Year after year, the care of Hawaii’s frail elders, is becoming a worry of mounting importance to families, many of which are simultaneously concerned with the raising of children and grandchildren. The pressures of working full-time to cover basic expenses has made at-home care of aging parents an insurmountable problem for many.
That is why there is such reliance on finding support through the state’s network of adult care homes, which themselves are in short supply to meet the demand.
And that’s why the struggles by the state Department of Health (DOH) to provide needed oversight constitute a looming crisis, if the lag in inspections is not handled in short order.
And although some reassurance has come from department officials that deficiencies are being corrected, state lawmakers should get a full progress report during the coming legislative session.
The Office of the Auditor has released a report that estimates a failure by DOH to complete about half the care-home inspections required by law for 2017. The auditor investigated a sampling of 214 care homes, and 116 of those were relicensed before the inspection process was completed, according to the audit.
Some of the problems identified relate to levels of staffing to handle what must be a crushing workload, and DOH officials say they have since dealt with this concern.
However, most alarmingly, the audit identified laxness in enforcing that violations are corrected as a deficiency of the system, and noted other protocols that seem lacking in its license-renewal process.
The report was based on a study of the relicensing process at the department’s Office of Health Care Assurance (OHCA), conducted from August 2017 through May 2018. The office must create licensing rules and standards to govern quality of care at 493 licensed adult residential care homes.
Under state law, the agency must conduct yearly inspections. According to stated practice, the nurse-consultants “generate a schedule of their upcoming inspections, then submit it to the OHCA clerical staff,” which then “generally send a notice of upcoming inspection to licensee six months before the license is due to expire.”
This, according to the auditor’s findings, is not what happens. One nurse-consultant told the auditor’s staff that, “in some cases, unless she receives a call from a care home operator who voices concerns that their license is about to expire, she lets the license expire.”
There are discrepancies in how deficiency corrections are compelled and licenses are handled, as well, the auditor asserted. It took an average of almost six months to move from inspection to the submission of a correction plan. In many cases this extended well beyond a care home’s license expiration date, according to the report.
The bottom line here is that the consumers — the resident themselves, as well as their families — can feel no certainty that holding a license means what it should: that the facility meets standards of safety and care.
In its response, the department pointed out that additional resources were requested by DOH and then were granted by the Legislature in 2016. This enabled hiring two nurse-consultants (inspectors) and one administrative assistant.
The office also is working to improve its enforcement procedures and, as a result, the assurance of the health and safety of residents, according to the DOH response. Some documentation of this improvement is due to be delivered soon.
Hawaii is beginning to see the predicted “silver tsunami” appear on the horizon. And although the hope is that many will be able to age in place, the reality is that many will not.
Course corrections made promptly will help to ensure that the state will be capable of overseeing, as it must, the care of its most vulnerable citizens.
