Auditor’s office finds flaws with licensing process for adult care homes

A November report from the State Auditor’s Office, found significant issues within the Office of Health Care Assurance’s (OHCA) Adult Residential Care Homes Program. The Department of Health’s OHCA governs the quality of care and relicensing for Hawaii’s adult residential care homes. According to the audit, findings indicate that OHCA lacks “the basic organizational infrastructure necessary to guide and support” relicensing activities.

As of November 2017, the number of adult residential care homes and expanded adult residential care homes in Hawaii totaled 500 facilities. As part of these care homes’ annual license renewal, state law requires OHCA to conduct annual inspections of each facility as well as separate unannounced visits. OHCA is charged with identifying deficiencies in care homes as part of the relicensing process.

According to the audit, about half of the 214 examined care homes were operating with either an expired license or a license issued before all relicensing requirements were met. In instances where care homes did not meet quality of care requirements, or in instances where there were substantial or repeat deficiencies, OHCA had no written guidelines or rules of enforcement. As a result, from 2007 – 2017 the office did not sanction, fine, or terminate a single care homes’ license. The report also states that when deficiencies are found, OHCA considers the relicensing process complete when they have received and approved a “Plan of Correction,” not when the actual deficiencies are fixed.

The report summed up it’s findings, writing,

“We found that OHCA’s primary objective appears to support the continued operations of those care homes, not to ensure the health, safety, or welfare of the facilities’ residents as mandated by statute. OHCA’s chief acknowledges that the office has an organizational culture that places importance on not disrupting the normal operation of care homes; however, he said that avoiding disruption while also ensuring residents’ welfare is a hard balance to achieve.”

Recommendations for OHCA from the auditor’s office include establishing policies/procedures to ensure deficiencies are corrected, conducting at least one announced visit for each care home, and developing a centralized data management system to share information.

In response to the audit findings, the Department of Health issued a statement saying the department was in the process of implementing new and revised procedures to improve management oversight. They also noted that the audit took place during a period of inadequate staffing at OHCA, but that funding for additional positions was approved in 2017.

Some of the current improvements at OHCA that are already underway include:

  • Development of a management information system to track workload and staff assignments;
  • Transition from a paper-based system to a fully electronic inspection process;
  • Development of an automated system to post electronic inspection reports online; and
  • Implementation of updated, revised, and new policies and procedures that ensure operational consistency.

Dr. Bruce Anderson, Director of the Department of Health, also stressed that despite the findings of the audit, those in residential care homes are not at risk of unsafe.

“Understandably, some may conclude from this audit that those in adult residential care homes were at risk and unsafe in 2016-2017. Timely inspections and reports are indeed important in assuring the quality of care,” said Anderson in the statement. “However, it is important to underscore that any risks to the safety, health and well-being of those in adult residential care home are immediately investigated and appropriate action is taken. Further, significant improvements in operations have been made during and since the audit period.”