Care-home lobby often wins
By Rob Perez
Advertiser Staff Writer
The pattern has held fairly steady in recent years.
The state Senate easily passes a bill designed to enhance consumer protections in the long-term care arena. The House kills or substantially weakens it.
Score another win for the care-home lobby.
As advocates for the elderly have pushed legislation to bolster safe- guards, they typically have clashed with an influential cadre of care providers wary about expanding a bureaucracy the operators already consider overly burdensome.
More often than not, the care providers have prevailed, helped by key allies in the House.
"The senior lobby has been mostly ineffective," said former legislator Jim Shon, who served in the House from 1984 to 1996. "Again and again, you see long-term care issues put on the back burner."
One clash last year involved a bill that would have required the state to post inspection reports for long-term care facilities on a public Web site. At least 17 other states have such online access, providing an easy way to get information about inspection results.
Despite opposition from the two state agencies responsible for Hawai'i's inspections, the Senate unanimously passed the bill.
But it didn't survive even the first hearing in the House, thanks in part to opposition from the care- and foster-home lobby.
Rep. John Mizuno, chairman of the House Human Services Committee and an ally of the care providers, said the legislation's timing wasn't right, mainly because of the state's severe budget crunch. He was instrumental in killing the measure.
"The intent behind the bill was laudable," Mizuno said. "But it just was not the right time to move out."
A year earlier, another measure met a similar fate.
The Senate overwhelmingly passed legislation that would have appropriated funding for three long-term care ombudsmen (advocates for patients) for the Neighbor Islands.
But the House succeeded in deleting the funding, diverting the money to a Senate majority bill that was later amended to increase payments for care- and foster-home operators, advocates for seniors say. Proponents of the Senate measure said that caregivers had received only three small increases over the previous 11 years.
Mizuno, in an article in the Fil-Am Courier newspaper, boasted about teaming with a care-home industry leader to devise the plan to hijack the Senate bill and insert the payment increases.
"We pulled off one of the biggest miracles of the session," Mizuno was quoted as saying.
Advocates for the elderly were not pleased.
"John Mizuno has killed these (senior) bills each time because care-home operators help him get elected," said Laura Manis, who lobbies for Kokua Council, an advocacy group for seniors. "It's as simple as that."
Mizuno, whose Kalihi Valley district has many care homes, acknowledged being an advocate for the care providers. But he stressed that he's also an advocate for seniors and the disabled and tries to balance their interests with the interests of care home operators.
Ultimately, Mizuno added, "consumer protection has to be No. 1."
Mizuno, who has headed the Human Services committee since last season, said he has supported funding for Neighbor Island ombudsmen and this year introduced the online inspection bill, though it didn't get a hearing.
The care providers wield considerable influence in the House for several reasons, according to legislators and lobbyists. They are mostly of Filipino ancestry and turn to the Filipino caucus in the House to champion their interests.
Many also are politically active, and because their homes are concentrated in Waipahu, Kalihi and 'Ewa Beach, the House members from those districts tend to be supportive of the care providers' concerns, legislators and lobbyists say.
House Speaker Calvin Say said that care providers are influential because of the composition of the House. Discussions, he added, have been held among majority Democrats about balancing the interests of caregivers with those of seniors.
"Consumer protection was an issue we tried to address," Say said.
STRIKING A BALANCE
This year's session has no major bills that pit advocates for seniors against the care-home lobby.
But the tension over striking the right balance has been evident in the push for other bills from previous sessions.
In 2003, AARP, the senior advocacy group, made unannounced inspections of care homes a top priority in the wake of some high-profile cases in which seniors suffered harm at the hands of neglectful or abusive caregivers.
The Senate took up the cause and pushed a bill, opposed by caregivers, that mandated that all inspections be unannounced. The House opposed that approach and eventually settled for a compromise: annual inspections for licensing renewals were to be announced but all other visits would be unannounced.
Care providers had argued that relicensing inspections were disruptive and that unannounced visits violated the privacy rights of care home owners.
That same year, the Senate backed a bill that, among other things, would have allowed people filing civil lawsuits against allegedly abusive caregivers to seek triple damages. The long-term care lobby, citing concerns about higher insurance rates, opposed the provision and the House removed it from the bill before it passed.
In the fight last year for the online inspection-reports bill, advocates for the elderly argued that virtually no information on the quality of community-based care facilities is readily available to the public.
"There is no real justification to have inspections conducted by state officials kept in difficult-to-access public files," Al Hamai, representing the Hawai'i Alliance for Retired Americans, said in written testimony. "Inspection reports placed on the Web site will help the increasing number of people who will have the responsibility to help find a suitable care facility for a loved one."
But care providers and other opponents argued that information in the reports can be misleading or biased and that care operators should be given a chance to address and correct any deficiencies before publication of negative comments.
"Publication of inspection reports would defeat the purpose of the inspection, which is supposed to provide constructive suggestions for improvements to the quality of care," Bryan Andaya, adviser to the Hawai'i Coalition of Caregivers, said in written testimony.
Officials with the departments of Human Services and Health, the two state agencies responsible for inspecting long-term care facilities, opposed the bill, citing the anticipated cost of the additional workload and saying the raw information in the reports might confuse the public.
Sen. Suzanne Chun Oakland, who heads the Senate's Human Services Committee, said most care providers shouldn't be worried about measures that enhance consumer protections.
"For those who are doing things right, they should not have a concern," Chun Oakland said. "If anything, they should be welcoming these (measures) because they protect the industry."
Some protection measures have passed the Legislature relatively intact, such as when lawmakers in 2006 adopted a bill requiring criminal background checks of employees of care providers. But those, advocates for seniors say, are the exception.
Care providers have repeatedly told the Legislature that they believe their profession already is overregulated. If even more requirements are added, they argue, fewer people will enter the profession at a time when many caregivers are nearing retirement age and the demand for services is expected to soar as Hawai'i's population of elderly grows.
"We all know there's a train wreck coming because there's not enough beds," caregiver advocate Ron Gallegos said at a Kupuna Caucus meeting last year. "There's going to be a tremendous shortage."