The term “silver tsunami” refers to the rapid rise in Hawaii’s aging population and the long high wave’s potential to overwhelm state services for this demographic sector, if preparations are inadequate. Nearly 1 in 4 residents are at least 60 years old.
With the oldest baby boomers now in their mid-70s, state lawmakers need to assess the status of community care homes. While Hawaii has about 1,700 licensed legal long-term care facilities serving 12,300 residents, the unlicensed, illegal sort has proliferated in recent years.
At a legislative briefing last week, health regulators reported on ongoing investigations aimed at reining in the unlicensed inventory. Also, care home operators and others spotlighted cases of consumers being duped by underground operators. The takeaway: The state must do more to alleviate the brunt of the tsunami.
While licensed facilities must comply with an extensive list of health and safety requirements, along with annual state Department of Health (DOH) inspections, unlicensed operators circumvent oversight — and taxes. A few years ago, it was estimated that as many as 200 unlicensed care homes were operating throughout Hawaii.
In an effort to crack down on unlicensed adult residential care homes, or ARCHs, Hawaii enacted a law that authorizes the DOH to inspect care facilities reported to be operating without a state-issued license; and establishes quickly rising fines for unlicensed operations, and for knowingly referring or transferring a patient to an unlicensed facility.
ARCHs provide at least minimal assistance with daily living activities, ranging from bathing and dining to walking. Since Act 148 took effect last year, the DOH’s Office of Health Care Assurance has received 114 complaints about unlicensed ARCHs and was last week poised to issue at least 13 notices of violation. Such vigilance is necessary.
Also, state officials have entered and inspected
52 homes so far and have been denied entry to 17. While the new law allows DOH to obtain a search warrant, the agency has yet to do so. It should — because unless unlicensed operations are clearly identified and fined, their count will likely continue to rise.
However, given the growing demand for ARCHs, state lawmakers and regulators also should do more to make securing a license more attractive and worthwhile.
Along those lines, in response to common complaints about a drawn-out application process, the agency has already reduced the typical wait to three to six months from nine months. That’s encouraging — and should prompt strategy to further step up an efficient process.
A scathing state audit of DOH’s Health Care Assurance office found that in 2017, nearly 500 ARCHs were operating with either no license or a “hastily issued” permit. Further, the DOH did not cite a single operator or terminate a license from 2007 to 2017, even for those with substantial or repeat deficiencies.
The audit rightly prodded much-needed improvements. Among them: clarified policies and procedures, implementation of Act 148, and new staffing positions to address snags tied to short-staffing.
If short-staffing problems resurface, the state should consider hiring contractors to assist with timely licensing and inspection tasks. This stopgap tactic has been employed in recent years to tackle delayed state certifications for high-demand kidney dialysis centers.
By 2035, 1 in 3 Hawaii residents will be at least
60 years old. State lawmakers in tandem with regulators and operators must continue to take steps toward better ensuring the health and safety of the facilities’ residents as mandated by statute. Failure to move swiftly and firmly now could leave the state grappling with decades of silver tsunami-related fallout.
