Rules needed for senior care options

The landscape of senior care is changing beneath the feet of everyone in Hawaii, and policymakers are racing to keep up. What’s driving this process, of course, is the mounting struggles families already are encountering in managing the care of frail elders. The aging of the baby boomers will compound that challenge, several times over.

House Bill 1911 can be seen as a vehicle for regulating this evolving service industry, a necessary step but certainly not the last one. The marketplace has developed a new approach — which is fine, as long as there are some provisions for quality control.

The bill, which has passed and now awaits Gov. David Ige’s signature, aims to strengthen the state’s capacity to check up on care facilities operating without a license. Included is language defining how the state Department of Health (DOH) could access the property following a report that it’s unlicensed, making referrals to unlicensed facilities illegal and imposing fines.

The question — and it’s not entirely answered by this legislation — is: What qualifies as a care facility requiring licensure?

The operators of a self-described “aging in place” (AIP) network of homes lobbied for, and secured, language in the bill that would exclude from licensing requirements a private residence that rents out rooms to seniors, as long the rental doesn’t hinge on the tenant’s use of paid care services.

Aging in place is a term used generically to describe an approach that keeps elders in their own homes, with any needed services brought in, rather than accommodating them in an institutional or residential-class facility. However, AIP is also adopted as a trademark of the roughly 40 member homes associated under a nonprofit, the Hawaii Platinum Group, said Maile Harada, who heads that group.

How much the exclusion shields these facilities from regulation is still unclear. The Legislature added its own language to this section, said its sponsor, state Rep. John Mizuno. It defines an “operator” subject to the law as “an individual or entity that operates or manages a healthcare facility or similar facility that provides care services in that facility.”

The aim was to keep residences that are run as a care facility within the scope of regulation, said Keith Ridley, chief of the Department of Health Office of Health Care Assurance, which oversees care homes and their licensure. However, Ridley also acknowledged that the regulatory effort is likely to face some legal challenges as the DOH attempts to pursue inspections based on reports or complaints.

This entire situation bears watching, and may need further regulatory refinements.

“It could be that some of these homes are providing good care,” Ridley added. “But how does the public know, until we get in to see? The fact is, they don’t.”

The bill also wisely seeks to extend state oversight on the “home service agencies” that provide personal care to seniors who are seeking to stay in their own home. These would include some housework, errands, bathing, feeding and other nonmedical services. It requires the imposition of at least interim rules governing how these agencies are licensed.

The DOH will begin May 14 with a series of public hearings on proposed permanent rules. This is a process that is needed for the protection of elders, and is long overdue.

Harada said residences such as those in her association fill a need, and she’s right. Wes Lo, CEO of Hale Makua Health Service, which provides a range of services on Maui, agrees.

“We need to create a new model, so this is good that people are talking about it,” Lo said.

But the conversation must continue. The state does have some interest in ensuring that this new niche is filled with qualified professionals, and that the public is protected.