When keiki can guarantee their kupuna elder care

By Dennis A. Arakaki

There is a saying that the only certainties in life are death and taxes. With advances in medicine and technology, we may need to update the truism to say with greater certainty that before death comes, most people will turn 100 and that, also with greater certainty, much of our taxes will be spent on caring for the aged and disabled.

Tai chi sessions in Waikiki increase health awareness among senior citizens. For younger generations, there is a need for awareness of the growing need to look after elders when they become infirm. Advertiser library photo

According to a recent AARP report, the federal government allocates hundreds of millions of dollars annually for research in genetics and other aspects of the aging process; dozens of biotech companies, financed by venture capitalists and staffed by top-tier scientists, now specialize in life extensions.

On the downside of long life are:

• The probability that those under 40 today will be living more years in retirement than working, but having to live on a limited income.

• The probability of living longer but having to deal with functional impairments.

• The rising cost of health care and related services for our older adults, particularly in instances of catastrophic illness and chronic illness. For example, the cost of institutional care, such as nursing homes, is now more than $68,000 a year in Hawai'i but is projected to rise to $200,000 a year by 2020.

The prospect of caring for disabled parents or grandparents who have fixed or limited incomes will fall on their children and even their grandchildren and great-grandchildren. When caring for a frail or disabled elder becomes too difficult at home, family members will then face the problem of paying for institutional care for a nursing-level patient. In most cases this will necessitate the impoverishment of the patient and dependence on government for payment of skilled nursing-level care. After all, how many will be able to afford $200,000 a year for care in a nursing home?

To compound matters, demographic data show that with the aging of the population, the labor force has changed dramatically over the past 50 years.

Where people in the work force once outnumbered retired people 7-to-1, in 20 years it is projected that the ratio will change to one retiree to every three workers. Despite the expected advances in assistive technology to lessen the need for a skilled work force, there will still be a dramatic shortage of caregivers, such as nurses, home health aides, care-home operators and nursing home aides.

An Executive Office on Aging "Report on Family Caregivers" cites Hawai'i as having the lowest nursing home bed ratio in the nation — 28 beds per 1,000 people 65 and older, compared to 61 beds per 1,000 nationwide.

Despite the inadequate number of nursing home beds here, families of disabled people in Hawai'i have been blessed by the abundance of caring families who are willing to fill the gap by providing space in their homes and personal care in what are known as adult residential care homes.

However, these care homes are being assigned sicker and more disabled patients. Many of the younger generation of family members have sworn off any thoughts of continuing the tradition after seeing and experiencing what the care home operator has to go through.

These adult residential care homes, as well as adult foster homes and programs such as the Program for All Inclusive Care for the Elderly, Nursing Home Without Walls, adult day health care centers, adult day care and senior centers, provide an array of services along a continuum responding to a variety of needs.

Studies have shown that it is not enough to provide health services to the elderly and disabled, but that social services, family support and senior activities also are an integral part of keeping them independent, vigorous and productive. It should also be noted that programs such as our community senior centers provide low-cost means to keeping the elderly out of institutional care.

Older and increasing

The problem of an aging population is especially critical for Hawai'i and its residents. Why? For one thing, our healthy environment and lifestyles will mean longer lifespans than those in most other places. Hawai'i has the highest rate of longevity in the nation and the third-highest in the world!

According to the Hawaii Medical Service Association's study "Health Trends in Hawaii," the numbers of the "older old" are increasing dramatically. In 1990-99, the number of residents 75 and older increased by 62 percent and the number of those age 65 to 74 increased 13 percent.

We can expect more aging boomers from the Mainland and other countries to see Hawai'i as a retirement paradise. Add to that our customs and cultural values that make it obligatory for children to care for parents.

More and more families will find themselves conflicted with having to care for an elderly family member while still having to work to pay for that care and support their own families. An estimated one-third of adults are engaged in providing informal care for a disabled person. The average age of caregivers is 46, and 70 percent are women.

