Hawaii Gets High Marks for Long-term Care Services, but Aging Baby Boomers Will Stress System in the Future

Hawaii ranks among the top states when it comes to meeting the long-term care needs of older residents and people with disabilities, but more needs to be done especially as Baby Boomers reach their 80s and the number of people who can provide family caregiving services decreases dramatically.

Despite the high ranking (7 ^th), AARP says Hawaii still needs to do more, at an accelerated pace, to meet the changing demographic demands of an older population. This, according to a new, comprehensive state-by-state Scorecard from AARP with support of the nation’s leading organizations behind quality long-term care, The Commonwealth Fund and SCAN Foundation.

Long-term care (also called long-term services and supports) is a diverse set of services designed to help older people and those with disabilities; services can be provided in a person’s home, in a community setting such as an adult day center, or in a group residential facility like a nursing home.

Hawaii improved in the support for family caregivers ranking in part because of the passage of the Caregiver, Advise, Record, Enable (CARE) Act last year. The CARE Act becomes law on July 1 and helps caregivers when a loved one goes into the hospital. It requires hospitals to allow patients to designate a family caregiver; requires notification of the caregiver before a patient is discharged; and requires hospitals to offer caregiver instructions on the medical tasks that need to be performed at home after a patient is discharged.

Picking Up the Pace of Change: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers –the third in a series of reports—ranks each state overall and on 25 specific indicators in 5 key dimensions: affordability and access; choice of setting and provider; quality of life and quality of care; support for family caregivers; and, effective transitions between nursing homes, hospitals and homes.

The Scorecard shows Hawaii needs to improve efforts to provide long-term care services under Med Quest, Hawaii’s Medicaid program, in the home rather than in more expensive nursing homes and that the state needs to increase the number of workers who can provide in-home long-term care.

The Scorecard reveals that in less than 10 years, Boomers will begin to turn 80, placing new expectations and demands on a still imperfect long-term care system. Further, this generation will have far fewer potential family caregivers to provide unpaid help.

“Because people in Hawaii tend to live longer, we will be among the first to feel the shortage of potential family caregivers to older residents needing care,” said Barbara Kim Stanton, the state director of AARP Hawaii. “State policymakers need to act sooner rather than later to prepare for this.”

In 2010, there were 6.1 potential family caregivers for every person 80 or older. By 2030, that ratio will fall to 3 to 1 and will drop further to 2 to 1 in 2050.

The Legislature took a first step to help caregivers with the passage of the Kupuna Caregiver bill (HB607, CD1). The bill attempts to help working caregivers by providing a system for them to get additional long term services like adult day care, transportation and meals so they don’t have to take time off work. But the governor must still sign the bill or allow it to become law and the Legislature must provide funding to pay for the services in next year’s budget.

FAMILY CAREGIVING

Today, unpaid family caregivers provide the bulk of care for older Hawaii residents, in part because the cost of long-term care remains unaffordable for most middle income families.  In Hawaii, about 154,000 residents help their aging parents, spouses and other loved ones stay at home by providing assistance with bathing and dressing, transportation, finances, complex medical tasks like wound care and injections, and more.  The value of this unpaid care totals about $2.1 billion.

“When it comes to helping older Hawaii residents live in the setting of their choice, family caregivers take on big responsibilities,” explains Stanton. “Many juggle full-time jobs with their caregiving duties; others provide 24/7 care for their loved ones.  With every task they undertake, these family caregivers save the state money by keeping their loved ones out of costly nursing homes – most often paid for by Med Quest. They have earned some basic support.”

MEDICAID/ HOME BASED CARE SERVICES

“Hawaii has made progress to improve long-term services and supports for older adults and people with disabilities, as highlighted in this Scorecard. But, proposals in Washington, D.C. to drastically cut federal funding for Med Quest would threaten these advancements, likely resulting in our most vulnerable citizens losing the lifesaving supports that they count on,” says  Stanton.

The single strongest predictor of a state’s long-term care system is the reach of its Medicaid long-term care safety net. That’s why AARP is also fighting to expand services provided at home and in the community, by shifting funds away from more expensive nursing home care.

The report suggests that if Hawaii improved its performance to the level of the average of the top five performing states,

• 28,936 more place-based subsidized units and vouchers would be available to help low-income people with LTSS needs afford housing;
• 24,673 more people of all ages would receive Medicaid LTSS to help them with daily activities;
• 6,250 more home health and personal care aides would be available to provide care in the community;
• 3,035 more low-moderate-income adults with disabilities would have Medicaid coverage;
• $133,100,000 more would go to home-and community-based services instead of nursing homes.

“This Scorecard gives us a snapshot of how well Hawaii serves our older residents, those with disabilities, and family caregivers—and shows us where we must sharpen our focus to better assist hardworking Hawaii residents,” concludes Stanton. “Now is the time for policymakers to act.”

The full state Scorecard, along with an interactive map of state rankings and information, is available at www.longtermscorecard.org.