Make coping with elder care a top priority

One of Hawaii’s vaunted family values — care of elders — will be put to the test of fire in the coming years, as the state’s already large senior population continues to grow.

The challenge of caring for aging loved ones intensifies when they are diagnosed with Alzheimer’s Disease and Related Dementias (ADRD), and such diagnoses are very typical as the years tick by. Alzheimer’s is by far the most common of these cognitive and functional disorders, accounting for 60-80 percent of dementia cases in the U.S.

In a state with a sizable senior population such as Hawaii, planning for the looming public health burdens is crucial. So the release of "Hawaii 2025: State Plan on Alzheimer’s Disease and Related Dementias" should give lawmakers and those directing state policy the impetus needed to get coping strategies in place.

Indeed, the two main Democratic candidates for governor — Neil Abercrombie and David Ige — recognized this issue in their campaign action plans, stressing the need to create a network of Aging and Disability Resource Centers in each county for people to access information on long-term care and support. Heading into the general election, the gubernatorial candidates of all political parties will need to articulate fully their strategies for this growing problem.

The statistics are alarming. By the end of the 2010-2015 period, the Hawaii population over 65 will have increased by 67 percent. As the seniors age, the risk of dementia also increases, doubling every five years after age 65.

Hawaii’s senior citizens have the highest average life expectancy in the nation — 86.3 years, according to the Centers for Disease Control. It’s not surprising, then, that the census of those afflicted is already daunting: 27,000 cases of dementia diagnosed in 2010, a number expected to top 34,000 by 2025.

The easiest repercussion to project is financial, given that the average per-person Medicare cost for those with ADRD is three times higher than for those without the disease. Those of lesser means put a heavier burden on government coffers, with the average per-person Medicaid spending among the dementia sufferers 19 times higher than for other seniors.

But the bolstering of community support systems for caregivers, especially family members who are under tremendous stress, is crucial. Those caring for dementia sufferers do so for a longer-than-average period — and they need support and information made available at the community level.

The next legislative session must include a review of this plan and legislation to begin implementing it — especially the support system for caregivers.

"The path to high-quality care and a dementia-capable community and infrastructure must also start with a one-stop resource for anyone needing help — a ‘no wrong door’ for professionals and the general public that leads to effective options and advice," according to the plan’s report, issued by the Executive Office on Aging and the state Department of Health.

Navigating the government and medical obstacle course that caregivers confront is a difficult task, and the neophyte needs guidance.

This support should include, as the plan recommends, better education and training for family caregivers, both from the health-care providers and the government agencies that oversee them.

Additionally, the plan correctly notes the need for better workforce development for professionals with the skills to provide the high-quality care for those with dementia; the expansion of educational programs in nursing professions, at the University of Hawaii-West Oahu and elsewhere, is a promising development.

The plan’s first listed goal is a hopeful one: to prevent and effectively treat Alzheimer’s disease by 2025. This will require the development of a Hawaii research consortium, according to the plan, and it is rational that a state with such a large elder population should be in the front ranks of a research campaign.

However, the reality is that, given the costs that are rising along with the ADRD population, most patients will be, for much of the time at least, the responsibility of family caregivers. Strengthening the support system is key: The same health care infrastructure that supports them will help the elder population, and their caregivers.

Finding ways to prepare families for the daunting task ahead, and support for those now coping with it, should rank among Hawaii’s highest priorities.