Mental care facilities to lose federal money

By Robbie Dingeman
Advertiser Health Writer

Four facilities that care for the mentally retarded are losing Medicaid money — and two have been forced to shut down — because of living conditions that included a lack of proper food and treatment, abused and neglected residents and the failure of staffers to report injuries, according to federal documents.

Federal survey reports obtained by The Advertiser under the Freedom of Information Act detail why the federal government terminated Medicaid eligibility for two facilities run by The Arc in Hawaii last year and will end financial support for two more in another week.

Already closed is a home on Dominis Street in Makiki and one in Wailua on Kaua'i. Last week, the agency — part of the federal Department of Health and Human Services — sent out a public notice that it will end Medicaid eligibility on March 3 for two more Arc facilities on O'ahu — in 'Ewa and Halawa. The Makiki house cared for seven residents. The others each care for about four or five residents.

Residents have been placed in other facilities or with their families, officials said.

The federal agency, which requires the facilities be inspected annually, trace problems at the four homes dating back about a year. The state Department of Health's Office of Health Care Assurance is also responsible for licensing and surveying the facilities.

The report noted problems that appear to be ongoing at some of the homes, including no clear policy for reporting injuries, allegations of abuse and neglect, absence of treatment for residents, facilities that were dirty and shabby and bathrooms with toilet paper, tissues and towels locked away.

One of the facilities was also faulted for an employee who fell asleep and crashed an agency vehicle on Kaua'i, injuring a resident; and at another, an investigation confirmed abuse on the part of an employee who "used unnecessary restraint" on a client by wrestling him to the floor.

The survey reports make other alarming observations. They include:

• In Makiki, "an allegation of nutritional neglect was reported on Oct. 19, 2001, which indicated that there was only 48 ounces of canned beef stew for the seven clients who lived at the house and three cans of mixed vegetables for dinner."

• In 'Ewa, staff acknowledged that they initially took no disciplinary action even though they knew that a home manager "told one client to hit another." Eventually that employee was suspended in July 2002 and terminated Aug. 12, 2002.

• In Makiki, toilet paper, paper towels, soap and paper cups were all stored in locked closets in two bathrooms because one of the clients would dump soap and toilet paper if given access to them.

• An observation that the Pearl City day program gave residents little to do. "Client #3 was sitting at a table with a plastic container filled with puzzle pieces sifting through the puzzle pieces. Client #2 was lying on a mat on the floor by the wall. Client #2 had recently had a seizure and was urine soaked, but refused to go with staff to change his clothes."

• In Makiki, the facility had not developed a system to investigate allegations of abuse or neglect "as evidenced by the facility's failure to provide evidence that investigations of allegations of mistreatment, including injuries of unknown origin, were thoroughly investigated since December 2001" even though they affect seven of the clients at the facility.

The Arc in Hawaii is a nonprofit organization whose programs at the homes are designed to improve quality of life and help people who are mentally retarded to lead independent lives. The chief executive officer of The Arc in Hawaii is Garrett Toguchi, who also is an elected member of the state Board of Education, a former lawmaker and a former aide to then-Lt. Gov. Ben Cayetano. Toguchi could not be reached despite numerous calls for comment.

In recent years, the organization has provided residential services through 14 homes for the developmentally disabled, 11 intermediate care facilities for the mentally ill and four apartment buildings on O'ahu and Kaua'i.

Lambert Wai, president of the board of directors of Arc, said he and other board members are working with agency officials to try to correct problems so that no other facilities will be forced to close.

Wai, who has a 49-year-old daughter who lives in one of Arc's intermediate care facilities for the mentally retarded, said he has been involved with the organization for nearly 50 years and understands the seriousness of the allegations.

"I'm very upset," said Wai, a widower, who noted that he could not care for his daughter at home. "We've been operating for years. I have a child in one of the homes. I don't want this to happen."

He said the agency may convert the two homes now threatened with loss of Medicaid to a different classification that does not receive such money and does not require nursing staff and active treatment programs.

Wai noted that the federal report's findings did not reveal life-threatening problems but did point to conditions that affected client health and safety.

The federal agency informed Arc last year of deficiencies at the homes and gave the organization time to report back with a plan about how the problems would be corrected. The letters of notice were signed by Steve Chickering of the Centers for Medicare and Medicaid Services and sent from the San Francisco office.

In a letter dated Sept. 18, Chickering wrote to Toguchi that Arc had failed to document correction of all deficiencies noted in a July 2002 survey. And Chickering notified Arc that it could not request voluntary termination from the Medicaid program after his agency had begun action for involuntary termination from the federal program.

But Wai said the organization had decided to pull out of the two facilities closed last year before receiving the termination letter. He said the Dominis facility was too large for staff to handle with seven clients and it was too hard to monitor staff on Kaua'i from a distance. Wai said the organization is still deciding whether to appeal the Medicaid termination of the two O'ahu facilities.

Officials from the state Department of Human Services said the federal government pays a little more than 58 percent of the $250.57 per day tab for residents of Arc facilities eligible for Medicaid while the state pays the rest. Most of the patients fall below federal government economic levels that allow them to receive the aid.

Dianne Okumura, acting chief of the Office of Health Care Assurance, said the federal agency first flagged the problems last year and her office is trying to work with Arc officials to try to resolve problems. "We are concerned about the quality of care that is being provided in all of the facilities," not just the two facing loss of federal support next month, she said.

Okumura said the state had offered to help train Arc staff and is working to help them correct problems that could leave mentally retarded citizens without a place to live. Okumura said she believes the organization is having a systemic problem and has met with the board as well as parents of clients, and has stepped up monitoring of the facilities.