State rules let facility bypass requirement for nursing staff

State law requires intermediate-care facilities for the mentally retarded with more than 15 beds to have full-time nurses on staff.

Opportunities for the Retarded Inc. has 35 beds for patients who need that level of care, but there are no nurses on the staff. That is because each of the seven homes on its property is classified as a separate facility, although all services - from meals to rehabilitation - are provided centrally.

ORI contracts with medical personnel to come in to provide health care. By contrast, the Arc in Hawaii employs three full-time nurses for its clients, including 32 residents in seven intermediate-care facilities scattered in different neighborhoods.

Gerald Chung, Medicare certification officer for the state, said the choice of whether to operate as one large or several small facilities on the same property is up to the provider. More facilities require more paperwork, he noted, but if something goes wrong and there are sanctions, they would affect just one facility.

In recent years, ORI has converted more of its regular "domiciliary homes" into intermediate-care facilities, which have a medical component. As residents have aged, their medical needs have grown, ORI Program Director Yvonne de Luna said. Intermediate-care homes require more sophisticated care and 24-hour supervision, and are reimbursed at a much higher rate.

Judie DeBone, a nurse, says she is pleased with the medical care given her daughter, Charlotte, who moved from a regular home at Helemano to an intermediate-care facility.

"She became diabetic, and they worked religiously on her diet," she said. "She got weight off and is off half her medications."

The only downside is that state regulations limit the number of nights that residents of intermediate-care facilities can spend elsewhere, she said. So Charlotte, who used to stay overnight at her family's home every weekend, now can do so just once a month. "We used to love to have her for the whole weekend," her mother said.

The number of intermediate-care facilities for the mentally retarded in the state has dropped, with eight closing since 2002, according to Chung. There are now 18 licensed facilities in the state with 91 beds, run by the Arc in Hawaii, the Arc of Maui, Kula Hospital and ORI.