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The Honolulu Advertiser
Posted on: Tuesday, March 30, 2010

What a surprise: Elder care oversight spotty

Who's Watching Our Kupuna?
Read the stories on the dangerous deficiencies in Hawaii's system of senior citizen care.

Hawaii news photo - The Honolulu Advertiser
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The last thing one should do with a leaky boat is to take on more passengers.

And yet something similar could happen to Hawai'i's patchy system of overseeing people and institutions that care for the elderly. As the Baby Boom generation ages into those senior years, there's going to be an explosion in the population of residents who need 24-hour care, whether in a small home or a large institution.

This week's four-part series by The Advertiser's Rob Perez outlines the critical importance of consolidating the state's inefficient and gap-ridden regulatory system, citing numerous heartbreaking episodes of abuse and neglect that result when frail elders are left in the custody of dishonest and careless people.

The system is rife with weaknesses, ranging from an inefficient and fraud-ridden system of placement in homes to a general lack of money to support inspections and enforcement.

But the overarching problem is one of uncoordinated oversight and regulation.

The case of Elvira Pineda, a care-home operator, provides a perfect example. Pineda pleaded guilty to felony theft after stealing from an elderly client; the Department of Health put her on a kind of blacklist that should have barred her from working in long-term care.

However, the guilty plea was deferred. That meant it didn't show up when, only eight months later, the Department of Human Services did its criminal check and then gave Pineda permission to open a foster home.

Over the years, DHS and DOH have worked to improve oversight. The health agency, for example, is working on rules to perform its own criminal checks, something that for now only DHS does.

But it's a little like bailing out a rowboat with a teacup: The entire system needs an overhaul to prevent situations like Pineda's. And increasing revenue through licensing fees will help finance the increased caseload that's anticipated with the retirement boom.

A big step in the right direction would be to consolidate this ineffectual dual regulation system. For instance, DOH licenses most of the facilities, including adult care homes and nursing homes; the smaller-capacity adult foster homes are regulated by DHS.

Comprehensive supervision of caregiving services for such a vulnerable population should be centered under one agency's umbrella, for the sake of efficiency and better coordination.

The Legislature has pushed for this at least since 2002, commissioning an audit to determine the best lead agency. Auditor Marion Higa recommended against the proposed consolidation under the health department. One reason she cited is the need to involve DHS in any case because it is the designated agency to handle Medicaid, which funds many of the eldercare cases.

Logically, however, a single department preferably DOH needs to be in charge, especially as growing numbers of people require care, even if consultation on Medicaid cases continues with DHS.

Tinkering around the edges of this critical social service is not enough. If the oversight of caregiving facilities is this rickety now, the system must be fortified and consolidated to weather the storms ahead.