Hawai'i first lady pushes long-term care program

By Lynda Arakawa
Advertiser Capitol Bureau

Hawai'i first lady Vicky Cayetano is quietly meeting with elected officials and state business leaders to promote a new tax to help finance a long-term care program for disabled residents.

First lady Vicky Cayetano is examining long-term care needs in Hawai'i. Advertiser library photo

Exactly who would be required to pay the monthly $10 fee or how it would be collected or administered has yet to be determined. Cayetano wants the contributions to come from as broad a section of the population as possible. A monthly payroll deduction was initially considered, but Cayetano said that idea was scrapped because it would have excluded people such as retirees and homemakers.

Cayetano has been meeting informally with state agency officials and others at Washington Place since February about how to help residents deal with the high costs of long-term care and to encourage more home-based and community-based services.

She emphasized that others have done most of the work regarding the proposed program and that she has just picked up on what many others have worked on for more than a decade.

But the involvement of Cayetano, a successful businesswoman who has rarely stepped into the role of public policy advocate in her four years of marriage to the governor, clearly raises the profile of long-term care, an issue that has simmered in the Legislature for years.

Hawai'i is among the top three states with populations aging most rapidly and there are 212,000 people aged 60 and older living in Hawai'i as of last year, said Cayetano, president and chief executive officer of United Laundry Services Inc.

She said she has discussed the proposal with House Speaker Calvin Say and Senate President Robert Bunda and she said she plans to pitch the program to every lawmaker. And, of course, she has discussed the idea with her husband, Gov. Ben Cayetano, and his chief of staff, Sam Callejo.

Referring to the challenges of long-term care, she said the governor "lived that difficulty firsthand" when he took care of his father, who suffered from dementia.

But she fell short of saying her husband was inclined to support the proposal. The governor could not be reached for comment late yesterday.

"I find it challenging that everybody says they're supportive but as somebody said, the devil's in the details, and that's the part that we have to try to bring some consensus to," she said. "But what I hope people realize is that you're not going to get a program that's going to please every single individual. We've been trying that for many years and nothing has come about, and we're really in a more difficult situation now than if we had acted 10 years earlier. So I hope that everybody will be a little bit compromising and something starting now is better than nothing."

With every legislative seat up for election next year and the economy in crisis following the Sept. 11 terrorist attacks, Hawai'i's first lady and other long-term care advocates face tough challenges. Realizing the public's aversion to the word "tax," those who attended a recent meeting of the Joint House and Senate Special Committee on Long-Term Care, which is working with the first lady, briefly brainstormed on other names for it, such as a "mandatory contribution," or a premium.

Cayetano said a voluntary contribution was considered but that "the numbers simply don't work and what we don't want is a program that's not going to be successful."

Rep. Dennis Arakaki, D-28th (Kalihi Valley, Kamehameha Heights), co-chairman of the special committee, acknowledged that it may not appear to be the right time to launch such a program because of the state's weakened economy.

"But when it comes to long-term care I don't think there will ever be a right time," he said. "One way or another we're going to pay for it. ... It's like paying premiums and it's like paying Social Security. So if you consider Social Security a tax, then I guess you can call it a tax. But it's more of an investment. It's like buying insurance."

Arakaki said the state needs an affordable long-term care program to address a large "gap group" that includes people who do not meet low-income requirements for Medicaid and don't have enough money to afford private long-term care insurance. Medicare benefits are limited and do not cover prescription drugs.

Reach Lynda Arakawa at larakawa@honoluluadvertiser.com or 525-8070.