As the elderly woman flailed her arms and legs, trying to fend off the assault, Mark Genetiano kept laughing.

With one hand, Genetiano, a certified nurse aide at Kahala Nui, pinned one of the woman’s arms down, according to a witness account detailed in court documents. With his free hand, Genetiano kept pinching her breast while dodging her swinging arm in May 2009.

"Stop, leave me alone!" the woman cried. She then pleaded with a second caregiver in the room: "Please make him stop."

Genetiano was convicted last year of six counts of third-degree sexual assault against that defenseless elderly woman and three others living at Kahala Nui. For his crimes, he spent a year in prison and was deported to the Philippines.

Genetiano was precisely the type of abusive caregiver the state had in mind when it established a blacklist years ago for certified nurse aides deemed unfit to work at long-term care facilities. Such caregivers found by a court or administrative agency to have abused, neglected or stolen from clients are supposed to be placed on the list, essentially banning them for life from working at such facilities. Would-be employers turn to the list and other sources of information to check the backgrounds of prospective hires.

But Genetiano, who was convicted in March 2010, still isn’t on the list.

In a sign of a cash-strapped state agency struggling to keep pace with the regulatory demands of serving a growing elderly population, the Department of Health hasn’t updated the so-called CNA findings list for nearly four years. No one has been added since December 2007.

"That’s a glaring gap," said Cullen Hayashida, Kapiolani Community College’s long-term-care coordinator who also runs its Kupuna Education Center. "It’s hard to come up with a retort to that kind of (omission)."

The department acknowledged that limited resources and staff cuts have contributed to a backlog in processing cases. It also said it is researching Genetiano’s absence from the list.

Loretta Fuddy, the state health director, told the Star-Advertiser the list would be updated by summer’s end.

Nursing homes and similar facilties are required to perform criminal background checks on caregivers they hire. Such checks typically would flag someone like Genetiano, who has a conviction, even if that person isn’t on the findings list.

But a certified nurse aide found by an administrative agency — as opposed to a criminal court — to have committed abuse or neglect would not show up in a criminal background check. CNAs are considered the worker bees of the long-term care industry.

The only way a prospective employer can discover whether an applicant has that type of record is through the findings list, according to Keith Ridley, head of the department’s Office of Health Care Assurance, which oversees the list.

The outdated list is just one example of how the Health Department has struggled in recent years with mandates related to elder care.

The agency still isn’t doing criminal background checks on new applicants for care homes — even though the law was enacted five years ago.

Ridley said the practice has not started because of delays due to staff turnover and position vacancies. Administrative rules have been drafted for the program, but an "expanded mechanism" to conduct the actual checks still must be developed, he said.