ARCHs; Underuse; Moratorium

Requires DOH to stop licensing new Type I adult residential care
homes (ARCH) on an island until the percentage of ARCH vacancies
falls below 10% on that island but allows licensing on a case-by-
case basis on neighbor islands that demonstrate a need for ARCHs.
Requires DHS, where appropriate, to encourage public-pay clients
to use underutilized ARCHs.  Upon approval.  (HB644, HD2)

a                                                      99-1775-1
HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 2
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            

                   A  BILL  FOR  AN  ACT



 1      SECTION 1.  The legislature finds that adult residential
 2 care homes play a crucial role in addressing the long-term care
 3 needs of Hawaii's aging population.  Adult residential care homes
 4 provide twenty-four-hour living accommodations for unrelated
 5 adults who require at least minimal assistance in the activities
 6 of daily living, personal care services, protection, and health
 7 care services, but who do not need the professional health
 8 services provided in an intermediate, skilled nursing, or acute
 9 care facility.  Type I adult residential care homes are allowed
10 to accommodate a maximum of five unrelated adults.  Type II homes
11 are based in the community and offer an important long-term care
12 alternative.  This is particularly true with the advent of newly
13 authorized expanded adult residential care homes which provide
14 twenty-four-hour living accommodations to nursing facility level
15 individuals who have been admitted to a medicaid waiver program,
16 or private pay clients who have been certified for this type of
17 facility.
18      However, the legislature finds that many regular Type I
19 adult residential care homes are currently underutilized.  Some

a                                                      99-1775-1
Page 2                                                     644
                                     H.B. NO.           H.D. 2

 1 have only one, two, or three residents.  This low utilization
 2 rate does not allow the operators of these Type I adult
 3 residential care homes to take full advantage of economies of
 4 scale in providing time- and labor-intensive twenty-four-hour
 5 care for their clients and thus creates great financial pressure
 6 for the operators to remain in business.  The purpose of this Act
 7 is to maximize the utilization of regular Type I adult
 8 residential care homes (not expanded adult residential care
 9 homes) by imposing a moratorium on the licensing of new regular
10 Type I adult residential care homes and by requiring the
11 department of human services, where appropriate, to encourage its
12 public-pay clients to enter these existing underutilized homes.
13 Because the underutilization problem exists primarily on the
14 island of Oahu, where most of the homes are located, provision is
15 made to avoid exporting the problem to the neighbor islands by
16 allowing the department of health to issue new licenses on the
17 neighbor islands on a case-by-case basis where there is a
18 demonstrable need for new homes.
19      SECTION 2.  (a)  The department of health shall determine
20 the number of existing Type I adult residential care homes in the
21 State that have any vacancy within their licensed capacity and
22 shall specifically identify each such facility.  The department
23 of health shall further determine, on each island, the Type I

a                                                      99-1775-1
Page 3                                                     644
                                     H.B. NO.           H.D. 2

 1 adult residential care home:
 2      (1)  Total bed capacity;
 3      (2)  Total number of vacancies; and
 4      (3)  Percentage of vacancies.
 5 The department of health shall cease issuing licenses to operate
 6 new regular Type I adult residential care homes on each island
 7 until the percentage of vacancies on each island falls below ten
 8 per cent of the total bed capacity of regular Type I adult
 9 residential care homes on each island; provided that the
10 department may issue new licenses on a case-by-case basis on the
11 neighbor islands if there is a demonstrable demand for such
12 facilities.
13      (b)  The department of human services, where appropriate,
14 shall encourage its clients, for whom the department makes
15 reimbursement payments for residence in regular Type I adult
16 residential care homes but who have not yet been admitted, to
17 enter those homes identified as having a vacancy by the
18 department of health pursuant to this Act.
19      (c)  This Act shall not apply to expanded adult residential
20 care homes.
21      SECTION 3.  This Act shall take effect upon its approval.

a                                                      99-1775-1