Wesley Lum

The most noticeable thing upon entering the director’s office at the Executive Office on Aging is that there’s no gray hair in sight.

Instead there’s Wesley Lum, who looks far younger than even his 40 years but who had accumulated significant experience in elder affairs before his appointment a year ago. He was an assistant professor at the University of Hawaii School of Social Work, has a doctorate and worked at the UH Center on Aging.

Then there’s the family experience: Lum is single but there’s been caregiving for his grandparents.

He lists among his key goals seeing the office take a greater leadership role in elder justice to grapple with the elder-abuse problem, now that a legal-services coordinator has been hired. A research project with UH-West Oahu should produce data to inform better policies in this area, he said.

But the primary aim is updating how the state delivers services to seniors. Programs such as Kupuna Care funnel assistance to families, but there needs to be more flexibility, he said. A pilot project to give families more choices is now under way as part of that reform.

In this legislative session, the governor wants to secure about $1.4 million to develop Aging and Disability Resource Centers on all islands. These comprise not so much brick-and-mortar complexes as standardized forms and additional community outreach workers. That will make it easier for people who inquire through a visit, phone call or website to be directed to the right resources, which now may be scattered among several departments, he said.

"Once you’re in the system, we actually want to go out to you," Lum added. "That’s our goal, actually, to be out there in the communities … so you’re no longer having to navigate the system, because right now, it’s so fragmented."

QUESTION: How did your career get on this track?

ANSWER: I always had an interest in gerontology. I really think it stemmed from just a really positive experience that I had with my grandparents, particularly my grandmothers. … And because of my background in public health, I really had an appreciation for prevention and what we can do across our lifespan.

Luckily, a position opened up at the (University of Hawaii) Center on Aging. and that’s how I actually got started. It was because there was a contract in place between the Center on Aging and the Executive Office on Aging to build a support system for family caregivers … during that time I was studying for my doctorate.

Q: What year was that?

A: 2009. My focus was on public policy and aging, as well as family caregiving for the elderly, and then I specifically looked at the development of public policies as it relates to balancing work and elder care in Hawaii.

Q: This support system you were working on, did it involve Kupuna Care?

A: Kupuna Care was before me, but it is still such a great program, because it really does look at providing supports in the home, home and community-based supports. Although a lot of the Kupuna Care services directly affect the older adult, it indirectly supports the caregiver.

For example, when we provide respite services, that’s all for the caregiver. So we may provide the monies for someone to come into the home and provide chore services or meals or housekeeping. But it does help the families as well.

Q: How did your own project amplify support services?

A: It was in several areas. One was looking at public policies in terms of how do you balance work and elder care, and how do you support those who are working? Because oftentimes individuals have to reduce their work hours from full-time to part-time, they quit their jobs completely, and so it affects them financially as well.

So we looked at different types of family-leave policies that would benefit people providing elder care, in addition to the existing family-leave policies relating to child care.

That was one area. Another area was, of course, respite, because that’s such a giant need, building a system of respite and starting an inventory of different types of respite.

Care coordination is another piece.

Q: What do you mean by that?

A: For example, so you’re not having to navigate the system alone, that there is some type of assistance to ensure there’s someone to help you along the way.

Q: You mean, "Who do you ask if you don’t know where to start?"

A: That’s part of it, yeah, either on the large-scale, macro level, or even individually. Oftentimes you get that call — say your dad is going to be released from the hospital and you only have a day’s notice. What do you do? He’s unable to actually go live independently, by himself. So you now are a caregiver: What do you do? That starts the coordination.

Q: What became of these support-system ideas?

A: It was really nice because a lot of the work we did then allowed us to advocate for families. And the data that we collected during that point in time allowed us (advocates, the Executive Office on Aging) to then apply for federal grants, and now we’re recipients of those grants.

So we’re using the concepts that we were advocating for back then, and we’re actually beginning to start implementing now.

Q: What kind of grants?

A: For example, one of the issues that we talked about quite extensively when I was at the Center on Aging was financial support, because there are so many out-of-pocket expenses.

So we looked, over like a three-year period of time, at different models of providing financial support. We used one of them — it’s called Cash and Counseling. That was done on the mainland as a demonstration project but for people on Medicaid. We were looking at it to assist people not on Medicaid.

So during that time period we got all this research done and, just before I came on board here, they used that data to apply for a federal grant. So the Executive Office on Aging is the recipient of that federal grant.

And as of December … we’re using those federal funds (from the Administration on Aging) to implement what’s called a Community Living Program. It’s phenomenal, because it’s a total shift in the way that we’ve traditionally been providing home- and community-based services, to the point where it’s so flexible that it allows the consumer, the participant to determine what type of services he or she needs, and who’s going to provide it, and who’s going to get paid for those services.

So if you want to now pay a family member or friend or neighbor, you have that possibility with this new pilot program that we received.

Q: How much could a family get?

A: For this pilot project, it’s up to $600 per month. … It’s going to run through September of this year, 2012.

Q: Is this pilot being done in other states?

A: Actually, at this point in time, it is. The way that we hope to do it is, because it’s a pilot, we’re going to learn what works and what doesn’t work. And we want to then imbed the concepts of consumer direction in the way that we’re operating this, as another option for Kupuna Care.

Q: If this is an alternative, what is the traditional way?

A: The traditional way is like if you contacted your county Office on Aging, and they deemed you eligible to receive Kupuna Care funds or other types of publicly funded services that are not Medicaid, they’d assess you and see what you need. But the way that the dollars come through, we contract out for units of service. So for example, with the Rainy Day Fund, we had this wonderful pot of monies for meals, but when you look at the data that we collected about the different services that were provided, of course, that’s what most people got, meals, because that’s what you had monies for.

Q: So that may not have been what they needed most?

A: Yeah. And it’s not to say it was not invaluable. It was helpful. But again, this other way, consumer-directed, is that families are going to tell us what they need. And so they’ll have a coach to enable them to set up a support plan and a financial plan.

And then we have a fiscal management agent who will take care of all of the human resources and the payroll responsibilities. Because now, the older adult is considered the employer. And you’re hiring someone to provide these services, and it could be a family member. But now that employee would be responsible for taxes, all those withholdings, and so the financial agent will take care of all of that. So there’s no exchange of monies between the participant and the employee, whoever that employee of choice may be.

Q: Are you going to be reporting to the Legislature on the results of this?

A: Well, we will, but it won’t be a mandated report. But we want to let them know about it because this is the direction that we’re going to be heading. And it’s our hope that we can head in this direction so we’ll be using state funds as well as, if we’re allowed to, federal funds, for these consumer-directed options.

Q: Is there something family members should be doing on their own to prepare for the care of their elders?

A: I would say just start the conversation. It could be that simple. … Mom and Dad, or Grandma, Grandpa, what are their needs? What are their wishes? Just start that conversation so that the families are able to have a sense of how Mom and Dad and Grandma and Grandpa want to be cared for, should that time come.

Q: What is discovered in these conversations?

A: Like the family dynamics. Who’s going to care for them? We always assume that if there’s a single person in the family, the other siblings with kids are assuming that the single person is the one who’s going to take care of the person. Or if siblings don’t have children, the assumption is they’re going to take care of Mom and Dad. … How is a sibling who’s moved away to the mainland going to be contributing? Those types of family dynamics. That’s why just starting that conversation gets people to at least start thinking.