Caregivers for disabled face legislative crisis

HAWAII is on the verge of losing an important part of its health care delivery network -- independent providers of health care services to developmentally and mentally retarded adults. Should this occur, hundreds of small businesses will be shut down and there will be severe consequences to thousands of disabled adults and their families.

The administrators of the Department of Labor and Industrial Relations have inexplicably decided to reinterpret a law that has served our state's disabled adults well for 20 years. This will devastate the service provider organizations and the independent caregivers with whom they contract.

Agencies that provide Medicaid waiver services, such as Catholic Charities Hawaii, Special Education Center of Hawaii and my business, Home & Community Services of Hawaii, deliver Medicaid waiver services and also contract with independent caregivers to provide home care and other types of health care services. These services enable mentally and physically disabled adults in Hawaii to live in a home setting in the community, instead of an institution.

Severely disabled adults, who make up a large portion of those receiving Medicaid waiver services, are often totally dependent on their caregivers for all daily living activities, including eating, brushing teeth, bathing, grooming and toileting. Many disabled individuals must be repositioned every two hours to prevent skin sores.

It's a big job, but it's more than a job because you cannot do it unless you are a caring person and ministering to the needs of others is your personal calling. Caring for even one or two individuals requires round-the-clock attention. Unfortunately, those who have devoted much of their lives to providing continuous care might no longer be able to do so.

Now, despite already being exempted under Hawaii law, many of the provider agencies that contract the services of these caregivers are being told that the state considers the caregivers to be employees of the provider agencies. Even though the caregivers work in their own licensed homes, pay their own taxes, carry their own liability insurance and maintain their own certifications, DLIR insists the agencies now must treat them as employees.

If independent caregivers are considered provider agency employees, the agencies will then be required to pay for benefits, including workers' compensation insurance. Shouldering these costs ultimately will force these agencies out of business, or at least force them to cancel the contracts for caregiver services to thousands of patients.

Instead of increasing the payments to cover the increased costs, the Department of Human Services and the Department of Health have done the opposite and decreased the payments for services. As a result, we are on the verge of being forced from a proven and effective system of care back to an institutional system that will cost the state taxpayers millions of dollars.

However, putting these patients, who are now cared for at licensed homes, into institutions will also exponentially raise the state's cost of operating and staffing these facilities with qualified caregivers.

Fortunately, a sensible solution has come from the Legislature, where the House Committees on Labor & Public Employment and Human Services & Housing recently passed House Bill 833, and the Senate is considering Senate Bill 1989.

These bills reaffirm the independent status of provider agencies and the caregivers and would allow them to continue serving the disabled. I hope all those who want to avoid inflicting a host of problems on our state will ask their legislators to support the bills.

Otherwise, we can look forward not only to a public health crisis, but also the trauma and expense the families of the disabled will experience, the devastation of hundreds of small businesses and managed care agencies, and a dramatic increase in health care costs that will have to be shouldered by Hawaii taxpayers.