Experts see elder-care shift
Trends change toward finding alternatives to nursing homes
Hawaii needs more alternatives to nursing homes because most adults prefer to age at home or in their communities, experts say.
Internationally noted gerontologist Bill Thomas and Susan Reinhard, a national expert on long-term care and AARP senior vice president for public policy, recently discussed long-term care issues in interviews on separate visits here.
Thomas, who participated in a presentation of plans for a continuing-care retirement community in Kapolei, said Hawaii is first in the nation in longevity and last for nursing home beds per capita. That is not a bad thing, he said.
He "flips it around," suggesting Hawaii is first in the nation to move away from institutionalizing older people.
"Every state in America is working double speed on developing options for older people who would otherwise be in a nursing home," said the renowned nursing home reformer.
"The future lies in fewer nursing homes and far more home- and community-based services," he said. "Hawaii has done pretty good on that."
Still, Reinhard said, Hawaii spends about 83 percent of its Medicaid long-term care funding on nursing homes, more than the national average of 75 percent. Isle nursing homes are at 94 percent capacity, the second-highest occupancy rate in the nation in 2005, she said.
LONG-TERM CARE EFFORTS
Among strides being made in Hawaii to meet long-term care needs:
» The state's new QUEST Expanded Access program requires insurers to spend at least 5 percent annually on home- and community-based services and offers incentives to improve choices for services. No caps are places on services.
» The state Department of Human Services had 880 clients as of April in a Going Home program allowing people to use Medicaid dollars for residential care.
» A Going Home Plus program, a collaboration between the Department of Human Services and the University of Hawaii Center on Disability Studies, is beginning this month under a five-year federal grant to help residents with more complex medical needs transition from hospitals and nursing facilities to community settings.
» A Long Term Care Commission will be established under legislation passed this year to develop a comprehensive five-year long-term care plan with system reforms.
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The average cost of nursing care in Hawaii is $107,000 a year, well above the national average, and many patients are in hospitals wait-listed for a nursing home opening, she said, adding, "You either have to start building more nursing homes or start working on alternatives."
Reinhard met with providers and community leaders across the state to discuss the long-term care crisis. She said they generally agree on the need to "be more creative and innovative" instead of building more nursing homes.
Reinhard, one of the authors of an AARP report, "A Balancing Act: State Long-Term Care Reform," said Hawaii's long-term care system is unbalanced, with all but 17 percent of funding being spent on nursing home care.
Thomas started the Green House Project in 2003 to replace nursing homes with clusters of small homes, each for up to 10 residents. He has a $10 million Robert Wood Johnson Foundation grant to replace more than 100 nursing homes in all 50 states with Green Houses.
He said the 'Ilima at Leihano development by Brookfield Homes Hawaii on 40 acres makai of Kapolei Regional Park "would be a great place to weave a Green House into Hawaii and see if it works. Right now it's just a typical nursing home design, but they have time to rethink this."
Kisco Senior Living, a California-based senior management company, will manage the complex, "dedicated to wellness as a way of living." A village is envisioned with a mix of independent adult living and continuing-care accommodations.
Thomas, who lives on a farm in New York, founded the Eden Alternative, a philosophy that has deinstitutionalized nursing homes over the past 20 years in the United States and overseas.
Under the Green House approach, he said, nursing homes are being torn down and replaced with small homelike environments.
Reinhard said Hawaii could do more with adult foster care or adult residential care homes, which have been successful in Oregon and Washington with Medicaid reimbursements.
Tony Krieg, chief executive officer of Hale Makua, which operates nursing facilities, foster homes and other programs for seniors on Maui, said the Lingle administration and state Human Services Director Lillian Koller "are about to change things dramatically with respect to privatizing the Medicaid system."
"They're building incentives into insurance companies to keep people in the community as long as possible," Krieg said.
The problem, at least on Maui, is creating infrastructure, he said.