Couple’s plight demands action

When Hawaii lawmakers really want to get things done, they get things done. Look at the marijuana-dispensary bill approved after the usual internal deadline, or the powdered alcohol ban passed in a gut-and-replace move, or the rail tax hike passed despite fierce public opposition.

So we simply don’t buy that lawmakers did all they could to aid an ailing Windward Oahu couple forced to live apart after 67 years of marriage. Noboru and Elaine Kawamoto, ages 94 and 88, respectively, are separated because state law prohibits two private-pay patients from living in the same community-care foster family home (CCFFH).

The rule is intended to protect impoverished patients, whose bills are paid by taxpayer-funded Medicaid, from being displaced by clients who are paying their own bills, either through insurance or personal resources, and may be more lucrative for the care home.

Although well intended, the rule is also flawed, virtually guaranteeing that some loving, hardworking couples who want to live in the family-style homes will be separated late in life, as has happened at least once before and is happening to the Kawamotos now.

Another dire possibility as the state’s population ages is that more couples will seek to offload their personal assets and get on Medicaid — transferring their bills to the taxpayers — so that they can stay together.

These negative unintended consequences cannot be ignored. Human beings such as the Kawamotos should not be treated as collateral damage in service of an overarching policy protecting Medicaid patients. Suggesting that the Kawamotos move to a different care home that lacks payment restrictions, as the state Department of Health has in the past, is a callous response.

Noboru, a World War II veteran of the 100th Battalion, 442nd Regimental Combat Team, is content in the CCFFH in which he resides in Kaneohe, and wants his wife, Elaine, to move in with him; she lives in a care home in Punaluu. This reasonable request should have been granted, as an exception to the current regulations and as an opportunity to review whether rules regarding care-home residency are fair to all patients.

Our community values and state policies should reward hardworking couples like the Kawamotos who saved and planned for their long-term care, not punish them.

The Kawamotos looked to the state Legislature for relief and got none, despite overcoming DOH’s initial opposition to House Bill 600, which was submitted on their behalf.

The bill, amended over the course of the session to meet the concerns of DOH and others, was deferred in conference committee. It would have granted the DOH flexibility for two years to permit two private-pay individuals to be cared for in the same CCFFH until new rules regulating residency were adopted.

DOH has resisted changing the rules before because CCFFHs were created with access for Medicaid patients in mind; it worries that changing the law could threaten the availability of beds for those patients. It notes that Expanded Adult Residential Care Homes (E-ARCHs) can take multiple private pay patients and provide the same level of care as CCFFHs; this is the option it has promoted for the Kawamotos.

But House Bill 600 rightly recognized that as long-term health care costs continue to rise, even elderly patients who are not on Medicaid have limited options. Many cannot afford private care at their own homes, and do not want to live at a larger institution. Couples like the Kawamotos, who prefer a family-style setting but do need 24-hour care, should not be denied that option. Moreover, the operator of Noboru’s care home assured lawmakers that no Medicaid patient would be displaced.

The Kawamotos were not the first to suffer this fate, and they won’t be the last. They deserve the same rights as impoverished patients to live in the care home that fits them best. Although the Legislature blew its chance to resolve this issue, the Department of Health should move ahead even without a legislative directive. It should take the lead on updating the CCFFH rules, as the bill provided.

Moreover, DOH should seek to act administratively to provide a waiver or exception in the Kawamotos’ case, allowing them to reunite in their preferred care home and live out their lives together. Their plight deserves a humane response, not a bureaucratic barrier.