Shoddy consumer protections plague Hawaii’s senior care home market

Senior care facilities operating without a license in Hawaii came under scrutiny at a joint House-Senate committee hearing on Tuesday at the Capitol. 

At the hearing, lawmakers heard testimony from state health regulators, senior care facility operators and case managers with direct knowledge of the unsafe conditions brought about by the proliferation of unlicensed senior care facilities.       

By operating without a license, facilities can evade health department regulations such as fire code implementation, wheelchair access, and background checks on employees.      

The testimony offered a peek inside a bait-and-switch scheme where, according to the Honolulu Civil Beat, “the licensed facility serves as a front to attract clients under the guise of legitimacy. But some of these clients then get funneled unwittingly into an illegal care home, operating surreptitiously without any state oversight.”


Get the latest state-specific policy intelligence for the health care sector delivered to your inbox.


While some facilities are up front with consumers about their unlicensed status — enticing seniors and their families with lower prices than licensed alternatives — many others are not.    

After a 2018 Department of Health (DOH) audit revealed a shadow market of unlicensed senior care homes, Governor David Ige signed Act 148, giving the Department of Health increased investigative authority to uncover illegal facilities.  

In the wake of the audit, DOH Director Bruce Anderson said:

Understandably, some may conclude from this audit that those in adult residential care homes were at risk and unsafe in 2016 to 2017.”

Anderson also pointed to ongoing efforts to improve oversight procedures. 

Since Act 148’s signage, investigators have received 114 total complaints about potentially unlicensed facilities. Of that total, 69 of the complaints have been fully investigated while 27 still require an initial visit by investigators.   

On top of the cost savings to be found beyond the reach of state oversight, operators of unlicensed facilities have cited a lengthy, bureaucratic licensing process as unconducive to going through the proper channels. Even some facilities that were operating legally gave up their licenses to escape regulation.  

Nicole Coglietta, CEO of a company that helps match seniors with care providers told Hawaii Public Radio:

The feedback that I received, years ago, is licensing took an unreasonable amount of time, it took too long and they couldn’t wait, they couldn’t sustain their cost of living.”

The Office Of Health Care Assurance (OCHA) has said that it has taken steps to expedite the licensing process.

Information regarding the licensing status of senior care facilities can be found here.