‘Silver wave’ about to hit shore

By now, most people likely have heard about the "silver wave" that is due to wash over Hawaii. Alternately, they are at least aware that the aging of the large baby boom generation is going to leave a huge imprint on society, not the least of which concerns its care. Lawmakers and policymakers have talked about it a lot, as anyone tracking activity at the state Capitol would confirm.

It’s time to move past the talking stage, however, in preparing the community to accommodate the long-term care of seniors in some way that their families — and the taxpayers underwriting social programs — can afford.

Above all, this will require a more flexible approach for federally subsidized services aimed at seniors, an approach that will allow more at-home care that can make more efficient use of limited tax dollars.

The spectrum of senior care starts for most families with the basic responsibility of checking in with elders who live independently, something most family members can handle readily.

But ask almost any of these adult children of seniors and they’ll attest that the costs and responsibilities can escalate suddenly as an elder’s health declines and becomes overwhelming. And few are prepared for the issues they’ll confront at the far end of the continuum, with decisions over end-of-life care.

Almost everybody needs help with all this, but help is hard to find. Skilled nursing costs are astronomical, and bed space in Hawaii facilities are insufficient for even the population that might afford it. Almost all of those who can’t would prefer to "age in place" in their own home or that of a family member, in any case.

The problem is that there is little being done to support family members on the path toward home care of their senior citizens.

Among those sounding the alarm bells this week has been Jeannine English, the national president of the AARP who was making the rounds on Oahu, talking about the nonprofit group’s caregiving survey.

The main takeaway from the data is that the number of Hawaii residents over 65 potentially in need of care will far outpace the number of potential caregivers by 2030. The gap actually starts to open sometime after the first term of the state’s next governor, said AARP officials, which is why they are putting pressure on gubernatorial candidates to develop an aggressive policy for dealing with the issue.

There is already at least a start down this road with the efforts of a state working group that is due shortly to release a report on licensed home- and community-based adult homes.

The oversight of these homes was transferred in July from the state Department of Human Services to the state Health Department, which also regulates skilled nursing homes and other adult care facilities.

These would be eligible for Medicaid dollars under a waiver program that federal regulations allow, but there are some rules guiding licensure, including requirements that the primary caregiver is a certified nurse aide.

Necessary as these standards are, there needs to be some preparation for family members who lack even this credential. Part of the discussion of the pending working group report needs to center on how the community can support family caregivers at all stages of providing elder care, with training programs that are easily accessible.

The next state administration also should grapple with the issue of private financing, such as insurance and health savings plans, since many middle-class families will need to pay for respite care and won’t qualify for Medicaid.

Finally, Hawaii residents need to be educated about hospice care and other end-of-life programs. A video production support- ed by the Hawaii Medical Service Association, being distributed to hospitals and hospices, represents an advance in the right direction.

Understandably, families in this high-cost state are occupied with the rigors of work and other concerns, making it tempting to postpone planning for senior care.

But the demographic realities of a large aging population must shift this issue to the front burner for island households — and for those seeking election as Hawaii’s leaders.