‘Silver wave’ about to crash on isle shores

Time marches on, which makes the following a solid prediction: Hawaii’s population age 65 and older will number about 327,000 by 2030, or roughly 22 percent of the overall population. That’s a huge expansion from the 14 percent segment it now represents. Considering that capacity for long-term care is already below current needs, that kind of future is a distressing prospect.

What’s worse is that the entire issue of long-term care is not even on the radar for most people.

Last week AARP Hawaii conducted workshops on its recent survey about long-term care awareness. Close to a third of respondents said they believed Medicare would pay for services, unaware that Medicare covers very little of what long-term care recipients require.

There are no easy answers here, either. On Friday, the Department of Health and Human Services announced it was killing the CLASS Act, a partial insurance scheme aimed at offsetting the costs of long-term care, because it couldn’t be set up as a self-sustaining operation.

Hawaii is in dire need of a consciousness-raising on this issue — and of a new way to define it. Preparedness for an aging population must be understood as a spectrum of conditions and services, not simply the number of beds at institutional nursing homes.

The simple fact is, this state does not have the network of home- and community-based services that would make it possible to "age in place," which is what most seniors prefer.

Lawmakers will be armed this session with additional data that should help them shape new legislation to begin addressing the problem.

The state’s Long Term Care Commission is due to issue a report on possible policy proposals before the Legislature convenes. This panel, as well as advocates in AARP, have some good ideas on changes that could be made, even in a year when fiscal constraints are expected to persist. Among these:

» Hawaii needs to begin directing more of its long-term care funds toward services that can be delivered at home.

Currently almost four of every five dollars are spent on institutional care. For the same amount of money spent on a single nursing-home resident, three people can receive care through home- and community-based services. Further, the federal government offers a cash incentive to states that rebalance their long-term care spending this way, so there’s no reason for delay.

» The state should accelerate the creation of aging and disability resource centers, which are like "one-stop shops" where seniors and their caregivers can come for advice and referrals to helping agencies.

Hawaii County is the first to develop a brick-and-mortar center; more are clearly needed.

» In order to qualify for the federal incentives, the state also needs to create uniform means of assessing services and better case management.

As it is, varied aspects of elder care are scattered among state and county offices, which complicates the task of finding seniors the help they need for home care.

The heavier lift is to persuade more residents — the younger, the better — to set aside money for their own future care. On average, nursing home care mounts up more than $300,000 in bills over three years.

There’s long-term care insurance, but even consumers who can afford that need to proceed carefully, given that some buy more coverage than they’re likely to exhaust, according to industry studies.

Even AARP, which has partnered with providers to sell insurance, acknowledges the need to shop carefully to avoid pitfalls.

The more practical approach at this juncture is for the state to direct more resources toward programs such as Kupuna Care that emphasize lower-cost elder services.

Preparing for the "gray wave" of an aging population must be a paramount concern for Hawaii’s leaders. Collectively sticking our heads in the sand may amount to averting our gaze, but it won’t head off a potential crisis in care.