Crisis seen in
elderly care
Costly health services can
By Gary T. Kubota
use up savings, burdening taxpayers
as the over-60 population
rapidly grows
Star-BulletinWAILUKU -- Gladys Baisa is amazed at how quickly her 88-year-old mother's life savings are dwindling as she pays for her nursing home care at Kula Hospital -- about $10,000 to $11,000 every month for the past year.
"It can be so expensive," said Baisa, executive director of the nonprofit group Maui Economic Opportunity Inc. "I've been in sticker shock ever since it happened."
State and Maui County officials expect more Hawaii families to face a similar predicament, as the population of the Aloha State ages and unless a change occurs in the health care system.
The medical cost at nursing facilities has also been high for state and federal agencies that eventually assume paying the bills once individuals no longer have money.
The state and federal government paid $147.5 million in Medicaid in fiscal 1997-98 to serve an estimated 5,000 elderly individuals at nursing facilities in Hawaii.
State officials expect to pay $162 million in nursing facility costs for the elderly by fiscal year 2001.
Officials project that by the year 2020, the number of people 60 years and older will rise from 200,836 to 369,407 residents, or nearly a fourth of the state's projected population. That could place a heavy financial burden on Hawaii taxpayers.
A major reason for the increase in the next 20 years is because post-World War II baby boomers, one of the largest demographic groups in Hawaii, will be reaching an age when they will need long-term medical care, experts say.
The elderly are also living longer. The average life expectancy for males and females in Hawaii was 78.8 in 1990, compared with 74.2 years in 1970, according to the state.
Officials estimate that nearly 15 percent of people 60 years and older will need help with transportation outside their home and personal needs, such as dressing and bathing.
The state Executive Office on Aging wants to deliver more health care services at home to reduce the cost of operating long-term care nursing beds.
State health officials point out they have been operating a program that provides for the medical needs of the elderly in a community setting and that the result has been less cost to taxpayers.
The Program for All-Inclusive Care for the Elderly has a budget of $2 million a year and serves 90 clients at a cost of $23,000 a year per elderly person.
Government agencies already assist in delivering help to the elderly, including lunch delivery, chore services, escorted transportation, adult day care, day hospital services and nursing care.
Roy Fusato, executive director of the Maui County Office on Aging, said more help is needed to give families emotional as well as financial relief.
"You get cases where 60- to 70-year-olds are taking care of 90- to 100-year-olds," Fusato said.
Marilyn Seely, director of the state Executive Office on Aging, said she feels the elderly need twice the number of home care services.
She said the more invested in home care services, the less the state will be paying for nursing home services.
Seely said the state also hopes to reduce the cost by relying on technology for medical help.
For instance, in the future a patient at home may be attached to machines and video cameras that enable a physician at a hospital to make a diagnosis, she said.
Seely said technology is already playing a role in monitoring patients who live alone at home.
Some of them have medical devices strapped around their necks that tell a hospital whether they need help, she said.
Some medical officials worry that limits in Medicaid payments by Congress could reduce home health care services at a time when they are needed.
Richard E. Meiers, president of Healthcare Association of Hawaii, said a reduction in Medicaid payments has already caused the shutdown of four home health businesses.
Seely says she sees the closures as an adjustment and not a trend.
Baisa says individuals also have to take more responsibility for the cost of elderly care and that a solution may be in developing long-term care insurance.
She said her mother, who requires 24-hour nursing care, bought a long-term care policy in 1987 that is helping to pay for some of the costs by providing $3,000 monthly for 30 months.
"I honestly believe people have to start taking it because the state cannot afford to be paying," she said.
Officials with the State Executive Office on Aging are holding a series of public meetings to receive comments about a proposed Hawaii State Plan on Aging: Comments welcomed on State Plan on Aging
Kauai: From 10 to 11 a.m on Tuesday at the Lihue Civic Center.
Copies of the plan may be obtained at the counties' offices on aging.
