Audit Looks at Health, Safety of Adult Care Homes

The Office of the State Auditor released an audit of the Hawai‘i Department of Health’s Office of Health Care Assurance today, identifying areas for improvement to ensure the health, safety, and welfare of residents in adult residential care homes.

“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 Dr. Bruce Anderson, director of the Department of Health.

“However,” Anderson said, “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.”

OHCA conducts inspections and visits, both announced and unannounced, of licensed adult residential care homes and expanded adult residential care homes on an annual basis.

State officials say that whenever OHCA surveyors identify potential abuse or neglect, these incidents are immediately reported to Adult Protective Services, another state agency, for a thorough investigation.

APS is part of the Adult Protective and Community Services Branch of the Hawai‘i Department of Human Services. In addition, OHCA also conducts timely investigations of consumer complaints or suspicions of abuse or neglect referred from APS. The inter-departmental collaboration has resulted in 277 referrals for all types of facilities between the two entities over the past five years.

“As the need for cost-effective care for our aging population continues to grow, OHCA’s role in assessing the quality of care at adult residential care homes will become even more important,” Anderson said. “Protecting the health, safety, and welfare of kūpuna and those with disabilities who live in residential care homes is an essential requirement we take very seriously. Addressing the audit findings and implementing their recommendations, including the submission of more timely inspection reports and developing clear policies and procedures related to monitoring and enforcement, will better prepare us for the future.”

The audit reviewed activities that took place from January 2016 to December 2017, which included the period in which OHCA was facing the challenge of inadequate staffing to meet its statutory obligations. Adequate staffing became a priority funding request and both the Governor, and the Legislature recognized this need and approved additional positions in 2017.

OHCA is also implementing new or revised procedures aimed at providing improved and structured management oversight on the inspection processes and enforcement.

“These new staff positions along with clear policies and procedures will ensure the sustained support needed to meet current and future workload requirements so that inspectors can consistently complete inspections and the license renewal process in a timely manner,” Anderson said.

Despite past challenges, OHCA conducted all required annual inspections in 2017, is on track to complete all annual inspections in 2018 and continues to make improvements in its operations. Current actions now underway to improve operations, which are consistent with the auditor’s recommendations, 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.

“OHCA made significant improvements since 2016 to live up to their mission of assuring that care homes in Hawaii are safe,” Anderson said.

The audit, including DOH’s full response, is available at the Office of State Auditor’s website.