For some of Hawai'i's most vulnerable kupuna, a little-known government position known as the Long-Term Care Ombudsman can mean the difference between torment and safety. "You're living in a nursing home — let's say you don't like the food, or a nurse is not treating you well, has some kind of attitude toward you,” said John McDermott, Hawai'i's long-term care ombudsman. “In the old days, you would talk to one of your kids and they could maybe resolve it. But your kids don’t live here anymore because nobody can afford housing, so everybody moves to the mainland. And so, that kind of network doesn't exist as much as it used to. So who can you talk to? Well, the ombudsman…"

On November 3, 2022, Hawaii Pacific Gerontological Society honored Hawaii’s Ombuddies and John McDermott, Hawaii’s Long-Term Care Ombudsman for his twenty-four years of undying devotion to Kupuna and their families throughout the state of Hawaii. The HPGS 6th Annual Fundraiser broadcast was live on Olelo with Emcee, Marilyn Steely leading us through incredible LTCOP history followed by a heartfelt wrap up. Check out the show here: https://youtu.be/KMJ5mlQseHc

For more HPGS information; https://hpgs.org/

John and Rick with the ‘ōlelo production team after the show. Choke Mahalos to Scott Nordquist, Kekoanui Graham, Deron Kamisato and the rest of the ‘ōlelo production team!

HONOLULU – The Hawaii Department of Health’s Office of Health Care Assurance (OHCA) and the Department of the Attorney General executed a search warrant at a suspected unlicensed adult residential care home in Pearl City.

HONOLULU - The Hawaii Department of Health's Office of Health Care Assurance (OHCA) revoked the operating certificate for a Community Care Foster Family Home operated by Herbert Sales at 94-1112 Lumikula Street in Waipahu. Mr. Sales was ordered to immediately transfer or discharge all clients from the foster family home, cease operating, and pay an administrative penalty.

HONOLULU - The Hawaii Department of Health (DOH) salutes the Class of 2022. DOH recognizes the importance of graduations and what they mean to Hawai’i families. DOH encourages graduates and their families to celebrate safely.

HONOLULU (HawaiiNewsNow) - Lolesio Iosefo has been living at Wahiawa General Hospital's long-term care facility for 10 years, after suffering a fall and debilitating neck injury.

How Hawaii cared for its older and most vulnerable residents during Covid, and on the need to hire more ombudsmen for the neighbor islands.

The staff of the Wahiawa Nursing and Rehabilitation Center will help about 60 residents find new homes, officials said.

This 2022 issue of Aging & Disabilities Issues is the 17th annual publication that offers an overview of legislative issues dealing with aging, disability, caregiving, and long-term care services and supports in Hawaii. This report calls attention to the priority issues that deserve the earnest attention of our lawmakers, advocates, and the public.

Hawaii's long-term care ombudsman program is chronically understaffed but new legislation would put an advocate for residents of the facilities in every county.

A community health improvement plan has become standard practice in the public health assessment and planning process. Along with a community health needs assessment (CHNA) and a health agency strategic plan, a health improvement plan is typically the middle step in the three-step process of identifying community health needs, setting goals and objectives, and devising a work plan to meet those objectives.

Hawaii Pandemic Applied Modeling Workgroup (HiPAM) and UH ACES have been closely monitoring our state's COVID situation using public data.

Key messages of the latest HiPAM Forecast Report dated 1/2/22 are as follows (please see attached):

1. Hospitalizations rather than cases are the critical gauge in the Omicron surge. Hence the forecast is now fitted more closely to hospitalizations.
2. Hospitalizations continue to increase in all counties. Oahu has an expected daily peak of more than 900 hospitalizations towards the end of January - greatly exceeding hospital capacities for the entire state, let alone for Oahu (see page 8). This is very dire. By comparison, during the Delta surge, hospitalizations for the whole state peaked at 473 in September of 2021.
3. The increases in hospitalizations from Hawaii, Maui, and Kauai counties continue to be highly concerning due to the limited hospital capacity.

