Vulnerable elders need access to foster care

Married couples deserve the benefits of mutual support, especially as they age.

After being together for many years, couples may have a deep understanding of each other’s needs and preferences. At a time when their support is most critical, no one likes the idea of having married couples live separately from each other.

Hawaii’s legislators and government agencies are currently facing this very dilemma: A wife is in a community care foster family home, paying for her care out of her own pocket or through private insurance, also known as "private pay." In the meantime, her husband, who would like to join her in the foster home, is unable to because the law prohibits foster care homes from having another private-pay resident.

Under the current law, community care foster family homes are, by definition, licensed for no more than two adults at any one time, and at least one of the adults must be a Medicaid recipient. The statute allows the Hawaii Department of Health to certify a home for a third adult who is at the nursing facility level and a Medicaid recipient. This means that a three-person home must have at least two Med-QUEST residents with one private pay resident.

Without changing the intent of existing laws, we can simply amend them by granting the Department of Health the discretion to allow the third person to be a private-pay resident, on a case-by-case basis, to accommodate married couples, siblings or a parent and child to live in the same community care foster family home. These relationships must be quantifiable and verifiable through documents such as birth certificates or marriage licenses.

As a way to ensure ongoing access to care for Medicaid residents, the second private-pay bed would automatically revert back to a Medicaid bed once the private-pay bed is no longer being used by the private-pay family member.

This would better preserve the intent of the community care foster family home program, which was designed to protect the most vulnerable, aging adults in our community by offering a lower-cost alternative to institutional settings such as skilled nursing facilities.

Under current law, low-income, older adults who qualify for Medicaid have a better chance of finding a suitable home-like setting when living independently is no longer possible. It also allows state government to be better stewards of taxpayers’ money by reducing the amount of money that Medicaid must pay to ensure that aging adults have access to the care they need.

Care home operators would naturally prefer to serve only private-pay residents since they would be able to command higher payments in comparison to what is charged to Medicaid recipients.

If a community care foster family home truly desires to accommodate married couples who are both private pay, they should seriously consider being licensed as an expanded adult residential care home, or E-ARCH. This would allow two or more private-pay residents. The majority of E-ARCH residents are private-pay clients and this translates into greater revenue for these operators. However, it is important to note the requirements for certification for an E-ARCH are more stringent because they typically have more residents, including residents who require care at nursing levels.

The Department of Health’s licensure programs are intended to ensure patient safety and quality of care, while also making prudent use of Medicaid funds.

As a state, we must make policy decisions with a long-term view to address the needs of our growing elderly population, but we can also act prudently and compassionately to meet the needs of specific individuals by exercising discretion and flexibility.