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The Honolulu Advertiser
Posted on: Wednesday, January 7, 2009

Daughter hopes care case highlights plight of Hawaii's elderly

By Rob Perez
Advertiser Staff Writer

Hawaii news photo - The Honolulu Advertiser

Florence Ko

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Hawaii news photo - The Honolulu Advertiser

Florence Ko had lived at Nu'uanu Hale since July 2007. Her family had stopped paying the nursing-home bill and Medicaid rejected her application for coverage.

Advertiser library photos

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Hawaii news photo - The Honolulu Advertiser

This property at 302 Portlock Road, assessed at more than $1 million, belonged to Ko until she gave it to her daughter. It may be why Medicaid won’t pay her care-home tab.

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A New York neurosurgeon who stopped paying the Nu'uanu nursing-home tab of her 81-year-old mother, leading to the mother's eviction just before Christmas, did so because she faced a family crisis of her own, an attorney said yesterday.

On Dec. 17, Florence Ko was evicted from Nu'uanu Hale because of thousands of dollars in unpaid bills and was dropped at the Straub Clinic & Hospital's emergency room, wearing only a hospital gown and with less than $3 in her purse. Ko, who is confined to a wheelchair because of polio-related ailments, told The Advertiser she didn't know what was happening when she was left at the hospital.

"Kathryn Ko, as one of Florence's four children, has helped her mother financially over many years and assisted in paying her mother's Nu'uanu Hale invoices until life-threatening illness within her immediate family made it necessary for Kathryn to redirect her resources," Honolulu attorney Alan Kido, who used to represent Florence Ko, wrote in a statement to The Advertiser. "Without financial support from Kathryn, Florence's unpaid long-term-care expenses at Nu'uanu Hale began to mount."

The plight of Florence Ko was reported Sunday on the front page of The Advertiser and has generated widespread comments over the nursing home's actions and the actions of the family regarding the unpaid bills.

Many of the comments have focused on Ko's unsuccessful attempt to get Medicaid, a government insurance program, to help with her long-term-care tab and her one-time ownership of a Portlock property that was placed in a family trust in the mid-1990s. The property, which was valued by the city at more than $1 million, was transferred to Kathryn Ko last year.

"Over a decade ago when Florence and her late husband faced financial stresses, including the inability to meet their mortgage obligations on the family home, a trust was established, leaving the property to their daughter, Kathryn, in exchange for mortgage payments, additional monetary considerations and accommodations for Florence's other daughter and grandson to reside on the property at no cost," Kido wrote.

"At the time Florence applied for Medicaid assistance, she had already exhausted the equity in her life interest (of the property) and caused the house to be demolished for health and safety considerations after her daughter and grandson vacated the property. Despite these circumstances, Florence's application was denied. Kathryn further assisted her mother in the appeals process by voluntarily funding the unsuccessful attempt to have the state reconsider the decision to deny Medicaid assistance."

Kido said he couldn't comment beyond the statement without permission from his former client.


Kathryn Ko, speaking through Kido, said she hoped coverage of her mother's situation will highlight the plight of the elderly in Hawai'i. As with all families who struggle with the care of their elderly parents, Florence's children will continue to do what they can for their mother, Kathryn Ko said.

She had no other comments, noting this was a private, family matter.

The elder Ko spent roughly half a day at Straub before being taken that evening to an 'Aiea respite home as a temporary solution. Ko still was there as of yesterday morning — nearly three weeks since her eviction.

Straub and the Ko family made arrangements for the temporary placement and were looking for more permanent housing, the Department of Human Services said last week. The agency, which investigated the circumstances surrounding the eviction, called Nu'uanu Hale's actions in dropping Ko at the hospital inappropriate but did not find any evidence of elder abuse.

Rep. John Mizuno, chairman of the House Human Services Committee, yesterday questioned the way the nursing home handled the eviction and wondered whether similar incidents are happening at other facilities.

"What I'm really worried about is that there are a hundred Mrs. Kos out there that we're just not hearing about," Mizuno said. "There's no excuse for something like that. It's just not right."

Nu'uanu Hale has said it could not comment on Ko's case because of federal law governing patient-privacy rights.


AARP Hawai'i, which advocates for seniors, has made reform of the long-term-care system its top priority, in part because so many families cannot afford to pay for nursing-home care for their loved ones.

Wealthy individuals and those who can qualify for Medicaid coverage generally can get care — if they can find space in the tight nursing-home market in Hawai'i. But many families don't fall into either category, and they struggle to pay the care bills.

Bruce Bottorff, AARP's associate state director, said the Medicaid system essentially provides incentives for people to divest themselves of their hard-earned assets over a period of years to meet the eligibility criteria for long-term-care coverage. Such a practice is legally permissible and often is done with the help of financial advisers.

But the trend fuels the perception that people are shifting risks or costs to taxpayers, Bottorff said. "In a sense, it's a way of (legally) gaming the system, if you will," he said.

That's one of the issues that AARP wants to address as part of a systemwide reform, he said.

Reach Rob Perez at rperez@honoluluadvertiser.com.