Hawai'i families caring for loved ones last year provided a service with an annual economic value estimated at more than $1.25 billion, according to an AARP study released yesterday.

While those statistics offer good news about current care in the Islands, AARP Hawai'i State President Stuart Ho said the study also serves as a warning.

"Many cultures living in the Islands feel strongly about caring for elderly family members. Unfortunately, this may change," Ho said. "Our high cost of living means, in many cases, that every adult in the household must hold a job, leaving no caregiver at home."

What's more, Hawai'i faces a long-term-care challenge "due to our serious shortage of nursing beds — a problem that demands far greater attention," Ho said.

Hawai'i's high cost of living has discouraged the development of new long-term-care facilities, Ho said. Developers tend to choose to build condominiums over care homes as a more cost-effective choice.

While the statistics show strong family care support, Ho warned that could change.

"Generations change — a lot of that cultural imperative may not be there in time," Ho said.

If families don't care for folks at home, private rates rise to $6,000 to $8,000 a month, Ho said. "I don't know where ordinary families can come up with that kind of scratch," which makes it likely that bill would go to taxpayers, said Ho, who is retiring this month as president and CEO of the Rehabilitation Hospital of the Pacific.

HUGE TOLL

Historically, Hawai'i shows a higher number of families willing to juggle other responsibilities to care for their parents, spouses and other loved ones at home.

Rep. Marilyn Lee, a nurse who has worked at Wahiawa General for 24 years, said the AARP study shows how important family caregiving is and how great a toll it can take. "It's a huge problem for many people," Lee said. "Some people have to give up their jobs."

Lee serves as president of a caregiver support group that meets monthly in Wahiawa. "We hear the stories of personal sacrifices that people make," Lee said. "We try to help people to get more knowledge and resources."

She hopes state lawmakers now in the second year of a joint Senate-House interim committee on family caregiving will be able to assess community needs and find practical ways to help.

SCARES AT HOME

Attorney Anthony Chang became more involved in his mother's daily life after an incident in 2001 that made him aware of how much help she needed.

"Someone called me to report that he had been in a traffic accident with my mother," Chang said. His mother, Ethel, now age 85, had told no one. Chang found her driver's license had expired. "She had forgotten to renew it. She had forgotten about the accident."

After that, Chang reconfigured the basement of his mom's Nu'uanu home to be his law office. A later scare came within two years when the family found his mom had left the stove burners on.

Chang and his wife moved in: "I decided I would be there day and night, and I disabled the stove."

He drives her daily to adult daycare at Furukawa's, which offers her mental stimulation, company and interaction with others. "They play games, perform arts and crafts, exercise, morning snack, midday meal," he said. "It's certainly better than having her sit at home alone reading magazines and watching TV."

Chang, a former state senator, describes his caregiver role as "pretty modest compared to most people." He notes that 80 percent of the children on his childhood street have moved back to help care for elderly relatives.

EIGHT YEARS OF CARE

Jody Mishan of Manoa put most of her life on hold for eight years to care for her father until he died last year at age 91.

Mishan, a writer-producer, cared for her dad — retired Navy Capt. John Mishan — through severe Alzheimer's disease.

"I took care of him on my own for eight years," she said. That meant fixing him three meals a day and turning him every three hours as the disease took a bigger toll.

With lots of responsibility and little sleep, "the idea of working and concentrating was too difficult" much of the time and she worked less and less.

Now in her late 50s, she's working to get back on track in her career and personal finances.

"It's still devastating to me financially," Mishan said. "I'm trying to avoid filing for bankruptcy."

She knows she chose the right path emotionally but hopes that state lawmakers and others can help the helpers more.

"It's going to be a long road to get where they need to be," she said.

Reach Robbie Dingeman at rdingeman@honoluluadvertiser.com.