Please access the latest HiPAM Forecast Report here:
https://www.hipam.org/flyers-feed/01/03/2022/rapid-modeling-covid-19-model-update-8dysh-g62jk 

The Hawai'i Department of Health (DOH) has detected additional COVID-19 cases of the Omicron variant bringing the statewide total of Omicron cases to 50. Forty-nine of the 50 cases are on Oahu. The source and location of the remaining case is still being investigated. It is reasonable to believe Omicron may be present on the neighbor islands.

With more than 2.4 million shots safely administered, the Hawai'i Department of Health (DOH) marks the one-year anniversary of COVID-19 vaccinations in the islands.

Even before the pandemic, licensed practical nurses, who do much of the work at long-term care facilities, were calling it quits.

Despite a high vaccination rate, a Skilled Nursing Facility (SNF) in Nuuanu has seen 93 COVID infections this month. The good news: The Care Center of Honolulu on Bachelot Street says the overwhelming majority of those who tested positive have recovered. Still, family members say the situation is worrisome.

HONOLULU - Police are investigating an apparent murder-suicide at a Waikiki assisted living facility on Tuesday morning.

In April, Hawaii News Now saw the rush to move out 60 assisted living residents after the state Health Department revoked the license and ordered the shutdown of Dignity Senior Living at Oceanside Hawaii.

At assisted living facility ordered closed, residents scramble for new homes but CEO is ‘gone’: Residents of a senior living community in Hauula are frantically moving out after the state ordered the company to shut down.

The State Department of Health announced it’s immediately revoking the license and closing Dignity Senior Living at Oceanside Hawaii, an assisted living facility on Kamehameha Highway.

Hawaii Health Department Orders Hauula Assisted Living Facility To Close: The state long-term care ombudsman says it will be difficult — and even harmful to their health — for residents to relocate.

Problems With Hawaii's Care Homes Must Be Fixed Now: It starts with real unannounced inspections by the state Department of Health.

Hawaii State Ombudsman, John McDermott, Discusses a Bill that Will Allow Him to Hire 3 Staff Members: John McDermott is the sole long-term care ombudsman for the entire state of Hawaii with only a small number of active volunteers to support him. Due to the ombudsman program being understaffed, McDermott struggles to meet both state and federal standards.

Check out this dashboard to view the impact the COVID-19 pandemic has had on the nation especially for residents and staff of nursing homes and other long-term care facilities. The AARP Public Policy Institute, in collaboration with the Scripps Gerontology Center at Miami University in Ohio, created the AARP Nursing Home COVID-19 Dashboard to provide four-week snapshots of the virus’ infiltration into nursing homes and impact on nursing home residents and staff, with the goal of identifying specific areas of concern at the national and state levels in a timely manner.

Media outlets have reported on the increasing use of antipsychotics by LTCFs to help manage the challenging behaviors of residents with behavioral and psychological symptoms, a concerning trend even before the pandemic.

Residents and staff of long-term care facilities began receiving the COVID-19 vaccine in December 2020. Federal and state partnerships with pharmacies and long-term care providers provided coordinated opportunities for residents and staff to receive the vaccine. As the pandemic evolved, scientists determined that a vaccine booster shot is needed for the best protection against the virus.

Get updated information on the state’s Safe Travels Hawai‘i program.

Get all the information you need to know if you’re on a cruise ship in Hawai‘i.

Need translations for COVID resources? Check out this Translation page.

The Hawaii Department of Health (DOH) is expanding access to free COVID-19 testing on O‘ahu by providing families with community testing options during winter break.

HONOLULU The Hawaii Department of Health (DOH) is adopting the most recent COVID-19 booster shot recommendations issued by the Centers for Disease Control and Prevention (CDC).

Dr. Sarah Kemble, Hawaii Department of Health state epidemiologist, released the following statement on mortality rates involving COVID-19 and influenza. Check out the Influenza/Respiratory Disease Surveillance Report from DOHs Disease Outbreak Control Division.

A study from Harvard has found more than 68,000 unreported COVID-19 cases and 16,000 unreported COVID-19 deaths in nursing homes nationwide. The study shows that federal data underestimates the impact of COVID-19 on nursing homes because federal reporting guidelines did not require facilities to report case and death data until May 24, 2020.

