Care home inspections
bill passes committee

New language would allow
but not require the state to
inspect facilities unannounced

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By Helen Altonn
haltonn@starbulletin.com

Proponents say unannounced inspections of adult residential care homes are needed to protect vulnerable adults from abuse and neglect.

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Opponents argue that such inspections would trample their constitutional rights and disrupt their programs.

This has been an issue for at least five years with lines clearly drawn between care home operators and groups and agencies concerned about the health and safety of frail occupants of the homes.

A task force was appointed in 1999 to recommend improvements to administrative rules for adult residential care homes and the state health and attorney general's departments drafted proposed rules two years ago. They still haven't been adopted.

Under current rules, the state Health Department, the licensing agency, is required to give care home operators the approximate time for the annual inspection.

The city prosecuting attorney, AARP Hawaii, Long Term Care Ombudsman and other organizations urged passage this session of House Bill 372, which would require unannounced annual inspections starting Dec. 31, establish criminal and civil penalties for people who inform a home of the date or time an inspection is scheduled and provide criteria for inspections.

However, both HB 372 and a companion bill in the Senate have been deferred in committees.

The House Health Committee instead combined HB 846, a diluted version of HB 372, with HB 914, generating a bill that says the Health Department "may" conduct unannounced inspections. State Long Term Care Ombudsman John McDermott said HB 846 is a good bill but not as strong as necessary to protect dependent people from abuse and neglect. He asked that "may" be changed to "shall conduct unannounced annual inspections."

The Health Committee approved HB 846 on Thursday, sending it to the Finance Committee.

House Health Chairman Dennis Arakaki (D, Kamehameha Heights-Kalihi Valley) said the weaker measure would give the Health Department time to gear up for an unannounced inspection program.

At hearings on HB 372 on Feb. 5, the Health Department said it supports the overall concept, but would need additional resources.

Advocates of unannounced inspections said the surviving bill, HB 914, won't survive the Legislature because of its original purpose -- requiring the state to establish a special fund to pay insurance premiums for care home operators who can't afford homeowner's insurance for their business.

Among those stressing the importance of unannounced inspections was city Prosecutor Peter Carlisle, who said they're necessary.

"Our department and the Department of Attorney General have several times in recent years found ourselves at the ultimate and tragic end of a course of events resulting from the death or serious injury of residents of care homes," he said.

Care home operators and administrators said unannounced visits would violate their rights of privacy and those of the residents and would upset their schedules.

Ron Gallegos, representing the Hawaii Coalition of Care Home Administrators and president of the Alliance of Residential Care Homes, said the main priority of the 545 licensed homes is the residents' health and safety.

He said they have no problem with unannounced investigations, already being done based on complaints, or 20- to 30-minute unannounced visits "if done by properly trained personnel."

But he said an unannounced annual inspection taking hours would "totally disrupt our day and is not reasonable or acceptable."