Mental illness compounds elder care crisis

The challenge presented by Hawaii’s "silver wave" — the surge of elders growing infirm as the baby boom generation retires — has many facets, not the least of which is the accompanying increase in those with mental illness also requiring nursing care.

There are simply too many frail elders whose physical ailments have developed alongside or after a lifetime of mental illness for the network of licensed adult residential care homes (known as ARCHs) to handle. And the need to solve this problem is urgent, given that the numbers of clients needing care are only going to increase. The shortage is expected to compound quickly, as well.

Star-Advertiser writer Mary Vorsino chronicled the frightening experience of one family, which had an elderly loved one in a care home where operators seemed ill equipped to care for her. The care provider would drop the woman, 67, at a hospital for an ailment and then refuse to take her back. This happened repeatedly.

And it doubtlessly happens to many more families, although there are no good figures of how many patients at risk there are. The best guess the state has is that about a third of the roughly 6,000 receiving continuing care from the state’s Adult Mental Health Division are age 55 and up. That’s one problem that needs to be solved: The state needs a better sense of the scope of the problem it faces now.

There is a raft of special licensing regulations covering the "expanded ARCH" level of facility that should be equipped to handle more complex cases, including those involving mental illness. These include a limit on the number of clients an expanded ARCH can house at a given time and the credentials of personnel working there. For example, according to the administrative rules governing these facilities, case management services must be provided by a registered nurse.

There’s no expectation that an institutional solution to the crisis is in the offing, either. The shortage of beds in nursing homes is chronic. And a project to construct a 150-bed skilled nursing facility on Hawaii State Hospital grounds, to be financed and built by the Utah-based Avalon Health Care Management Inc., has languished in the planning stages for several years. Calls and emails seeking comment from an Avalon executive went unanswered.

The state Department of Health is taking steps to address the situation, but they are not yet equal to the task. In May the department will conduct one of its annual training classes on the care of residents with persistent, severe mental illness. For the first time it will be open to all care home operators instead of only those with E-ARCH licenses.

Janice Okubo, state Department of Health spokeswoman, said the training is intended as an orientation to the issues for regular care home operators, who would have to get the expanded license before taking in referral residents with mental illness. Currently there are only 36 such facilities that can take senior citizens discharged from the state hospital.

Surely this process needs to be accelerated if more capacity is to be built into the state’s elder-care system. Clearly there are numerous care home operators dealing with case-management issues that are way above their heads.

That becomes obvious with each instance that one of them leaves a mentally ill senior in the hospital, abandoning the case. And it can’t be tolerated in a state where residents at least cling to the principle of responsible elder care.