Have questions about visiting your loved one in a long-term care facility? Read this fact sheet for the latest guidance from the Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention.

Have you considered bringing your loved one home from a long-term care facility due to Covid-19? Here are some questions to consider to ensure that your loved ones’ care needs are met safely.

Here are some suggestions to stay in touch with loved one in a facility.

Nursing homes have been telling Members of Congress why they can't provide quality care and hire staff. Your Members need to hear from YOU to say "Yes, they can" and to support policies that will hold the nursing homes accountable.

The Kupuna Caucus at the Hawaii State Legislature convenes to introduce and advocate for legislation that helps Hawaii's seniors. The caucus regularly meets on the first Friday of each month at 2pm, though this is subject to change during legislative session.

In preparation for the upcoming session, attend these workshops for a refresher on the legislative process.

Consumer Voice is following several pieces of federal legislation that affect consumers of long-term care.

Learn how to engage and participate in the State legislative process. Workshops and videos on how to use the Legislature’s website, submit testimony, track bills, and more.

Make your voice heard! Create an account to submit testimony electronically, search for and track bills of interest, and view sessions live and on demand.

Justice in Aging has updated its essential guide, 25 Common Nursing Home Problems—& How to Resolve Them. This revised guide includes focused information on how to fight evictions, updated eligibility standards for Medicare coverage, and more.

The 25 problems identified in the guide are common across the country and in all types of nursing homes. The guide gives residents, family members, friends, and other advocates the tools they need to identify and solve the problems residents most frequently face.

Tests work with an online application that provides audio with a step-by-step instruction for conducting the test and reading the results. Individuals will need a smartphone with Bluetooth and capabilities to download and install a free application from the Apply Store or Google Play.

Interested individuals can order test by…

1. Calling: 1-800-232-0233
2. Ordering online: https://special.usps.com/testkits/accessible

Each order will include 2 rapid-antigen tests that are more accessible for people who are blind or have low vision. Orders will ship free, while supplies last.  

On June 29, 2022, the Centers for Medicare & Medicaid (CMS) released revised Surveyor’s Guidelines for nursing facilities, along with a policy memorandum describing the revised Guidelines and accompanying revisions. The Guidelines are used by government inspectors in determining whether and to what extent a nursing facility has violated federal requirements.

The revised Guidelines implement certain regulations promulgated in 2016, and also incorporate concepts from President Biden’s recently announced initiative to improve nursing facility care.

The Social Security Administration issued its 2022-2023 Diversity, Equity, Inclusion, and Accessibility (DEIA) Strategic Plan. The detailed plan, which outlines goals and priorities in each of the four areas, includes establishing a Chief Equity Officer and a DEIA Implementation Team.

With millions of older adults and people with disabilities unable to afford the dental care they need to stay healthy. Adding oral health coverage to Medicare is both much needed and in high demand. Over 80% of voters in America support such policies, including a majority of Republicans, Democrats and Independents. The inclusion of Medicare dental coverage in the Build Back Better agenda brought the issue to the political foreground. However, Congress did not ultimately enact legislation that included the comprehensive dental benefit.

Now the Biden Administration has an opportunity to deliver an important piece of this much sought-after benefit to older adults and people with disabilities. The Centers for Medicare and Medicaid Services (CMS) has authority under current law to cover “medically necessary” dental care through Medicare. Acting to maximize this authority would help many of the people who need dental coverage the most.

On June 29, 2022, the Centers for Medicare & Medicaid (CMS) released revised Surveyor’s Guidelines for nursing facilities, along with a policy memorandum describing the revised Guidelines and accompanying revisions. The Guidelines are used by government inspectors in determining whether and to what extent a nursing facility has violated federal requirements.

The revised Guidelines implement certain regulations promulgated in 2016, and also incorporate concepts from President Biden’s recently announced initiative to improve nursing facility care.

Consumer Voice Executive Director Lori Smetanka spoke at the recent Elder Justice Coordinating Council (EJCC) meeting.  She participated in a discussion on nursing home reform, enforcement and residents' rights.  The EJCC coordinates activities related to elder abuse, neglect, and exploitation across the federal government.