Family care also takes its toll in the workplace. According to the AARP's National Caregivers Survey, the aggregate costs of caregiving, in terms of lost productivity to U.S. business, is $11.4 billion per year. Although all we have is anecdotal information, we know that many productive, tax-paying wage earners are compelled to quit their jobs or drastically curtail their work hours to care for a family member.

We also know, anecdotally, that there are large numbers of caregivers who die before the sick family member or need long-term care themselves because of stress, burnout and depression. Another form of stress is from the scams and undue influence imposed on the elderly because of decreased mental capacity or lack of financial guidance by a responsible caregiver.

Even while most people in Hawai'i have family members or know of someone who is being cared for at home or in an institution, a recent AARP survey showed that most Americans who are 45 and older are not familiar with the costs of, and sources of money for, long-term care services.

The truth is that few are prepared for long-term care costs. Private insurance covers less than 3 percent of the cost of all long-term care, and most people do not find out about long-term care until they are confronted by the need for it.

Difficult to define

Although we may be familiar with the term, few can put a finger on an actual definition for long-term care. According to the Coalition for Affordable Long Term Care, it is the ongoing help needed when a person becomes disabled by an illness, accident or chronic condition. It includes nursing, rehabilitative services, social services and personal assistance in bathing, dressing, eating, using the toilet and moving from bed to chair. Long-term care may be given in the person's own home, in a day care center or other community setting, or in an institution such as a nursing home.

According to the Coalition for Affordable Long Term Care, 85 percent of long-term care is provided in the home by families and friends who pay for most of the expense out of their pockets. While the personal costs for families are spiraling, so too are the government expenses.

Costs to families and to government will continue to spiral unless we can establish a comprehensive plan that will ease the financial burden on families and government. Families will continue to be forced to make tough decisions on whether a member is cared for at home, in the community or in an institution. That is, unless they are provided a range of options that offer quality care that is affordable.

'Care Plus'

In Hawai'i, the Joint House-Senate Committee on Financing Long Term Care, along with first lady Vicky Cayetano's ad hoc committee on long-term care, met over the past year and researched the issues relevant to Hawai'i. The result is a proposal called "Care Plus," a sensible plan to ensure that long-term care will be affordable in the years to come.

The goal of Care Plus is to provide Hawai'i residents with access to long-term care coverage providing about $70 per day for 365 to 450 days, all at an affordable mandatory premium of $10 per month for those older than 25.

It may be hard to believe that for the cost of two plate lunches, for less than the price of two movie tickets and certainly for less than the cost of a carton of cigarettes or bottle of wine, Hawai'i's residents could be the first in the country to be covered by a "universal" long-term care plan. While the details are still being developed, the plan must be conceptually and actuarially sound before it is established.

One thing is certain, however: A maximum number of residents must participate for the plan to work, and young working adults especially will need to participate in order to make it actuarially feasible. Unless we are willing to consider morbid Orwellian measures such as those portrayed in the book "1984," where people are euthanized when they reach a certain age or level of infirmity, we must face the growing problem of aging and human frailty with a sense of resolve and reality.

Our longevity and our tradition of honoring our elders make Hawai'i the perfect setting to lead the nation in providing compassionate, affordable, quality care for the frail and disabled elderly and other adults. We must show foresight and courage to establish a system of care, and a caring system that will provide for those in need.

The time to act is now! We owe it to our elders who labored and sacrificed to provide us with a Hawai'i that has become such a special place to live. Now is the time to show the nation and the rest of the world what it is to have a society and government that will honor elders with care, compassion and aloha.

State Rep. Dennis Arakaki, D-28th (Kalihi Valley, Kamehameha Heights), is chairman of the House Health Committee and co-chairman of the Joint Senate-House Committee on Long-Term Care Financing. He has also been a caregiver for more than 10 years, along with other family members, for his 83-year-old disabled mother.