Rules needed for se­nior care op­tions

Honolulu Star-Advertiser - - VIEWS & VOICES -

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.

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