FOCUS
Adult care homes defend their work with state's elderly

By Melba Acido, Maria Etrata, Ron Gallegos, Nancy Inez and Esther Pascual

Several weeks ago The Advertiser ran a series of articles on the abuse of elderly people. These articles were well written, and we agree with the basic conclusions of the writer — there are examples of elder abuse in Hawai'i, and procedures should be in place to assure that our seniors are not neglected or abused.

Nora Fuerte, a home-care aide, checks the blood pressure of Hazel Yasutomi, 74, at the Harry & Jeanette Weinberg senior residence at Maluhia on Hala Drive. Adult residential care homes are not at the root of Hawai'i's elder-abuse problem, care-home operators say. Advertiser library photo • Jun. 25, 2002

That picture is false.

There is no doubt that abuse and neglect does happen, even in adult care homes, and that it should be stopped. But to even imply that adult residential care homes are the main problem for elder abuse in Hawai'i is demeaning to the hundreds of caring people who daily feed, bathe and otherwise care for many of Hawai'i's elderly people. To better understand this issue, perhaps a few things need to be explained, since the term "care home" is easily tossed about and easily misunderstood.

There are approximately 160,000 people in Hawai'i older than 65. Many — perhaps most — of these people live in their own homes or in homes of their immediate families. Others live in 12 different kinds of private and public care residences, plus many live in institutional settings. These include adult residential care homes, foster homes, nursing homes, assisted-living facilities and even hospices. Each of these types of residential homes operate under different rules and regulations, with some overseen by the state Department of Health and others by the Department of Human Services.

There are about 550 adult residential care homes in Hawai'i, providing daily care to about 2,600 elderly residents. Most of the residents — 95 percent — who live in these homes pay $1,040 to $2,200 a month for 24-hour board and care. This is much lower than costs for the larger, institutional-type facilities. It's estimated that the state and federal governments and private families save up to $120 million a year in Hawai'i because of the affordable costs of adult residential care homes.

Going into business as an adult residential care home isn't easy. These facilities are licensed by the Department of Health and must abide by strict regulations. It takes $30,000 to $100,000 to modify a family home that allows up to five residents to live with the family 24 hours, seven days a week. Plus, every home must be operated by a nurse aide who has completed formal nursing education, as well as a minimum of 12 months (2,000 hours) working in a nursing home or hospital giving direct patient care.

People working in expanded adult residential care homes (which allow up to five residents, two of whom may need skilled nursing care) are required to have additional training. It takes a dedicated family to turn its home into a care home and to welcome complete strangers as new family members. Very few adult residential care home operators will risk their investment, reputation and future by neglecting or abusing the people who live with them.

Yet The Advertiser articles seemed to imply that adult residential care homes were a major cause of the abuse problem. For example, of the 10 abuse cases discussed in the Feb. 16 issue of the paper, five of these were former residents of adult residential care homes. Yet in the same article, The Advertiser reports that over the past six years, an average of only 18 percent of elder abuse can be traced to staff working in all the different types of facilities, not just adult residential care homes.

By our records, adult care homes accounted for 4 percent to 5 percent of the 157 confirmed cases of abuse reported to Adult Protective Services last year. That's nowhere near the majority of problem cases. We agree that even one case of neglect or abuse is not acceptable — but to make it appear that adult residential care homes are the primary problem is both wrong and dishonest.

Unfortunately, it appears there are even people in responsible positions ready to jump on the bandwagon against adult care homes. They should not be attacking these facilities in the media or through other communications with senior-citizen associations. But that is what has been happening, instead of trying to work directly with us. How can any problems be solved when one section of the government goes after another section? We all must work together.

What hasn't been publicized is that the adult residential care homes have been taking steps on their own to ensure that our elderly are protected. As a coalition, we have increased our in-service training for caregivers this past year, and we recently had a Care-Givers Expo, complete with training sessions. We have high standards for our coalition members. We won't tolerate members who hurt their residents.

The Advertiser also made it appear that adult residential care home operators were opposed to unannounced inspections and that, as a result, the state could not ensure the safety of residents living in these facilities. This is absolutely false.

Our coalition allows state inspectors access to our care homes, at any time, for short-term visits to check for neglect or abuse of our residents. Half an hour is ample time to see and talk to each home's few residents and discover if there is anything wrong.

It would be instantly obvious, for example, if a resident were suffering from decubitus ulcers (bed sores), which The Advertiser claims accounted for 33 deaths in the past decade.

The only thing we oppose is having our annual license-renewal inspections be unannounced. The reason is simple. Annual license-renewal inspections take three to seven hours and completely disrupt the household. While residents are sometimes interviewed, these annual inspections are primarily for the purpose of looking at the physical aspects of the home and checking required paperwork documentation.

The kinds of things that are checked in annual license-renewal inspections include looking at fire-drill and emergency procedures, making sure the schedule of resident activities is maintained, reviewing the training and education of people working at the facility, making sure the hallways and wheelchair ramps are up to code and so forth.

There is no valid reason that such inspections need to be unannounced, because they are extremely disruptive to residents and are commercially unreasonable. If paperwork and/or the physical design of a care home is wrong, it can't be hidden with a week's, or even a month's, notice.

Giving adult residential care home owners some advance notice for these annual license-renewal inspections allows them to minimize disruption of the home environment that the state should want to protect. And, as stated, Hawai'i's adult care homes are open to short-term unannounced inspections by licensed personnel at any time if all they want to do is look for abuse or neglect of our residents.

A larger problem state officials should look at is what we call "transfer trauma." This occurs when residents are forced by the government to move from the adult care home where they live because they require full-time nursing. Statistics are not kept on this, but there is ample anecdotal evidence that many of these elderly people die within weeks after being removed from their care homes.

More effort must be made to develop effective ways that allow the elderly in Hawai'i to age in the community-based facilities they choose.

The people who manage Hawai'i's adult residential care homes are very concerned with the health and welfare of the people living in our homes. These elderly, often frail, people become members of our extended family. We are not aware of anyone in our industry who would intentionally harm a resident.

For that reason, we are satisfied with laws that protect the elderly. But such laws should not make it impossible to operate a care home, or so costly that older people cannot afford to live in single-family care homes. With an aging baby-boomer population reaching retirement age, it has been estimated that Hawai'i will need up to 10,000 more spaces for elderly people by 2010.

Allowing these people to live out their final years with the best quality of life possible should be the priority. Adult residential care homes provide that lifestyle choice for many people.

The writers represent all five care home operator associations in Hawai'i: Melba Acido, Big Island Adult Residential Care Home Association; Maria Etrata, Primary Care Providers of Hawaii; Ron Gallegos, Alliance of Residential Home Association of Maui; Nancy Inez, Adult Residential Care Home Operators; Esther Pascual, United Group of Care Administrators.