When it comes to sanctions, a low number of them usually means a good thing. But when transgressions are unreported or under-reported, or there’s a lack of urgency in investigating questionable situations, a low sanctions rate signals that the system needs tightening.

Numerous warning bells are being sounded about the weakness of oversight of Hawaii’s nursing homes. In four of the past five years, the state Department of Health has failed to meet federal standards for properly evaluating the severity of complaints, reports the Star-Advertiser’s Rob Perez. The state also shows a laxness when it comes to assessing and penalizing serious deficiencies, and the regulatory gaps are worrisome given the expected demand for nursing homes in the near future.

There are 48 federally certified nursing homes in Hawaii, and presently, just 10 state inspectors to oversee them. Complaints ranging from elderly physical and sex abuse to subpar medical care have been filed, but deficient care has rarely resulted in any penalties in Hawaii, whereas they would have in other states.

The state health director, acknowledging there are problems, says hiring freezes, retirements and furloughs have stymied better inspection of nursing homes in recent years. But she sees improvements coming, including a boost in staffing. Indeed, they are sorely needed.

Hawaii is on the verge of a "silver wave" — and quality of elderly care will be a major issue for a growing number of Hawaii’s population. Seniors age 65 and older made up 15 percent of residents here last year; that number is expected to rise to 20 percent by 2020, and up to 23 percent by 2030, the state projects. Factor in that Hawaii has the nation’s highest average longevity — about 81 years — and the outlook for the senior-care industry is fraught with opportunities in need of forceful monitoring.

While the focus must remain on quality care, the high costs can’t be overlooked. In Hawaii, the median annual price for private-room nursing home care is $122,640 — 58 percent higher than the national median of $77,745 — having risen 4.7 percent annually in the past six years, according to Genworth’s 2011 Cost of Care Survey. That is projected to rise to $199,768 in 10 years. There must be scrutiny to ensure that people get what they are paying for: quality, safe care.

In 2002, the National Center on Elder Abuse came out with prevention strategies against abuse in nursing homes and other long-term care settings, which included coordination between law enforcement, regulatory, adult protection and nursing home advocacy groups, as well as strict enforcement of mandatory reporting. In both these aspects, Hawaii’s oversight over nursing homes must be shored up.

A third prevention strategy — to assure that hiring practices include screening of prospective employees for criminal backgrounds, history of substance abuse and domestic violence, and other red flags — truly reveals a gaping hole in the state’s system. Hawaii years ago created a blacklist of certified nurse aides deemed unfit to work at long-term care facilities — but the list has not been updated for four years, a galling dereliction of a simple task that should not be excused away by short-staffing. Creating safeguards means little if they are not used and enforced.

We must do better. Reporting and sanctions should err on the side of vigilance, to protect the many seniors who, at this stage of their lives, are at their most vulnerable.

"Our society must make it right and possible for old people not to fear the young or be deserted by them, for the test of a civilization is the way that it cares for its helpless members," wrote the author Pearl S. Buck. These words will become increasingly apt as we in Hawaii and the nation become increasingly gray. Now is the time to actively take stock of our senior care systems such as nursing homes and their oversight — and make them right.