Photo by Ken Sakamoto, Star-Bulletin
An aide helps a patient at Alzheimer's
Respite Center in Alewa Heights.

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No one wants to face the price
of long-term care

By Jerry Tune
Star-Bulletin

IN January, a man called the governor's office in frustration, saying he would leave his wheelchairbound mother-in-law on the steps of the state Capitol if he didn't get help.

He had been taking care of the woman, who has Alzheimer's disease, and his inability to get help from government or an outside agency led him to the breaking point.

Fortunately, the man was able to get help. But his threat may be a harbinger of things to come in Hawaii.

On the mainland, enough caregivers have abandoned elderly relatives that the practice has been given a nickname -- "granny dumping."

Although Hawaii has been spared, local government officials and gerontology experts say the high emotional and financial costs of taking care of elderly relatives coupled with the graying of Hawaii's population is putting a great strain on families and society.

The experts say there are no simple solutions to an extremely complex problem but there are ways that families can ease the burden.

"A typical caregiver is 57 years old and is burned out," said Edwin S. Ohta, vice president for the Queen Emma Foundation which is developing a senior care village in Waipahu.

In the past, especially in Hawaii, there has been a tradition of one generation taking care of the next. But that's changing because so many young people must move away from Hawaii to find jobs, and those who stay in Hawaii often must work two or three jobs.

For many children, there just isn't time to take care of parents when they reach their late 70s and 80s. But they can't afford rising elder-care costs either.

Employing aides to come into the home full-time can cost $100,000 a year, said Mildred Ramsey, a gerontology administrator at the nonprofit Child and Family Service agency.

Nursing homes can cost up to $72,000 a year. Assisted-living facilities, which help with some chores but don't offer 24-hour skilled care, cost about half of that, or up to $36,000 a year. Licensed care homes cost about $24,000 a year.

There are limited places in the state for Alzheimer's patients but they can cost $40,000 a year, or more. (Other programs can be used for part-time or crisis situations. A list is in the Senior Information and Assistance Handbook available at American Savings Bank branches.)

Marilyn Seely, executive director of the state's Executive Office on Aging, says there are no "silver bullet" solutions to solve all the elder-care problems facing the state.

Still, there are some options for families and caregivers to consider. They include:

Take out long-term care insurance. Ron Bernard, an insurance agent with Long Term Care Hawaii, said only about 2 percent of adults in Hawaii have this kind of insurance -- a low rate that's also typical for the nation as a whole.

"They already are paying about $75 a month for car insurance and $96 a month for homeowners and hurricane insurance, so they don't get long-term care insurance," he said. "They think government is going to take care of them but government is going the other way, if anything."

If adults get the insurance early, it is cheap, Bernard said. For example, a 44-year-old person can get coverage for $13.50 a month that pays 60 to 80 percent of nursing care costs.

"From 40 to 65 is an ideal time to buy (long-term care insurance)," Bernard said.

But Seely doesn't see it that way. She thinks the private insurance is expensive, and "the payout record hasn't been good."

"Most people don't even think about the problem until after they get to 65 years old," Seely said.

ByKen Sakamoto, Star-Bulletin
Kathy Komori works with pattients at Alzheimer's Respite Center.
Most people don't even think about how they will pay for such care
until they are in their 60s; yet the best time is decades earlier.

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Bernard and Seely agree that it is difficult to market and sell long-term care insurance to lower economic groups.

"The solution is to get employers involved," Bernard said. But he concedes that employers already feel burdened by the requirement for pre-paid health coverage so adding care insurance is unlikely.

The federal Health Insurance Portability and Accountability Act passed last year, allows employers a tax deduction for the costs of providing long-term care insurance to employees. However, both Bernard and Seely don't see this law stimulating employers into action.

Set up a family caregiving support group, and get relief by using aides for a few hours a week. Many families use aides two times a week, four hours at a time. Ramsey says keeping seniors in their home is the least expensive way to go, on a part-time basis.

Cost for aides ranges from $10 to $20 an hour, depending on whether the family hires the aides or goes through an agency. If the family hires the aide, the state considers the family an employer and the family must follow Department of Labor requirements. If the agency supplies the aide, then the agency is the employer.

Check out senior day care at facilities with a nursing staff.

Facilities such as the Leahi Adult Day Health Center can provide a nursing staff, meals and even physical therapy. Costs range from $60 to $75 a day. There are limitations, however. Elders can't be on medical-support systems or have contagious diseases. Hale Kako'o, the Alzheimer's respite center on Alewa Heights, has capacity for 18 persons. Costs are $50 a day for full-time use or $60 a day for part-time use.

Other adult day-care facilities provide only social services, with no nursing support personnel at about half of the cost.

Talk to a financial adviser about setting up a trust to avoid estate taxes, and use these proceeds for elder-care.

"The charitable remainder trust can be an effective way to pay for elder-care depending on the needs and goals of the donor," said Abe Lee, marketing director for Lee & Associates Inc., which does estate planning.