Check out this new Podcast Episode on Consumer Voice. In this episode we are talking with Dr. Laura Mosqueda, a professor of Family Medicine and Geriatrics, and Beverley Laubert, the National Ombudsman Program Coordinator at the Administration for Community Living about abuse of those living in long-term care facilities – an issue that affects thousands of residents of nursing homes, assisted living facilities, and other long-term care settings.

Residential households in the U.S. can order one set of 4 free at-home tests from USPS.com. Here’s what you need to know about your order:

• Limit of one order per residential address
• One order includes 4 individual rapid antigen COVID-19 tests
• Orders will ship free starting in late January
• Fill in this form with your contact and shipping information to order your tests.

Research has shown that staffing in nursing homes - numbers of staff, skills mix, and training - are critical indicators of quality care and positive resident outcomes. Yet too many nursing homes are understaffed, and the long-term care industry claims it does not have the resources to hire more staff.

But is that really true? Check out this new Podcast Episode on Consumer Voice and listen to a discussion with David Brevda, Esq., Partner, Senior Justice Law Firm, and Robyn Grant, Director of Public Policy at Consumer Voice about how complex facility practices and resource allocation, combined with a lack of minimum standards, put residents at risk for poor care and bad outcomes; as well as recommendations for addressing these problems.

"Difficult" is not a diagnosis and it is inappropriate to label any resident this way. Actions and behaviors are a form of communication by which residents are expressing an unmet need. There are a great deal of reasons that may explain your mother’s actions, and you do not have to agree to any treatment or medication you are uncomfortable with.

The need for additional nurses in nursing homes has led to more discussions about changing federal immigration law to bring new workers to the country.

On February 28, 2022, the Biden-Harris Administration announced a set of wide-ranging reforms aimed at improving the quality of nursing home care for residents.

The President is committed to ensuring that all Americans, including older Americans and people with disabilities, live in a society that is accessible, inclusive, and equitable.

CMS is providing clarification to recent guidance for visitation (see Nursing Home Visitation - COVID-19 (Revised) – hyperlink to pdf from that page). While CMS cannot address every aspect of visitation that may occur, additional details are provided about certain scenarios. However, the bottom line is visitation must be permitted at all times with very limited and rare exceptions, in accordance with residents’ rights.

Older Americans are falling victim to fraud, physical violence and neglect as family isolation and staffing shortages erode safeguards.

California Advocates for Nursing Home Reform (CANHR) Letter to CMS regarding impact of CMS revision to nursing home visitation guidance on November 12, 2021 which allowed thousands of residents to reunite with their loved ones.

National Association of State Ombudsman Programs (NASOP) Thank You Letter to CMS for the revised nursing home visitation guidance issued by CMS on Friday, November 12, 2021, restoring residents’ rights to visit “at all times” with family, friends, and others.

Chronic understaffing has been a serious problem in nursing homes for decades and has been exacerbated by the COVID-19 pandemic. While there are numerous factors contributing to this problem, one major cause is the lack of adequate minimum staffing standards at both the state and federal levels. Minimum standards ensure that staffing will not fall to a level that would be harmful to residents [Staffing Report]. 

The Department of Health and Human Services Office of Inspector General released this report, that raise concerns about weaknesses in the safeguards to protect nursing home residents from harm that may result from inappropriate facility-initiated discharges.

The guidance for Medicare-certified nursing homes was updated by the Centers for Medicare and Medicaid Services (CMS) on 11/12/21 and visitation is now allowed for all residents at all times! The Core Principles of COVID-19 Infection Prevention – hand hygiene, face covering/masking, and physical distancing, etc. must be adhered to, and outdoor visitation is preferred when the resident and/or visitor are not fully vaccinated.

The Hawaii Supreme Court ruled Thursday that the Legislature should not be allowed to gut the contents of a bill and replace it with new provisions, sometimes unrelated to the original bill, because the practice “discourages public confidence and participation.”

CMS is making it easier to check COVID-19 vaccination rates for nursing home staff and residents with a new feature on Medicare.gov.

The Biden-Harris Administration will require COVID-19 vaccination of staff within all Medicare and Medicaid-certified facilities to protect both them and patients from the virus and its more contagious Delta variant.

