Hawaii government hospital administrators will take over a state-owned veterans care home on Hawaii island from a private operator overwhelmed by COVID-19 infections and deaths.
The arrangement, disclosed Friday, comes amid mounting criticism from industry and elected officials that not enough is being done to protect a particularly vulnerable population in Hawaii from the new coronavirus: seniors who rely on professional caregivers.
Hawaii island Mayor Harry Kim said state officials and Utah-based Avalon Health Care, the operator of Yukio Okutsu State Veterans Home in Hilo, agreed to the change that will have the Hawaii Health Systems Corp. run the facility where 26 residents have died in connection with COVID-19.
Kim, who previously called for replacing Avalon, said he was informed of the move by Gov. David Ige.
“I consider this to be what is needed,” Kim said. “I really believe it is the best way forward.”
Also on Friday, U.S. Sen. Brian Schatz, D-Hawaii, sent a letter to Ige asking that additional steps be taken to protect residents in local long-term care facilities.
Schatz noted that he first raised the issue with Ige in a letter in May and received no response.
In May, Hawaii had few COVID-19 cases while many mainland states battled bad outbreaks in general populations and care home facilities. Since then there have been outbreaks in at least several large nursing homes in Hawaii, while at least 31 residents at the Hilo veterans home and one other facility have died in connection with the coronavirus.
“We have now seen outbreaks of the virus at multiple (Hawaii) nursing homes and care facilities, including the tragedy at the Yukio Okutsu State Veterans Home,” Schatz said in his Friday letter. “I am even more concerned about whether these facilities are well-prepared.”
John McDermott, Hawaii’s long-term care ombudsman, said Hawaii care home operators had plenty of advance notice on how to implement procedures that shouldn’t have led to 26 veterans dying at the Hilo facility.
“It should never have gotten that bad,” McDermott said, noting that Avalon was navigating COVID-19 at long-term care facilities in many mainland cities.
Also, Avalon experienced outbreaks in June and August at its Hale Nani Rehabilitation and Nursing Center facility on Oahu, where 42 residents and 40 workers tested positive for COVID-19 that contributed to the death of five residents.
“It’s like the band played on when the Titanic was taking on water,” McDermott said.
In July after seven residents and four employees at Pearl City Nursing Home tested positive for COVID-19, Dr. Scott Miscovich, who has been heavily involved in testing programs, told Hawaii News Now that there was a “crisis” at hand that necessitated a closer look at handling coronavirus cases at long-term care facilities.
Jodi Leong, press secretary for Ige, said many of the issues raised by Schatz would be better addressed by the state Department of Health.
Department officials were asked to respond to issues raised by Schatz, including his request for an assessment on whether all Hawaii long-term care facilities are following best practices for infection control, whether any deficiencies were identified in state reviews of Hawaii nursing homes and how the state is supporting facilities not regulated by the federal government.
The agency did not provide a response.
The agency also was not able to say how many COVID-19 cases and related deaths there have been among Hawaii long-term care facility residents and employees.
On its website the agency lists 21 long-term care facilities that have had resident or staff cases within 28 days through Thursday, but the number of cases isn’t included.
This list includes Hawaii Kai Retirement & Assisted Living, Palolo Chinese home, 15 Craigside in Nuuanu, Ilima at Leihano in Kapolei, Roselani Place on Maui and Life Care Center of Hilo.
McDermott said there are 1,729 long-term care facilities with 12,876 beds in Hawaii, from the biggest skilled-nursing facilities to community-based care homes with fewer than five residents.
Of this total, 46 are major care facilities.
Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, a trade organization representing the big facilities, said the industry has worked with federal and state government agencies to understand, apply and share best practices to prevent the spread of COVID-19.
Raethel said in a statement that even with the current resurgence of COVID-19 cases, Hawaii ranks third lowest for positive tests per 1,000 residents, and fourth lowest in deaths per 1,000 residents, in U.S. nursing homes, based on Centers for Medicare and Medicaid Services data.
Recent outbreaks, Raethel suggested, are correlated with more cases in the community, which increase the chances of the virus entering a long-term care facility.
“With more infection circulating in the community, there are more opportunities for the disease to take hold, despite even the best infection-control measures in skilled-nursing facilities,” he said. “COVID-19 can enter a facility even when everything is done right.”
Avalon has defended its practices, though reports from the Hawaii Emergency Management Agency and U.S. Department of Veterans Affairs concluded from inspections that faulty practices existed in the Hilo care home, including employees gathering in a break room without masks, “loose” mask use and allowing residents with dementia to wander.
There were 89 residents living at the care home before the COVID-19 outbreak. Since then, 71 residents have contracted the virus along with 35 employees.
In some states, attorneys general have launched investigations into coronavirus deaths at nursing homes, according to a Associated Press report Friday that also said two former administrators of a veterans home in Massachusetts were charged with criminal offenses related to 76 deaths tied to COVID-19 since March 1.
The Hawaii Department of the Attorney General did not say Friday whether it is investigating any long-term care facility operators over handling COVID-19.
Statewide, there have been 11,891 COVID-19 cases and 127 related deaths, including 112 new cases and three deaths reported Friday.
Some of the deaths at the Hilo veterans home have yet to be included in the tally.
Schatz praised the state’s takeover of the facility.
“The recent reports have shown that Avalon is ill-equipped to operate the veterans home and contain this outbreak,” he said in a statement. “Avalon has also been unwilling to take responsibility for their mismanagement, so this was the right decision.”
Dan Brinkman, a Hawaii Health Systems executive, said the management transition with Avalon will happen over the next several months.
“We are humbled and privileged to be entrusted with caring for our veterans,” Brinkman, CEO of the organization’s East Hawaii Region, said in a statement.
Allison Griffiths, an Avalon attorney and spokeswoman, said the company has diligently sought to implement guidelines from the state Department of Health, the U.S. Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid Services throughout the pandemic.
“Avalon deeply appreciates the service that our nation’s veterans have provided to our country,” she said. “Avalon has been and continues to be deeply committed to the welfare of all of our residents and will work with HHSC to transition the facility to its leadership.”
Hawaii Health Systems operates 847 beds in nine facilities on three islands, including Hilo Medical Center, Kona Community Hospital, Leahi Hospital and West Kauai Medical Center.
The Hawaii State Hospital, part of the Department of Health, announced Friday that one patient and three employees in the admissions unit of the Kaneohe facility have tested positive for COVID-19.