ISLAND VOICES
Long-term care needs closer look
By Oscar Kurren
Oscar Kurren, Ph. D., is a professor emeritus of the University of Hawai'i.
Rep. Galen Fox's critique of the Democrats' CarePlus option and the Medicaid program that appeared in Thursday's editorial section ("Long-term care: There's a better way") is on track. I agree that Hawai'i does not need another substantial tax increase, as called for in the CarePlus long-term-care option for the reasons identified by Rep. Fox.
CarePlus does not really help with nursing-home costs. CarePlus' flat rate is regressive and unfair to the poor, and CarePlus fails to take on the real problems with the current long-term-care system. The recommendations for long-term-care change advanced by Rep. Fox in his commentary will, however, not lead to a better way for Hawai'i's long-term care of the elderly.
Fox recommends that the Medicaid system that now finances more than 90 percent of nursing-home care in the United States should be replaced with a catastrophic-health insurance policy as part of the federally funded Medicare system. Shifting the financial burden for long-term care to the federal sector in these days of mounting multibillion-dollar federal deficits along with mounting war expenditures surely must be recognized by Rep. Fox as being totally unrealistic.
A better, more immediate change in Hawai'i's long-term care that Rep. Fox fails to recognize is our fragmented, overly centralized and wasteful state system of long-term-care services. Aging in place is the heartfelt desire of all elderly. Fox notes that the present Medicaid system that forces the elderly into nursing homes is a "poor alternative to receiving skilled care at home."
Auwe, Hawai'i's system of long-term care has not structurally changed in the past 30 years, if not longer. It is overly centralized and bureaucratized. Expenditures of federal, state and local funds are dispersed by a variety of state agencies, resulting in a highly splintered and wasteful system that diminishes its capacity to meet the new challenges of "aging in place."
To achieve the goal of "aging in place" with dignity and security requires a fundamental change strategy. New partnerships in the public and private sectors need to be forged to create the environment and resources for home and community-based long-term care.
