The state Department of Health has revoked the license of a Hauula assisted living facility, informing the facility that it must shut down by the end of the month — a move that left the fate of dozens of residents in limbo.

The Office of Health Care Assurance sent a letter dated April 12 to Dignity Senior Living at Oceanside Hawaii and wrote that it must discharge or transfer all residents by April 30. Dignity received the letter on April 16 and notified its elderly residents this week that they would likely need to vacate the facility by the end of the month.

Keith Ridley, who leads the Office of Health Care Assurance, said it’s the first time he knows of that the state has sought to shut down an assisted living facility. He said the decision was made after his office learned Adult Protective Services had concluded there was caregiver neglect at the facility.

“Once APS issued that finding we really had no choice but to revoke their license,” he said Wednesday. “By law, we don’t have a choice. The facility cannot continue to operate.”

However, the company has until Monday to request a hearing to contest the state’s decision, which Ridley said could delay when residents would have to vacate.

The company’s chief executive officer said he planned to appeal the decision and urged residents and their families not to panic.

The state’s long-term care ombudsman expressed concern that such a sudden move would pose major challenges for many of the residents and their families.

“I’m not aware of this ever happening in the state of Hawaii,” John McDermott said in an interview. “It’s a shocker. This will cause a real problem for the residents who have to find another home, because many of them have family members that live in other states or on a neighbor island.”

In addition to caregiver neglect, the license revocation stemmed from three complaint investigations that led the state to cite 149 facility deficiencies, “including deficiencies that placed residents at risk of harm without immediate corrective action,” according to the April 12 letter from the Office of Health Care Assurance.

The facility also did not have a registered nurse available 24 hours per day, a licensure requirement, and allowed unlicensed staff to administer medications without Health Department approval, the letter alleged.

The letter noted that the facility has 10 days from the day it’s received to request a hearing to appeal the shutdown.

Albert Chen, Dignity Senior Living’s CEO, said the company plans to do so.

“I want to make it clear that we are not closing the facility. We will be contacting the Department of Health,” he said in a phone interview from China where he is visiting. “We have a good working relationship with licensing. So this decision came to us as a surprise.”

He said the facility’s location makes it difficult to recruit talent and he’s working with the state to resolve the problems.  He said that the facility is the only large assisted living facility in the state that accepts Medicaid patients.

“They already have a very limited choice of where to stay. It’s very challenging for them to find a quality place to stay,” he said.

When asked about the state’s list of problems at the facility, Chen said, “We don’t want people to take it wrongly that we are taking advantage of our seniors. It’s entirely not the case.”

Abrupt Eviction

McDermott said federal law requires nursing homes to give patients 30 days notice before they discharge them, but that requirement does not apply to Dignity because it’s an assisted living facility, not a nursing home.

Nursing homes tend to provide more medical care than assisted living facilities and are subject to more stringent regulations.

McDermott noted if Dignity were a nursing home, it would have been required “to notify the ombudsman the same time they notify the resident so the ombudsman can help if the resident wants to appeal.”

Ridley from the Office of Health Care Assurance said he understands it may be challenging to discharge or transfer patients within weeks but said it is necessary for their health and well-being.

“The residents, if they stayed, would be at high risk,” he said. “Really, the state can’t allow the facility to operate under circumstances that endanger their clients or their residents.”

The news has alarmed Waimanalo resident and former Civil Beat reporter Kirstin Downey, who said she learned Tuesday that her mother is among 61 elderly residents who will need to find another place to live.

“This is ludicrous that they would shut down this fast during COVID,” she said. She said her mother is terrified and the concern is taking a toll on her health.

Downey doesn’t know where she’ll move her mother, who requires 24-hour care.

“If there are problems it’s very good to highlight them and address them, but why would you do it in a COVID-19 pandemic where they have no place to go? What kind of madness is this?” she said.

McDermott agreed that it would be difficult to find new homes for the residents in such a short time frame since other facilities might be full or too expensive.

“It’s not easy for older people, especially if they’re having some confusion, to adjust to a totally new environment. It can become very confusing and very frightening,” he said. “In fact, there’s a term for it. It’s called transfer trauma. People can even die sometimes from this kind of a major, major move.”

He said if the facility were a nursing home, the Health Department could replace the facility’s administrator in order to fix the deficiencies but that law doesn’t apply in this case.

“I don’t know what they can do with assisted living because there are no federal laws for this,” he said. “This is basically saying that this is a hopeless situation and that no matter who is the manager or what company takes over, it’s not fixable, so everybody has to move out.”

Problems At The Facility

Ridley said it’s possible that a hearings officer could side with the company and keep the facility open. He doesn’t know of a precedent for this particular type of hearing — in the past, he said, facilities that faced similar citations closed of their own accord.

In the meantime, Ridley said he’s working with Dignity Senior Living to create a plan to transfer or discharge the residents. He said the onus is on the company to find spots for their clients at other facilities.

Dignity Senior Living has been cited by state health inspectors in the past, including in a 2020 annual inspection report last January that found one resident whose doctor-recommended diabetic diet was not being honored by the facility’s service plan.

Other complaints included missing documentation about physicians’ orders and issues with the administration of medications and related record keeping.

Records also showed that one resident needed additional help, like nighttime care, incontinence care and laundry services in May 2019 but had not received those services by the time of the department’s 2020 check.

Problems with employee training and medical clearance also were reported. Three employees had not received proper training to administer medications and treat wounds. Ten staff members had not provided the required documentation that they had been cleared for tuberculosis. One employee did not have the CPR and first aid certification required at such facilities.

Other issues were related to the building itself. In 2019, the Honolulu Fire Department found that the facility’s fire alarm system needed repair, exit signs were not properly lit and a laundry room needed new smoke and fire barriers. At the 2020 inspection, there was no sign the facility corrected those issues.

An elevator permit that expired in October of 2019 had not been addressed at the time of the January 2020 inspection.