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Adult care home
officials defend
their integrity
One care home resident's
By Helen Altonn
death last August shouldn't
taint the industry, they say
Star-BulletinHawaii's adult care home officials fear the manslaughter conviction of one operator will taint all of those in the business -- most of whom, they say, do a good job.
"When people assume care homes are doing this and doing that, it is really a put-down for the industry," says Maria Etrata of Pearl City. She cares for two developmentally disabled mentally retarded adults and heads Primary Caregivers of Hawaii.
Raquel Bermisa, licensed operator of a Pearl City care home, recently was prosecuted for the death of Chiyeko Tanouye, 79, last August. Tanouye, one of five clients in Bermisa's home, died from symptoms of decubitus ulcers, or large bedsores.
Such incidents are rare, said Helen Yoshimi, chief of the state Department of Health's Office of Health Care Assurance, which inspects and licenses all facilities statewide that provide adult care.
"When you think we have over 550 (adult residential care) homes and operators caring for them over 24-hour periods, they definitely are most dedicated," she said. "I commend all of our licensed operators for the job they take on."
She said her office receives few allegations of abuse, and she "can't speak for what happened" in Tanouye's death. As soon as her office is alerted to any such situation, she said, "We go in to be sure the rest of the residents are not in jeopardy."
Her office handles inspections and licensing for all settings where adult care is provided: hospitals, nursing homes, intermediate care facilities for mentally retarded persons, homes for the developmentally disabled, home health agencies, adult day care centers and behavioral health treatment facilities, as well as adult residential care homes. It also licenses clinical labs.
A state licensing section has eight registered nurses and two registered dietitian positions (only one is filled).
A Medicare section that does state licensing and certification of facilities for federal reimbursements has nine nurses, two social work positions and a dietitian.
Unannounced annual inspections are authorized in all cases except for adult care homes, where surprise visits are only done to investigate allegations or complaints.
However, state Health Director Bruce Anderson issued a new policy in November that all inspections related to licensing, including follow-up visits and complaint investigations, shall be unannounced.
"The people they serve are vulnerable and can't often protect themselves. As such, it is essential that we have the ability to follow up on complaints and inspect facilities day or night."
Arranged meetings also will be conducted when necessary to obtain certain information, he said.
Yoshimi said a draft of the rule has been finished for review by the attorney general. A public hearing will be held after approval by the governor, possibly in about two months, she said.
Facilities generally know when their annual inspections will be held because they are related to the date they applied for their one-year licenses, Yoshimi said. "We do not announce but they all know."
Etrata said the adult residential care operators understand the need for unannounced visits to follow up on complaints or suspicions. But most oppose unannounced annual inspections, which they believe would upset scheduling of doctor's appointments or programs planned for residents, she said.
Under current practice, Etrata said, she receives a notice in February that her annual inspection will be done on a Tuesday in May. No date or time are given, but she does not schedule anything on those days, she said.
Etrata angrily denounced an accusation that care home operators do not want unannounced visits because they only clean one week before the inspection date.
"We clean every single day," she said. "That is absurd."
Etrata formerly was president of the Alliance for Residential Care Home Association. She formed the new "chop suey" group in January to expand services from adult care home operators to other types of caregivers, such as those for the developmentally disabled and mentally retarded. It has about 65 members and is growing, she said.
She holds quarterly meetings to provide information and advice to the operators. "We tell them, 'You have to watch out for yourself. You have to really check your clients, to see what they need, because that is your job, to provide things for them.'"
The group is now meeting about every three weeks for updates on the new rules, she said.
The operators are concerned about some unlicensed underground care operations, Etrata said. "We've told the association, 'If you know of anybody doing that, alert the department because you want to protect our business.' Some people are giving us a bad name. We have to look out for those."
