DOH making progress in nursing home inspections

Back in summer 2013, the Hawaii Department of Health (DOH) proactively informed the U.S. Centers for Medicare and Medicaid Services (CMS) that, because of unexpected staffing turnover and funding issues, the department could not meet the federal inspection requirements for nursing homes here.

Although those factors are not within the DOH’s control, the department took ownership to formulate a plan of action with CMS. Quality assurance of nursing home services is a responsibility we take very seriously.

By being proactive in notifying and working with CMS, the department is confident there will be no sanctions against the state and no penalties levied by CMS, as DOH is well on the way to completing the priorities agreed upon by both agencies. As part of the plan jointly developed last year, the department and CMS identified 11 priority nursing homes on the neighbor islands for inspections.

To date, 10 of these priority inspections are complete, and the one remaining facility will be completed this month — ahead of the agreed-upon schedule.

That proactive aspect regarding nursing home inspections was an important fact missing in the Honolulu Star-Advertiser’s June 29 article ("Dept. of Health fails nursing home inspections") and July 1 editorial ("There’s no excuse for nursing home inspection delays," Our View). To our DOH team who took appropriate steps to address the realities of this challenge, the timing of the newspaper’s selective coverage would have been discouraging — but they are professionals and remain committed to the health, safety and well-being of the people of Hawaii.

State inspections of nursing homes are intensive and require as many as five inspectors over five or more days to complete. They involve a review of the facility’s quality of care, governance and management, medical records, medication safety, infection control, dietary and food safety, recreation and activities, patients’ rights and dignity, life safety features, building and utilities maintenance, and other licensing requirements to ensure the safety and welfare of patients. Inspections also include interviews conducted with staff, patients and patients’ families.

Inspectors are trained and experienced clinical professionals who know where to look and how to uncover clues of irregularities and non-compliance with the law.

When inspecting nursing homes on a neighbor island, inspectors work on-island away from family and friends on Oahu and often sacrifice valuable time with loved ones. The work is difficult, but rewarding and done for the sake of the public.

In addition to nursing homes, the department inspects all hospitals, adult residential care homes, outpatient surgery centers, home health agencies, dialysis centers, clinical laboratories, hospices and other health care facilities totaling more than 1,600 facilities, organizations or agencies located across the state.

Besides nursing home inspections, there are other indicators of service quality and compliance with industry standards. DOH works with key stakeholders involved with health care quality, including Hawaii’s Quality Improvement Organization for Medicare (Mountain Pacific Quality Health Foundation), Healthcare Association of Hawaii, Hawaii Long Term Care Association, Hawaii Association of Directors of Nursing Administration, and independent physicians to continuously improve patient-centered care, enhance interaction with patients, residents and families, and reduce the unnecessary use of certain medications.

In Hawaii, 37 percent of our nursing homes obtained CMS’s five-star rating — the highest in CMS’s rating system in comparison with 25 percent of all nursing homes nationwide.

The department is currently recruiting and filling vacant positions with qualified and motivated clinical professionals. This is putting DOH back on track for regularly scheduled inspections of nursing homes statewide. We know that we are ultimately accountable to Hawaii’s families and will continue to work closely with CMS and local organizations to maintain high standards of patient care and safety in Hawaii nursing homes.