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Address costs of elder care before coping turns to crisis

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It was sobering news, but not unexpected. Last week an annual survey on long-term care costs showed that the rate in Hawaii is far outpacing the national average. This observation was expected because it simply continues an ongoing trend, but Hawaii families are no better prepared to cope with the reality than they’ve ever been.

Placing an adequate focus on the problem has been difficult in recent years, when state lawmakers struggled to find money to cover even the most immediate needs, let alone an elder-care crisis that looms for the years ahead.

Lawmakers should feel more compelled to confront the issue next session, however, because of work done by the state Long Term Care Commission and its consultant in the past year. The commission will in the next several months review some proposed policy shifts and develop a five-year plan to address the state’s lack of elder-care capacity. The Legislature will consider the first set of initiatives when it reconvenes in January.

Higher-than-average costs occur in every care category. Even if a senior needs only adult day health care and is otherwise self-sufficient, the annual median cost is $16,640. That’s 7 percent higher than the national average.

The more care that’s needed, the worse the situation gets. In-home care, whether for homemaking or health services, costs well above $50,000 a year, about one-quarter to one-third higher than most mainlanders pay. At the top of the long-term care scale are nursing-home costs, which in Hawaii was recorded at about $108,000 for a semiprivate room to more than $122,000 for a private room, which is 54-58 percent above the national median. These are frightening costs.

Relatively few families in Hawaii can factor that into their financial planning. The poorest residents qualify for Medicaid coverage but — as became clear last week with announced cuts in that service — even that safety net is under duress.

Laws passed by the Legislature in 2008 and 2010 created the commission and in March RTI International, consultants hired by the panel, released an overview that included, among many other statistics, the projection that the over-65 age group will grow to 326,957 by 2030. That’s roughly 22 percent of the overall population, compared with the 14 percent segment it now represents. In March, the commission presented an interim report to the Legislature in which it noted that Hawaii has the fastest aging population in the U.S.

Already families are trying to cope by providing home care themselves, but respite and other support services backing up the caregivers are already insufficient. That gap can only widen in the next two decades.

During the interim, guided by the testimony provided in March, the commission will review several policy options that are still seen as viable. They include:

» Create a public-awareness campaign. Many of the stakeholders believe that the public and even the policymakers are unaware of the problem’s scope.

» Expand Kupuna Care, the program for elders who need home- and community-based services but don’t qualify for Medicaid.

» Reconsider CarePlus — a state-run long-term care insurance program that passed the Legislature but was vetoed by Gov. Linda Lingle — and consider private insurance partnerships and income-tax incentives.

It’s too soon to predict how robust the economic recovery will look in January, and some options will depend on budgetary accommodations. But clearly the Legislature needs to give these ideas a full discussion. The needs of a growing elderly population will not go away, and neither will the state’s moral obligation to see that seniors have the support of their own community.

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