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Subject: Civil Beat story on audit of licensing process for adult care homes <br />From: McDermott, John G. Oohn.mcdermott@doh.hawaii.gov) <br />To: blyte@civilbeat.org; <br />Date: Friday, November 16, 2018 11:12 AM <br />Aloha Brittany, <br />Thanks for sending me a copy of the State Auditor's Report. I hope this time it makes a difference. <br />These are clearly NOT new issues but the good news is they are all fixable: I became the State Long <br />Term Care Ombudsman (SLTCO) in 1998 after working for 9 years in 2 different nursing homes as the <br />Director of Social Services. The federal Nursing Home Reform Act of 1987 mandated that all nursing <br />home annual inspections be "unannounced"so it wasn't a big deal to me, that's all I knew, but some <br />of the staff who had started years before_ me took a while to accept this change. Eventually every <br />nursing home got used to it and realized it resulted in better, more consistent care. <br />When I became the SLTCO I was shocked to discover our Department of Health is required by state <br />law to notify adult residential care homes [which is also their practice for assisted living facilities and <br />community care foster family homes] when they are coming for their annual inspections. How do you <br />find anything wrong if you tell folks when you are coming? No other state does this. To me it was just <br />"paper compliance" offering our vulnerable seniors no protection at all. <br />Marilyn Seely was thenDirector for the Executive Office on Aging (and my boss) and we went to <br />discuss our concerns about this to then Department of Health Director Bruce Anderson. He was not <br />aware of this practice and agreed with us that it needed to change. <br />On November 26, 1999, Dr. Anderson _sent out a "policy directive" to the,ARCH Industry notifying <br />them that "all inspections pursuant to licensing activities, including licensing, follow-up visits, and <br />complaint investigations shall be unannounced." Please note the word "shall," not "may." Words <br />matter. <br />We thought we had won this battle but this policy directive never went into effect. The ARCH <br />Industry went running to their favorite legislators and to then Gov. Cayatano and Dr. Anderson's <br />policy directive quietly disappeared. Ugly politics again. <br />Despite this set back we didn't give up and recruited AARP's help in the following election cycle. They <br />made "unannounced inspections" one of their three top priorities. I was disappointed that Mazie <br />Hirano, when asked about this issue at a public debate at the State Capitol auditorium, stated she <br />