Report Title:
ARCH Inspections
Description:
Conforms State ARCH and expanded ARCH inspection requirements with federal law by: (1) Requiring unannounced annual inspections; (2) Establishing criminal and civil penalties for persons who notifies or causes to be notified an ARCH or expanded ARCH of the date or time an inspection is scheduled to be conducted; and (3) Providing criteria for inspections. Requires the Department of Health, in conjunction with the Executive Office on Aging, the Department of Human Services, and county Fire Chiefs, to adopt rules on the scheduling and implementation of inspections by September 1, 2003. Mandates the Department of Health to implement unannounced inspections by December 31, 2003. Requires the Department of Health to provide information on inspections in its annual reports over the next four years.
HOUSE OF REPRESENTATIVES |
H.B. NO. |
372 |
TWENTY-SECOND LEGISLATURE, 2003 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO ADULT RESIDENTIAL CARE HOMES AND EXPANDED ADULT RESIDENTIAL CARE HOMES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that national expenditures for long-term care services for people age sixty-five and older will grow through the year 2040. This growth has been attributed to the fact that the United States population is aging, and that elderly people receive the most long-term care services because they are more likely than younger people to have some kind of functional limitation.
The legislature further finds that many "baby-boomers" will begin to reach the age of sixty-five in 2011. In addition, more elderly people will reach advanced ages of eighty-five years and older than in the past because of declining mortality rates.
These trends will cause the proportion of the population that is elderly--which was just under thirteen per cent in 1995--to rise to twenty per cent in 2040. More importantly, the population over age eighty-five--the segment most likely to require long-term care--will grow over three times its current size by 2040.
The long-term care needs of many of Hawaii's elderly are being provided by adult residential care homes (ARCHs) and expanded ARCHs. These facilities are regulated by the department of health in accordance with sections 321-15.6, 321-15.61, and 321-15.62, Hawaii Revised Statutes, and administrative rules.
Currently, there are forty-seven licensed nursing facilities in the State. For the most part, these facilities are at full capacity with no new nursing facilities planned for construction in the near future. As the aged population in Hawaii continues to rise, people who need nursing care will not be admitted to nursing homes because of a lack of available beds. They will likely be serviced by ARCHs and expanded ARCHs.
In recent years, the media has reported abuses by ARCH providers that have jeopardized the health, welfare, and safety of Hawaii's elderly. While these abuses may be anomalies that do not reflect the entire ARCH industry, questions have arisen as to whether existing licensure laws are adequate to protect the interests of ARCH residents.
In practice, inspectors announce the date and time of inspections in advance, allowing disreputable ARCH providers to make superficial changes to their practices and facilities so that they will be able to retain their licenses and continue operations. However, once these inspections are completed, practices and facilities revert back to the past, and the health, welfare, and safety of residents are once again threatened.
On July 26, 1999, the department of health convened a task force to review the administrative rules for ARCHs and make recommendations on how the rules could be improved upon. The membership of the task force consisted of ARCH providers throughout the State, government officials, senior citizen advocates, and concerned citizens.
The task force met for almost two years and facilitated many compromises. However, regarding the issue of requiring unannounced, annual inspections, the task force was split with ARCH providers strongly opposed to unannounced, annual inspections, and the other members strongly in favor of the inspections.
Pursuant to the task force's efforts, the department of health and the department of the attorney general drafted proposed rules nearly two years ago, but these rules are still under their review.
While the public awaited action on the proposed rules, many citizen groups signed petitions urging the governor and the director of health to impose unannounced annual inspections of ARCHs and expanded ARCHs. These groups included the American Association of Retired Persons, Kokua Council, the Hawaii Retired Teachers Association, the Hawaii Retired Federal Workers Association, the Lion's Club, and the Young Women's Christian Association. Yet, despite these efforts, unannounced annual inspections of ARCHs and expanded ARCHs have not been implemented.
The legislature recognizes that federal law seems to have sufficiently addressed this problem. Under 42 United States Code section 1396, federal inspectors are required to perform unannounced inspections of nursing homes. To ensure that inspections are unannounced, federal law authorizes the United States Department of Health and Human Services to assess civil fines of up to $2,000 on any person who notifies or causes to be notified a nursing facility of the time or date on which an inspection is scheduled to be conducted.
While it may be argued that ARCHs and expanded ARCHs are not nursing homes and thus should not be subjected to the same federal requirements, in many cases, ARCHs and expanded ARCHs are responsible for the care of patients with nursing home level (SNF and ICF) needs. Many ARCH and expanded ARCH residents are frail and vulnerable and receive much more than just custodial care.
The legislature believes that Hawaii's elderly can no longer wait for the proposed rules to be adopted. It is necessary for the legislature to take affirmative action on this issue by establishing an inspection scheme that will promote the health, welfare, and safety of Hawaii's elderly population residing in ARCH and expanded ARCH facilities.
The purpose of this Act is to conform State ARCH and expanded ARCH facility inspection requirements with federal laws for nursing homes.
SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§321- Standard inspection of adult residential care home and expanded adult residential care home. (a) Each adult residential care home and expanded adult residential care home shall be subject to a standard inspection, to be conducted without any prior notice to the facility. The standard inspection shall be conducted as frequently as the department deems necessary for the proper operation, sanitation, and safety of the facility; provided that at the minimum, the department shall inspect each facility at least once annually.
(b) Each inspection shall include but not be limited to a survey of the quality of care furnished, as measured by indicators of medical, nursing, and rehabilitative care, dietary and nutrition services, activities and social participation, sanitation, infection control, and the physical environment, and a determination of the accuracy of all assessments and the adequacy of plans of care required under 42 United States Code section 1396, or any other federal, State, or county law related to the health, welfare, and safety of patients residing at an adult residential care home or expanded adult residential care home.
(c) Any individual who notifies, or causes to be notified, an adult residential care home or expanded adult residential care home of the time or date on which an inspection is scheduled to be conducted pursuant to this section shall be guilty of a misdemeanor and assessed a civil fine of not less than $100 nor more than $5,000."
SECTION 3. (a) The director, in consultation with the head of the executive office on aging, the director of human services, and the fire chiefs of the city and county of Honolulu, and the counties of Hawaii, Kauai, and Maui, shall adopt rules concerning the scheduling and implementation of inspections in accordance with chapter 91 by September 1, 2003.
(b) The department shall implement unannounced standard inspections of ARCHs and expanded ARCHs by December 31, 2003.
(c) The department shall include in its annual report summaries of all inspections conducted after the enactment of this Act and prior to July 1, 2007, including but not limited to lists containing:
(1) The date and location of each inspection conducted pursuant to this section;
(2) The name of the facility and the name and address of the owner of each adult residential care home and expanded adult residential care home that fails to meet all standards required pursuant to chapter 321, Hawaii Revised Statutes, and the reasons for noncompliance; and
(3) The name of each person fined for notifying an adult residential care home or expanded adult residential care home of the date and time of an inspection, and the amount of the fine levied against the person.
SECTION 4. New statutory material is underscored.
SECTION 5. This Act shall take effect upon its approval.
INTRODUCED BY: |
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