On August 18th, President Biden announced that the HHS will develop new regulations requiring nursing homes to require that all of their workers be fully vaccinated against Covid-19 as a condition of participating in the Medicare and Medicaid programs.

In response to the Covid-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) authorized a waiver of the three-day prior hospitalization requirement for a Medicare Skilled Nursing Facility (SNF) covered stay, giving temporary SNF emergency coverage without a qualifying hospital stay, or renewal of SNF coverage without having to start a new benefit period in locations that are affected by Covid-19.

Nursing homes have been severely impacted by COVID-19, with outbreaks causing high rates of infection, morbidity, and mortality. The vulnerable nature of the nursing home population, combined with the inherent risks of congregate living in a healthcare setting, have required aggressive efforts to limit COVID-19 exposure and to prevent the spread of COVID-19 within these facilities.

These guidelines aim to raise awareness, guide learning, and support the use of culturally sensitive terms and phrases that center the voices and perspectives of those who are often marginalized or stereotyped. They also explain the origins for problematic terms and phrases and offer suitable alternatives or more contemporary replacements.

On November 12, the Centers for Medicare & Medicaid Services (CMS) updated their Nursing Home Visitation Guidance. Because of the high rates of vaccination among residents and the new vaccine requirement for staff, as well as the reduced number of new COVID-19 cases each week, visitation is now allowed at all times for all residents, this includes indoor visitation. All visitors must continue to adhere to infection prevention practices.

A new tool on Medicare.gov has been launched which helps inform the public about vaccination rates amongst residents and staff in Skilled Nursing Facilities (SNF). By inputting your specified zip code, you can compare nursing homes within that location. You can also look up COVID vaccination rates within the facility of your choice.

Agent/Brokers for Medicare Advantage (MA) Plans and Prescription Drug (PD) Plans must be licensed in the State in which they do business, annually complete training, and follow all Medicare marketing rules. Protect yourself from being exploited by agent/brokers with these do’s and don’ts.

Consumer Financial Protection Bureau’s Office for Older Americans released a new guide to help family members and friends of people living in nursing homes and assisted living communities learn how to prevent and report elder financial abuse.

This Ombudsman program infographic has been created to give a brief overview of the work Ombudsman programs do and the impact they have around the nation. This infographic can be used for volunteer recruitment or program promotion.

Ensuring Comfort for Terminally Ill Patients

Research suggests that from 15% to 50% of older adults experience diminished appetite and associated weight loss at some point during the aging process.1,2 Women, nursing home residents, hospitalized patients, and those of very advanced age appear to be among the groups most at risk.

Check out this article by Scott Janssen, MA, MSW, LCSW from Today’s Geriatric Medicine Vol. 15 No. 4 P. 14

All older adults and people with disabilities should have the option to choose to remain at home and receive the services and supports they need there, rather than being forced to move into a nursing facility to get the care they need. But the current Medicaid home and community-based services (HCBS) system cannot meet the current or growing need.

The Hawaii Pacific Gerontological Society (HPGS) will be hosting its 6th Annual Fundraiser on Thursday, November 4, 2022, from 5:30 – 7:00 pm.  This year the 2022 HPGS Scholarship Fundraiser will be honoring John McDermott, State Long-Term Care Ombudsman, of the Long-Term Care Ombudsman Program (LTCOP), the position he has held since August 1998.

This Bill of Rights describes the fundamental rights of air travelers with disabilities under the Air Carrier Access Act and its implementing regulation, 14 Code of Federal Regulations (CFR) Part 382.

Check out the Consumer Voice newsletter for long-term care residents containing news and information on rights, care issues, and updates on national policy. Topics Include: Residents Across the Country Sharing Their Experiences Living in a Nursing Home, Compassionate Care Visits, and The Fight Against Chemical Restraints.

In light of recent investigative reports from the New York Times about increases in schizophrenia diagnoses for residents, purportedly to prescribe antipsychotic drugs, Consumer Voice Executive Director Lori Smetanka wrote an article for the American Society on Aging's Generations about the spike in antipsychotic drug use in nursing homes.