beyond just center-based licensing. Home health care — nurses that come to your house — are a huge part of this sector, and they too are licensed.

Home care aides — helpers but not to a medical level — often help patch the remaining gaps, but they’ve been in limbo for years despite a 2009 law requiring the state to license home care.

“There’s just not the same standards, universal standards for protection of our consumer and most definitely our kupuna,” Wilson said. “We’ve had a couple of clients we’ve cared for that have had some issues of being taken advantage of. They’ve come from unlicensed or independent care.”

We asked the state, what’s the status of home-care regulation – required by that old law – and why is it taking so long?

“We have been working on administrative rules for too long of a period of time,” Ridley said. “We had a number of other things we were working on as well. We did have other licensing programs that we were asked to do by the Legislature.”

One of the biggest was getting a cannabis dispensary system for medical marijuana licensing underway.

“It didn’t take away inspectors from our current staffing,” Ridley said, “but there was a tremendous amount of infrastructural support that had to go along with that. So those are the kind of things that drew attention away from other management responsibilities.”

Ridley says the department is finalizing draft rules and is weeks away from submitting them to the governor to go to public hearings. They’ll be proposing a fee for all licensees to raise under $500,000 a year to cover a data system, and the rules will finally get home-care licensing in place.

“After that, it will be the enforcement,” Ridley said. “How are we going to do that with our current resources? We can’t. We’ll need to get the support of the Legislature in order to provide funding.”

Lawmakers say they’ll back it.

“I want to offer and encourage extra positions going forward next year so they can never be behind,” Green said. “Until then, they know they are up against the wall.”

“The Department of Health needs help. They desperately need help,” Wilson said. “There are really good people there, and we want to keep those good people there and provide the support and resources so they can manage this growing crisis.”

When care facilities finally do get their annual inspections, how transparent are the results to the public? We’re digging into the reports to find the most common violations to watch out for, and asking why so much so far is blacked-out from public view.

That’s coming up Monday on KHON2 News at 10.

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