Gaps are found throughout the regulatory system for Hawai'i’s long-term care facilities. Below are three examples of what can happen when caregivers go astray but regulators don’t keep pace.

CASE 1

Facts: In 2000, a care-home operator left residents at her home unattended. While she was away, two clients got into a fight, and one died after he was punched in the face. State health regulators investigated, but the operator denied being away at the time of the fight. When the attorney general’s office pursued the case, the caregiver admitted to not being home and was prosecuted for endangering the welfare of an incompetent person. The caregiver pleaded no contest, getting a deferred acceptance of the plea. Based on her admission about leaving the home, regulators in 2002 tried to revoke her care-home license. She contested the revocation, leading to a drawn-out administrative process. As that process unfolded, regulators made a surprise visit to the home in 2004 and found that the operator had left a resident unattended again.

Outcome: In 2004, four years after the initial incident, her license was revoked and the home shut down.

CASE 2

Facts: The operator of a care home pleaded guilty to felony theft for stealing money from an elderly dementia client. The caregiver in October 2004 was ordered to pay $6,500 in restitution and was placed on five years probation. Because of her offense, the state Department of Health placed the woman on a blacklist for caregivers deemed unfit to work in long-term care facilities. But because the guilty plea was deferred by the court, no conviction showed up on her record when she applied to open an adult foster home. While she was still on probation and on the caregiver blacklist, the woman in June 2005 received certification from the Department of Human Services to open an adult foster home.

Outcome: By the end of 2005, her certification was revoked because the caregiver abused, neglected or stole from a client again or committed another licensing violation.

CASE 3

Facts: A certified nurse aide at an expanded care home repeatedly mistreated elderly clients. The woman bent and injured the thumb of an 82-year-old man, stood idly by while the man continued to bang his head against a shower wall and threw him from his wheelchair to the bed. She also allowed an 86-year-old woman to sit in a soiled diaper for a prolonged period. The aide had been written up for mistreating other residents before.

Outcome: In January 2007 a judge sentenced the caregiver to a year’s probation after a jury found her guilty of four counts of abuse. The aide also was placed on a federal list for people deemed unfit to work at federally certified healthcare facilities. But the woman was not placed on a comparable state list for problem CNAs.