Senior Solution

Care-home owners provide services that mirror traditional nursing homes - but for a fraction of the price.

July, 2002

Hawaii’s rightful reputation as the healthiest state in the United States, with the enviable life span of its people, has developed side effects. Longevity is taking its toll. These days, the state has the oldest, sickest and most dependent nursing home population in the country, and the challenges are formidable. Long-term-care residents are older, on average, than residents in other states. As baby boomers age, the increased numbers of sicker patients require greater state and federal resources. The total number of long-term care beds increased by 21 percent between 1995 and 2000. Today’s best guess is that Hawaii will require 7,000 to 10,000 more beds for its elderly and disabled population in the next decade.

Small wonder, then, that the Hawaii Coalition of Care Home Administrators is now battling with considerable zeal current legislative bills, the so-called Chapter 100.1, that seek to modify — and, says HCCHA, complicate — existing systems for state care homes. These 550 homes serve more than 2,900 mainly elderly residents, who live out their lives in comfort and companionship with local, mainly Filipino families in regular or specially equipped homes. The families pay from $50,000 to $100,000 to modify their homes, often taking a second mortgage to do so, to provide necessary facilities and satisfy stringent state structural and staffing requirements. A 12- to 18-month nurses’ aide education process is also required before a new caregiver can open a business. Care is then provided in a home environment for a monthly fee that is said to be half or less that of a larger nursing home. HCCHA claims to save state, federal government and private-pay families more than $100,000 annually, a figure not disputed by government authorities. The group also believes that the care homes, because of their affordability, are essential to meet the demands of Hawaii’s future elderly population. However, in the long run, care home operators are concerned that if new state Department of Health regulations are adopted, many homes will have to shut down and others will be prevented from entering the business.

At issue are proposed DOH rules that will make it more difficult for some of the existing homes to qualify or renew their yearly operating permits. Carefully detailed, right down to suitable bedpan-flushing attachments and disposal of infectious waste, the regulations seek to impose stringent and costly requirements on the modification of all care homes. Some of these include life safety codes, hard wiring of smoke detectors for fire prevention, nonslip tub/shower surfaces, grab bars, ramps and extensive out-of-pocket expenses for the hiring of full-time registered nurses. The proposed rules have been characterized by HCCHA as “overly burdensome and detrimental to the establishment of more community-based facilities for the elderly.”

Also quite fiercely contested are the government’s plans for unannounced inspections of the homes for license renewal, and license revocation without due process. If passed into law, these administrative rules mean state regulators will be permitted to enter a care home whenever they want, without a warrant, and conduct an inspection of the premises and people. What is more vexing, says HCCHA, the government can also shut down a care home temporarily and relocate the residents. This type of legislation is alarming to the HCCHA, which claims that random inspections don’t add to the quality of life in the homes and disrupt the normal living environment for the elderly.

For some relocated people, the move is a real trauma. They die. The dream solution for the Care Home Coalition is to police its own members, but this is unlikely.

“Current laws in place and administered by the DOH are already strict and confining,” said Ron Gallegos, voluntary president of the Alliance of Residential Care Administrators (whose full-time job is national sales director and senior vice president of Primerica, a member of Citigroup), one of four major Hawaii groups seeking to influence government home care policy. “They make it difficult for owners of these care homes to make a living providing this much-needed service to our community. With the economic difficulties that most of us face, protecting long-term elderly care should be a priority.”

Most care home owners are in the business because they want to be their own bosses, they can usually save some money for their retirement and because they feel they can make an impact on the lives of others. According to HCCHA, the business can be profitable, but for the majority of owners, it is not. In general, the resident client pays a fee of about $2,500 a month (some fees are as low as $1,000), and the average number of residents in a home is four.

Says Gallegos: “People aren’t always in it for the money, but they don’t want to lose money either. It’s a tough business, and if a person’s in it only for the money, he’ll never survive. We’re talking about running an emergency room for the elderly in the middle of the night, and sacrificing your family and social life for many years.”

To ease the care homes’ worries, HCCHA is seeking to persuade the government to adopt what Gallegos calls “a social model of care” for the elderly, instead of the more traditional “medical model.” In essence, the HCCHA argues that care homes should not be treated like hospitals or nursing homes, because they are dwellings in which families live and call home.

Says Gallegos: “The Legislature in 1998 passed a law that said care homes should be based on a social model. This way, elderly people can be cared for as if they were in a family. The proposed DOH regulations want to make it a medical model, so that it’s like you’re in a hospital, instead of a private home. This means the homes must be regulated like a hospital.”

Gallegos speaks from considerable experience. His care home is managed by his wife, Teo, a registered nurse. Living in the home are four elderly residents, his two young children and at least two full-time staff. The elderly residents average 80 years. “Our children sit with them, hold hands with them, read to them and watch TV with them,” says Gallegos. “It’s been a great blessing to the children, because their grandparents live far away.”

Despite their differences, Gallegos believes that both sides are taking great pains to work things out, and that relations are good. Overall, HCCHA has no argument with the need to be closely regulated. “We work very well with the DOH, very closely with them, and we know they are very loving, caring people also,” says Gallegos. The thing is, he adds, “the DOH has been out of contact with the elderly for so long, they’re only used to interpreting the medical model, because they’ve always done it this way. They’ve accepted the social model in the new rules, but they’re not following it. We’re still treated like mini-hospitals.”

HCCHA is fighting back. To sway public opinion and help elucidate differences between care homes, large nursing homes and other assisted-living residences, the alliance has enlisted Starr-Seigle to do public relations and special communications.

“Unsurprisingly, there’s much confusion in the public mind between one care institution and another. We’re sometimes tarred by the excesses of other institutions,” says Gallegos. “HCCHA has the dual problem of educating the public and the government. In the long run, what the alliance is trying to avoid is the passage of so many care home restrictions that we’re not going to be able to stay in business.” Not only does HCCHA believe its programs are necessary, but it’s also something the state wants. Asks Gallegos: “Where is everybody going to live when they’re old? This is one industry that’s not going to go away. If it does, we’re all losers.”

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Tom Chapman