Legislation to regulate unlicensed care homes faces its final hurdle today as both House and Senate lawmakers vote on the controversial bill.

House Bill 1911 would give regulators the power to crack down on care homes, including so-called aging-in-place, or AIP, facilities, the first of which was fined $325,000 earlier this year by the state Department of Health.

The state considers AIP facilities illegal in Hawaii, which has roughly 2,000 licensed care homes that provide care for about 13,000 seniors and disabled. The bill would give regulators the power to enter a private home to investigate a licensing complaint.

“These people are making millions of dollars, and they have hired not only top lobbyists, but they’ve also got a team of attorneys because they really feel like they’re not violating the law,” said state Rep. John Mizuno, chairman of the House Health and Human Services Committee, estimating that there are more than 200 unlicensed facilities. “They think it’s legit. In their mind they don’t need to be licensed. But if they’re not doing anything wrong, why aren’t they licensed? Why are they so secretive about their industry? They are blocking everyone out and there’s a reason for that.”

Maile Harada, a nurse and case manager who helped build the AIP model in Hawaii, said aging-in-place facilities are not unlicensed care homes, which she agrees need to be shut down.

AIPs merely coordinate homeowners, personal caregivers and case managers — things that already exist in the market — to provide another option for seniors, she said. Seniors share a home together and may get help from personal caregivers for certain services only if needed under the oversight of a registered nurse. Agreements for rental housing, personal care and case management are all separate.

“I’m not developing a model that can kill people or hurt people. Our intention is to give seniors another alternative to meet their care needs. We are worthy of having respect in the islands,” she said. “We do link people together, but we’re not affiliated with each other. A homeowner is only a homeowner. They’re not providing the care. They’re coming together under one business model.”

She said some unlicensed care homes are misrepresenting themselves as AIPs, which is why she has hired attorneys to crack down on them.

“There’s unlicensed care homes, there’s no doubt, and I would not even hesitate to turn them in,” Harada said. “Hands down, I think it’s unsafe for the community because a lot of them are doing it without RN supervision. I want clients to be safe.”

Harada said she fully supports the regulation of home care services. There are about 40 AIP facilities under her nonprofit, the Hawaii Platinum Group, she said.

“I definitely want to work with the state. I think our model is a good model. I don’t think our model will be shutting down, because we’re not doing anything illegal,” Harada said. “We’re even putting RN supervision over everybody just to make sure everybody’s safe.”

Nancy Walch, a nurse and certified case manager, said it is critical for the state to regulate the unlicensed industry because otherwise, legitimate businesses will be hurt.

“If this bill is killed, it will affect all of us. The people that are doing care home businesses right now, they will drop their licenses” if the government does not enforce the rules, she said. “This is all about safety.”

The bill proposes fines of $100 to $1,000 daily for unlicensed operations and $500 to $2,000 for providers who knowingly refer or transfer people to illegitimate facilities.

Care homes must follow stringent state regulations that include annual inspections and unannounced visits as well as requirements to carry liability insurance, complete criminal background checks and adhere to patients’ rights laws. Most licensed homes have five to eight people, while some unlicensed facilities might have as many as 10 to 15 residents.

“It’s the Wild West. They do not have any of this criteria,” Mizuno said. “There’s no criminal background check, so you could have a rapist or murderer being a primary caregiver — that is scary. This is … consumer protection — life or death.”