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The Honolulu Advertiser
Posted on: Wednesday, December 16, 2009

Caregiving network under critical strain

The death of an elderly Kailua man by his own hand is a complicated case in which all the facts are still awaiting the completion of police investigations.

Still, the tragedy of Robert Yagi, 71, casts a spotlight on Hawai'i's patchy network of family caregivers, the people most crucial to the delivery of care to our growing population of aging elders.

Yagi, by all accounts a loving caregiver to his ailing spouse, killed himself in the wake of his arrest on charges that he shot his wife in the hospital where she is a terminal patient.

This is an extreme and heart-rending case. But it underscores an underlying condition that can apply to a broad group: Hawai'i's overwhelming need for community support of caregivers.

The demand for at-home care of elders will increase dramatically in the coming years, due to the aging of the Baby Boom generation, the population's largest contingent.

In Hawai'i it's a particular problem because this state posts the nation's highest occupancy rate in nursing-home beds. It's crucial that there be enough support services in the community that can be tapped by elders still capable of living alone, and by the caregivers who step in when assistance is needed. Without support, the most devoted caregiver can succumb to the strain of duty.

Creating this support is an imperative still unmet in Hawai'i. This challenge cannot be waved off as a future problem. It needs attention now.

In the immediate term, lawmakers must find a way to underwrite the support services that already exist in the communities. These include programs such as Kupuna Care, which is struggling just to maintain the same funding level it's received for seven years, while demand for services keeps mounting. The program is open to seniors on a sliding-fee scale, providing personal care, household services, meals, transportation, adult day programs and care management.

All of these services assist caregivers and enable seniors to remain at home longer, forestalling the time when institutional care may become necessary.

During today's difficult fiscal times, lawmakers should explore private partnerships that may help underwrite these services, to leverage the limited public funds available.

For the future, the state Long Term Care Commission has retained the research group RTI International to assess more precisely what support services our communities need and to craft a five-year plan to improve the network of support.

Having that guidance is absolutely crucial as Hawai'i confronts the realities of elder care. This state must bolster the work of caregivers that help seniors age in place — not only because that's the more affordable option open to so many families, but because the seniors themselves want to stay at home. They deserve that measure of dignity.