Taking Care of Our Elders

Barbara Kim Stanton — Tue, 18 Jan 2011 20:30:23 +0000

Aiea resident Kathryn Okazaki was a vice president at First Hawaiian Bank in 2007 when she made the difficult decision to cut short her career in order to take care of her parents. She walked away from her job before she was ready when it became clear that her father was no longer able to handle on his own the daily rigors of caring for her mother, who at age 90 was struggling with dementia.

“I wanted to give them a better quality of life while they both still knew who I was,” she said. “It was important to do everything I could to help them stay in the home where they’d lived much of their lives.”

The aging of Hawaii’s population is forcing tens of thousands of residents across the state to make difficult decisions about parents and grandparents in physical decline. As responsibility falls to adult children — often at the peak of their careers — many are waking up to the reality that Hawaii doesn’t have any long-term care options that are sustainable for middle-income earners. And while tough choices and personal and financial sacrifices are necessary for everyone in these tight economic times, it’s clear that state government needs to be a more active partner in supporting possible solutions.

State leadership is especially critical given the prohibitively high cost of nursing care. According to the latest Genworth study, the median cost of private nursing care in Hawaii is around $115,000 per year – out of reach for all but the very rich. Even if you have that kind of money there are few nursing beds available: at 95 percent Hawaii has the highest nursing home capacity in the nation. Individuals falling below the qualifying income threshold may be eligible for Medicaid, but raising the number of residents eligible for low-income health services is not a good solution for our kupuna – and it’s not sustainable for taxpayers.

During the 2011 legislative session, AARP is calling on state leaders to fund social service programs that provide an alternative to costly nursing home care by allowing residents to remain in their homes as they age. Of particular importance is Kupuna Care, a state-funded program that gives seniors who aren’t eligible for Medicaid access to in-home services that supplement the care of family members. Examples of care include personal bathing and grooming, light housekeeping assistance, and home-delivered meals.

Kupuna Care is the best option we have to help prevent middle-income residents from impoverishing themselves and qualifying for Medicaid. It’s also essential to the physical, emotional, and financial well-being of an estimated 169,000 family caregivers who provide uncompensated care valued at nearly $1.5 billion annually. Advocates for the elderly have long recognized that Hawaii’s long-term care ‘system’ would collapse without our family caregivers.

Clearly, the public sector can’t pay for or replace the services friends and family members provide. Still, it’s vitally important for the state to do everything possible to support caregivers and their loved ones by offering life-sustaining resources that help keep them in their homes and communities – and off the Medicaid rolls.

Last year the state Legislature was nearly unanimous in appropriating $23.7 million for social service programs – including $3 million for Kupuna Care and $500,000 for home delivered meals for the elderly. These funds were needed to address the chronic and increasing unmet needs of the non-Medicaid eligible gap group of seniors living at home. AARP commends Gov. Abercrombie for releasing these funds in one of his first official acts as governor.

But this was a one-time appropriation from the Rainy Day Special Fund only. What is needed are sustainable cost-effective services so that long-awaited critical services are not provided, only to be cut immediately after. We also need to ensure that the recently released funds have sufficient time to reach the service providers and not lapse. Lastly, we need for the state to develop a more cost-efficient and balanced approach to funding long-term care services for the Medicaid population.

Currently, the state allocates 81 per cent of Medicaid long-term care funds to nursing homes and just 19 per cent to home and community based services (HCBS). The savings for dedicating any new funds towards HCBS would be considerable, as on average, Medicaid LTC dollars can support nearly three persons in a home and community based setting for every person in a nursing facility. This is a longer-term correction since existing Medicaid nursing homes residents would not be displaced. However, we need to move towards this goal to prepare for the increase in seniors to nearly one in four residents by 2030.

In summary, AARP’s legislative priorities are the following:
Include $3.5 million for Kupuna Care and meal delivery to the FY 2011-2012 base budget so that services can be maintained.
Extend the lapse date for the Rainy Day funds from Act 191, SLH 2010, from June 30th to December 31st. This will provide sufficient time for the agencies to expend funds that were just released in December 2010.

Balance Medicaid long-term care dollars by increasing the amount and proportion of HCBS funds without reducing the funds necessary to sustain sufficient levels of institutional care.

Doing nothing is not an option. As we enter the second decade of the century, the future of our elder-care system rests on a robust home and community based care infrastructure. Seniors in need – who have spent a working lifetime contributing to the state – should not bear a disproportionate burden of the budget axe. AARP will work to ensure the voices of its 150,000 members in Hawaii are heard during this legislative session.

Barbara Kim Stanton is the director of the Hawaii branch of the AARP.

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Barbara Kim Stanton – ������Ƶ

Taking Care of Our Elders

Barbara Kim Stanton – ��Ƶ