A crisis is looming in Hawaii if the public system is not fixed to address Hawaii's rapidly aging population, shortage of nursing homes and lack of home and community-based services, says AARP's national expert on long-term care.

When she mentions that the average median cost of a nursing home in Hawaii is $137,673 a year, “;literally I've seen people's jaws drop,”; says Enid Kassner, director of independent living and long-term care at AARP's Public Policy Institute in Washington, D.C.

The nursing home shortage “;is a problem pretty much unique to Hawaii,”; she said. The occupancy rate (95 percent in 2007) is the highest in the country, she added.

Without alternatives, the Hawaii system depends upon about 169,000 family caregivers who provide free services, she said.

Kassner discussed the problems of planning and paying for long-term care in public talks across the state earlier this month and in an interview. She also gave a presentation to representatives of about 35 companies Nov. 30 focusing on their challenges as an increasing number of employees have family caregiver responsibilities at home.

“;She's made the point that while other states have it bad, Hawaii has it worse,”; said AARP Hawaii Associate Director Jackie Boland. “;We have a population that is aging rapidly. Our care is more expensive than care on the mainland. Most available public resources pay for nursing homes rather than home and community-based services. We don't have enough nursing homes, and our family caregivers are under pressure, particularly as our state budget crisis leads to cuts in the little support available.”;

An AARP survey showed 88 percent of islanders want to age in their own homes, Kassner said. “;Nobody has their goal of going to a nursing home.”; But there are not enough services for home care, assisted living or group homes, she said.

The older population, particularly 85 and older, is growing rapidly—more so in Hawaii than any other state, Kassner said. However, primary caregivers—in the mid-40s to early 60s—are decreasing in population, she said.

“;What is going to happen when those people who are holding down jobs, raising families and taking care of elders say ... 'I can't do this anymore'? If they stop providing services, the system will be ready for collapse.”;

An AARP survey found last year that 74 percent of Hawaii residents were either “;extremely worried”; or “;very worried”; about being able to receive long-term care services in a setting of their choice, she said.

And people should not be forced to impoverish themselves to qualify for Medicaid, she emphasized. “;Most people are falling through the cracks or spending down their entire life savings and qualifying for Medicaid,”; which allows no more than $2,000 in liquid assets.

States such as Oregon and Washington, Alaska, Vermont and New Mexico have reformed their system to serve more people, with more than half of their Medicaid long-term care dollars being spent on home and community-based services, Kassner said.

In Hawaii, she said, 83 percent of Medicaid dollars is going to nursing homes, with only 17 percent for home care services.

A Hawaii Long Term Care Commission was established last year to explore care options and financing alternatives and facilitate long-term care planning.

States must preserve such programs such as Kupuna Care, which provides services to help older adults of all income levels live independently without impoverishing themselves, Kassner said. “;But unfortunately, funding is seriously threatened.”;