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When advocates for the elderly talk about this year's legislative session, their words are laden with relief. They got what they wanted — bills that protect Hawai'i's seniors and punish those who abuse and neglect them — but it took weeks of packed hearings, heated debate and last-minute compromises. At the start of the session, legislators introduced three bills that addressed weaknesses identified by those who watch over the elderly. Only two survived. One allows for unannounced inspections of adult residential care homes; another gives the state Attorney General greater powers to prosecute abusers. A bill mandating criminal background checks of adult care-home owners and employees was deferred, and could be brought up again next session. Gov. Linda Lingle has not said whether she will sign or veto the two bills that passed. She has until June 23 to tell the Legislature what she plans to veto. Publicly, she has said she generally supports unannounced inspections, but she did not respond to requests for comment. The inspection bill that passed began the session in another form. In the last weeks of the session, after three other bills had fallen by the wayside, House Bill 914 was gutted and inspection language inserted. The bill now requires the Department of Health, which licenses the state's 545 adult residential care homes, to conduct "unannounced visits" at least once a year "to ensure the health, safety and welfare of each resident." The "visits" are separate from annual relicensing inspections. The bill gives health officials the flexibility to arrive unannounced or notify care-home owners of the date of their relicensing inspection. The bill would eliminate the health department practice of providing a tentative schedule of annual relicensing inspections — a contentious practice since 1999, when the inspections were authorized by former Health Director Bruce Anderson. He put the change on hold while related rules are being reviewed. In February, The Advertiser documented that at least 10 elderly people had died from neglect or abuse since 1999, and that in the last decade, 33 people of age 65 and older had died in cases where decubitus ulcers — pressure sores associated with neglect — were the underlying causes of death. The Advertiser also reported that laws that would have strengthened protections for the elderly had been rejected for years. This year, frustrated lawmakers decided to act. But they argued, along with care-home owners and advocates, until the last day of committee meetings, said Alicia Maluafiti, associate state director of AARP Hawai'i. The group advocates for the elderly. "It came down to trust," Maluafiti said. "Is everyone going to trust the Department of Health and give them the flexibility they need to ensure the health and safety of our elderly?" That's what finally happened, Maluafiti said, albeit "after many gray hairs." Ron Gallegos, president of the Alliance of Residential Care Administrators, lobbied hard against inspections. During the legislative session, he said relicensing inspections were disruptive and arriving unannounced violated the privacy rights of the licensed care-home owner. But even Gallegos supports the final product. "I think we can live with it," he said. "The total outcome depends on the attitude of the Department of Health and how they implement it." He said he hoped inspectors would offer suggestions to improve care. "Some people come in as fault-finders, trying to shut us down and sniff out problems that may not be there," he said. "As long as they approach with the right attitude, it will be fantastic." Dianne Okumura, chief of the health department's Office of Health Care Assurance, which oversees licensing of care homes, said care-home owners were happy to see the debate end. "They asked, 'Dianne, can we work together?' And I thought that was really positive," she said. "That is what I really want — to work with them and to ensure the safety of all the individuals in their homes." Okumura said she was glad "legislators heard what the community was requesting" and gave her the option of an unannounced inspection or visit. "That was what we were asking for the whole legislative session," she said. The visit concept is new. It does not specify duration or frequency, she said. An inspector can stay as long as necessary and return the next day to review documents. "'Visit' was used to give a broader perspective when we do go in," she said. "We will look at the entire situation to ensure the home is safe and that the residents are cared for." Meanwhile, the long-sought rule changes ordered in 1999 are being reviewed by the Health Department for approval by the governor. Okumura said she would recommend that the inspection-bill language be used. Giving the attorney general greater powers was the core of the bill lawmakers called the Elder Justice Act. Under existing law, the Attorney General can prosecute only care-home owners under a misdemeanor criminal charge in cases of abuse or neglect. Only seven other states allow for this kind of civil remedy for abuse and neglect cases. The bill calls for fines of $500 to $1,000 for every day of neglect or abuse, and allows the Attorney General to prosecute anyone caring for an elderly Hawai'i resident. But lawmakers eliminated language that allowed the courts to triple judgments awarded to victims. "I think it was a bit short-sighted and unfortunate that they didn't include that," said Thomas Grande, an attorney who helped draft the bill. "The enhanced damages for seniors and attorneys would have encouraged people to come forward and encourage actions to be filed. Copyright
© 2002 Global Action on Aging |
