Step up inspections of nursing homes

Hawaii has a reputation for providing quality elder care and related services. The Aloha State ranks among the states with the highest percentage nursing homes scoring top overall ratings from the U.S. Centers for Medicare &Medicaid Services (CMS).

But resting on laurels and reputation is not an option. Not when an evaluation conducted by the CMS last year found that the state Department of Health (DOH) failed to meet eight of 13 minimum facility inspection standards pertaining to frequency, quality and enforcement.

And that poor showing has barely budged in recent years. It was the same in 2015, which was only slightly improved from a 12-month period that ended Sept. 30, 2014, when the state fell short of nine standards. In that year, the average interval between inspections in nursing homes was slightly longer than 19 months — a lag of about a half-year past the allowed gap of nearly 13 months.

In each of the past three years, the DOH was dinged for failing to meet set thresholds for timely inspections and prioritizing complaints and incidents at facilities. Also, this time around, the state fell short in documenting deficiencies found during inspections after having met that standard in the prior two years.

The upshot is that inspectors could be missing trouble spots tied to health and safety issues. That’s concerning because many kupuna entering the 46 nursing homes and other related facilities here are already in fragile condition. Allowing site problems to linger or fester is inexcusable as they could hasten wellness decline.

Keith Ridley, who heads the DOH’s Office of Health Care Assurance, which handles Medicare certification inspections for CMS, concedes that the state needs to step up its efforts, but notes that his agency is down three of 10 inspectors and competing with other programs for limited state funding. The office’s resources are further pinched by loss of $346,000 in federal grant funding over the past three years due to its weak record.

The state must move quickly to meet at least minimum CMS standards and draw maximum available federal funding. The safety and well-being of our kupuna is, of course, deserving of such priority. Plus, the count of older residents entering nursing homes and other facilities is on the rise. As a state, we’re aging more rapidly and living longer than any other state.

In Hawaii, our lifespan expectancy is 81.3 years, topping the national average by 2.3 years. And the latest U.S. Census Bureau data finds that 17 percent of the state’s 1.4 million residents are age 65 or older, with the oldest among some 333,550 baby boomers, those born between 1946 and 1964, now in their early 70s.

According to a recent AARP survey, Hawaii ranks among the top states when it comes to meeting the long-term care needs of older residents and people with disabilities, but more needs to be done as baby boomers reach their 80s and the number of people who can provide family caregiving services decreases.

This year, Hawaii’s AARP chapter and others cheered the Legislature’s passage of House Bill 607, which drafts framework for a Kupuna Caregivers program — respite support for people caring for elders while remaining in the workforce. (The desire among kupuna to live at home for as long as possible and avoid the often-exorbitant price tag tied to other types of assisted-care prompted the voucher plan.) But AARP points out that the average lay caregiver served is a 62-year-old woman. And within a couple of decades, she will likely leave the workforce and may need care services herself.

Hawaii must continue to prep for the challenges linked to its aging population.

Despite deficiencies, it’s encouraging to see the state Health Department planning to soon fill inspector vacancies and taking other steps toward earning a better CMS rating. Also, state lawmakers must provide adequate funding to ensure that prompt and efficient facility inspections are the rule.

Our shifting demographics should sound an alarm to confront these and other emerging elder issues — the so-called silver tsunami is rolling in.