Dottie Sunio helps others deal with the difficult legal concerns
of caregiving. She took care of her mother, who had
Alzheimer's disease.
Photo by Kathryn Bender, Star-Bulletin

Many families employing home caregiving aides aren't aware of the laws, or find them too confusing and burdensome, say those who work with the elderly.

"There are 12 different steps and I can't even figure out how to do a worker's comp form," said Mildred Ramsey, administrator of Child and Family Service's Honolulu Gerontology Program.

"And you have to find an insurance company that will give you worker's comp. Ask an 84-year-old lady to do this and she can't."

The only alternative, Ramsey said, is to go through a firm that will take the aide as its employee and pay everything, or hire someone through an agency for $18 to $20 an hour.

"If you're doing everything right, that's what it's going to cost you."

The result: "A great subterranean work force that works for less," Ramsey said.

Even at $10 an hour, it runs $80 to $100 a night, she said.

"That's pretty much to put out if you need somebody three times a week."

Appearing annually before legislators, Ramsey stresses the savings to

the state from family caregivers. "But the state requires them to pay an aide as though it's a for-profit business, and it's just not fair."

Labor laws are designed to protect workers and ensure they have benefits, she said. "But these laws are so nitpicking."

For instance, Ramsey said, a helper becomes an employee instead of an independent contractor the minute any instruction is given by the family.

"Chances of (hiring) a fly-by-night person are less likely." And the employer is protected in case the caregiver is injured in the home, he said.

Although paperwork and higher costs are big drawbacks, Pietsch said, people who do everything up front may find many costs can be paid by Medicare or other coverage.

Pietsch said he's been talking to Child and Family Service and the Executive Office on Aging about finding volunteers to assist families with the legal process.

Rules, regulations and laws should be explored to see if family members can be paid for services, Pietsch said.

"If your daughter or son takes off from work to help you, maybe you could reimburse them. Now, you have to have a stranger and who knows what you're going to get?"

They don't know if they can afford it and too much stress causes family blow-ups, he said. "It causes divorce. Children leave home. It gets kind of crowded when one family moves in with another family.

"Once you're in this situation, these things just compound and it seems so frustrating," Pietsch said. Other legal issues add to the frustration and can lead to abuse, or families just give up, he said.

"Everybody can see themselves leading to that frustration point. You never know if and when it will happen to an individual, so the whole community ought to look at this. We have to see if our laws make sense, and if they don't, what can we do about it."

As funding decreases for elderly projects, tensions are apparent in his program, which provides legal information and services primarily to needy residents, Pietsch said.

People are on a waiting list at times when they can't wait, he said. "People get very angry. They are very frustrated at the hoops they jump through just to get to us."

She sponsored a bill in the last session eliminating the need for unemployment insurance for anyone paid less than $1,000 per quarter for domestic services. The previous limit was $225.

Also needed, she said: Financing for more day care and respite centers; more nursing care facilities; money for caregiver training, senior centers and support services; programs such as assisted living or Maluhia Hospital's PACE Project, and a program to renovate or modify houses for the safety of elders.

Diane Murayama, head of Catholic Charities Elderly Services, said she and Ramsey are always at the Legislature, "harping at these people. "