It's not much, but for the first time since 1988, the state plans to increase a federally mandated monthly living allowance for about 6,100 patients in care and nursing homes. By July 1, the "personal needs allowance" will go from $30 to $50.

Medicaid recipients in nursing facilities and care homes get the allowance after handing over all their other monthly income from Social Security and other sources to their care providers for room and board.

The stipend is supposed to cover everything from hygiene products and bus fare to clothing, shoes, hearing aids and glasses for nursing or care home residents who are frail, have a mental illness or a disability and are on Medicaid.

"It's never enough," said Christine R. Saito, a 75-year-old resident of the nursing home and rehabilitation center at Wahiawa General Hospital. Saito said she spends her allowance quickly on soap, shampoo and "things we all have to buy."

She added any increase is welcome. This month, she plans to splurge a little.

"I'm going to buy some shorts and night clothes," she said.

Advocates say the increase is long overdue, but also said the allowance still falls far short compared to other states. Arizona leads the nation with a $90.45 monthly allowance. The average allowance nationally is $50, but Hawai'i and five other states still base their payouts on a 1988 federal law, which set the minimum payout at $30.

"This is unconscionable," said Marion Poirier, executive director of the National Alliance on Mental Illness in Hawai'i. "If you're a resident in a care home or a long-term care facility, you get $1 a day to pay for everything from toothpaste to bus fare."

Marya Grambs, executive director of Mental Health America of Hawai'i, said advocates at care homes and nursing facilities have been trying for seven years to increase the allowance. This year, though, they went straight to the governor, who then recommended the state Department of Human Services raise the allowance.

WHERE IT GOES

The $20 monthly increase per person will cost an extra $1.5 million annually.

Human Services Director Lillian Koller said the funds were put into the department's budget request for the next fiscal year, which starts July 1.

"It's just a matter of personal dignity," Koller said, adding she was unable to put in an increase earlier because the department was dealing with other budget priorities.

Advocates said there is nothing currently in the law that requires care homes to give their clients the allowance, and some said they have heard of care homes keeping the $30 to cover toiletries and other necessities.

The bill moving through the Legislature that would authorize the allowance increase also says care homes are required to give the allowance to clients in addition to providing certain needs, including generic toiletries, linens and meals.

The original draft of the bill would have added an annual cost of living increase to the allowance, which advocates said was needed to keep up with inflation.

The increase would have been based on the annual percentage hike in Social Security benefits. However, the cost of living increase has been cut from the bill.

The amended version of Senate Bill 1182 passed through the Senate Human Services and Public Housing Committee on Wednesday after about 1,300 people — including dozens of care home clients — sent in letters of support or testified in person.

Though Koller has expressed support for increasing the dollar amount of the allowance, she has not yet weighed in on an annual increase.

In an interview last week, she said she did not have enough information on the proposal to comment.

PRESSING THE ISSUE

It's still unclear whether the cost of living increase will come up again in a bill this legislative session, but advocates say they don't intend to drop the issue.

"All of us expect some cost of living increase," said Chris Ridley, director of the Life Care Center of Hilo. "We need to bring it up to the average."

Ridley, who helped coordinate the effort to get the allowance increase this year, said she has heard so many stories of patients in nursing facilities or care homes doing without basic necessities or a little comfort because they run out of money.

Ridley often finds herself using her own money to cover the needs of her patients.

Earlier this week, she crocheted a beanie for a woman who couldn't afford to buy her own. In the past, she has purchased several other beanies for patients.

And just recently, Ridley and her staff were moved when another woman in her facility said she couldn't afford a birthday card for her adult son.

But as advocates are pushing for the increase, some also say they want to see more state oversight to make sure monthly allowances are getting to patients.

WATCHING CARE HOMES

Nursing facilities are required under federal law to make meticulous accounts of any purchases made on behalf of patients, but accounting at care homes is not as strict.

Denise Pamala, director of the state-funded Hale o Honolulu clubhouse for mentally ill residents, said some care homes use portions of their clients' allowance to buy toiletries.

"Sometimes, we have to tell the care homes to give them their money," Pamala said.

Care home operators say more accounting will only create more headaches and costs. They also say their facilities are supposed to be run like homes, not businesses.

"We are concerned with the time that it is going to take ... to provide that accounting," said Tim Lyons, legislative liaison for the Hawai'i Coalition of Care Home Administrators, in testimony submitted last week on the allowance bill.

Koller said she has heard no specific concerns about accountability at care homes and so has no plans to increase oversight. She also said any extra accounting or oversight would require a complex, expensive infrastructure, including personnel.

Michael Rouch, who lives at a foster home for adults in Central O'ahu, said he has always received his monthly allowance on time.

The 68-year-old diagnosed with schizophrenia said he uses his money to buy hygiene products.

"I buy my deodorant, my razors, Kleenex, toilet paper and things," he said. "Sometimes, I don't have enough money. I wish they would raise it to $100."

Reach Mary Vorsino at mvorsino@honoluluadvertiser.com.