43 years later, long-term care residents on neighboring islands could finally get their own ombudsman

When Hawaii established the first state long-term care ombudsman program in 1979, residents of nursing homes, nursing homes, nursing homes, and assisted living facilities gained an independent advocate to ensure their quality of care.

But a key problem from 43 years ago persists today: there is a glaring lack of access to ombudsman commissioned by the federal government on neighboring islands.

Hawaii’s insularity makes it difficult for staff at the Honolulu-based ombudsman program to build trust with long-term care residents on neighboring islands or to proactively monitor facilities outside of Oahu.

And despite Guidance from the National Academy of Medicine that Hawaii should retain at least six ombudsmen for its nearly 13,000 long-term care residents, the state has had only one for many years.

State Long-Term Care Ombudsman John McDermott says residents of long-term care facilities outside of Oahu don’t have equal access to his state-mandated service. Getty Images

When the state’s sole ombudsman was unable to fly between the islands during the worst of the coronavirus pandemic, and later in the Covid crisis when arranging a rental car became an expensive, almost impossible task, the need for ombudsmen based on neighboring islands are painfully clear, proponents say.

“This office is completely understaffed and just doesn’t make sense,” said Audrey Suga Nakagawa, advocacy director for the AARP of Hawaii, a nonprofit organization with about 140,000 members.

Now state legislators are considering two bills. Senate Act 2676 and House bill 1824this would create five new full-time ombudsman positions, giving the program a total of two ombudsmen for Oahu, one on Maui, one on Kauai, and two on the Big Island in Kona and Hilo, as well as the statewide ombudsman who oversees the program.

Senator Sharon Moriwaki, who sponsored one of the bills, said when lawmakers considered a similar bill last year, it was introduced because of pandemic-related funding constraints.

“I don’t know why it’s been so overlooked over the years,” Moriwaki said. “It seems like a simple yes.”

According to McDermott, the problem is finding funding to create new staff positions.

“Government employees receive state pensions and benefits, and yes, I understand nobody wants the state government to get bigger because we, the taxpayers, are all footing the bill,” he said. “But it’s really a matter of fairness. Residents of neighboring islands pay the same state taxes as Honolulu. But Honolulu has access to me, and the neighboring islands have access to me if I have the time to go there. It’s not the same. That’s not fair. So they really need their own ombudsman.”

In his fiscal 2023 budget, Gov. David Ige would fund two additional posts for the state long-term care ombudsman program. Moriwaki said she is optimistic the Legislature will pass legislation to fund all five new jobs the program is aiming for.

The House passed HB 1824, which now leads to the Senate. SB 2676 was referred to Ways and Means for its final Senate hearing.

“It’s just kind of obscene”

When John McDermott joined the Hawaii Long-Term Care Ombudsman Program at the Executive Office on Aging in 1998, John McDermott headed an office consisting of himself and another ombudsman associated with Oahu.

John McDermott during the Unlicensed Nursing Home Hearing Capitol Room 329.
John McDermott, Hawaii’s long-term care ombudsman, said he remains concerned about the program’s chronic staffing shortage. Cory Lum/Civil Beat/2018

In 2001, the office gained a full-time volunteer coordinator and clerk. But by 2015, the positions of Oahu Ombudsman and clerk were eliminated, and the position of volunteer coordinator was left vacant.

McDermott had been the state’s sole ombudsman for seven years until Tuesday, when the office was restored to an Oahu-focused position as ombudsman.

“If you go to a facility in the neighboring islands and they haven’t seen you in a year, you have to re-establish who you are, show your ID, explain how you are there as their attorney,” said McDermott, who is 63 “It takes a while for people to open up and start talking to you because you’re a stranger now. And the facility knows they won’t be seeing you for the next few years or six months because you have too many other places to go.”

Lacking sufficient human resources, the state ombudsman program has relied on more than 200 volunteers and part-time specialists over the past decade.

However, McDermott said that while this help is appreciated, it does not make up for the lack of full-time staff on neighboring islands who, over time, could build trust and relationships with long-term care residents and facility operators.

“The neighboring islands have been waiting for their own ombudsmen for 43 years and that’s just kind of obscene when you think about it,” he said.

“The need does not go away”

In a typical year, McDermott reviews more than a thousand confidential complaints from long-time residents of the facility or their family members.

A recent complainant alleged that an establishment on a neighboring island continues to charge its residents for a la carte services, such as Room, according to McDermott.

Dignity Senior Living in the Oceanside Hawaii building.
Last year, state officials found that there was caregiver neglect at Dignity Senior Living in Oceanside in Hauula, an issue that might have been resolved sooner had McDermott’s program provided more funding for additional staff. Cory Lum/Civil Beat/2021

McDermott recently stepped in to resolve an issue related to a patient being discharged from an Oahu facility without his clothing and other items, which were accidentally discarded by staff.

He is currently dealing with a complaint alleging that a facility on a neighboring island threatened to release a homeless resident to a bus stop if he could not find somewhere else to stay.

Another case McDermott is working on involves an overweight nursing home patient on Oahu who doesn’t fit in his bed. For months, the facility did nothing about the patient’s inability to sleep comfortably in his undersized bed, McDermott said.

“I’m fighting for the Kupuna who don’t have a voice because of their dementia, because they have Alzheimer’s disease, because they don’t have a family or because they have a family but moved to the mainland,” he said.

In 2020, people 65 and older made up 19% of Hawaii’s population. As the state’s elderly population continues to grow, experts say Hawaii is not ready to meet the rising need for kupuna health care.

“The need is not going away,” said Caroline Cadirao, director of the state executive office on aging. “In fact, it’s likely to increase.”

According to a December 2021 report by the Hawaii Department of Business, Economic Development and Tourism, the elderly population is expected to continue to grow much faster than the overall population through 2030. And by 2040, one in four older people in Hawaii will be 85 or older, overtaking other states.

“This is a state with the longest life expectancy, and I feel like we worship our older adults as much as we do anywhere else,” Cadirao said. “And we’ve done a great job of supporting them at home and in community-based settings, but I think we need to do the same for those in institutional settings because they’re the most vulnerable.”

Civil Beat health insurance is supported by the Atherton Family FoundationSwayne Family Fund of the Hawaii Community Foundation, Cooke Foundation and Papa Ola Lokahi.

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