Long-Term Healthcare in Dire Straits?

Most Hawaii residents are dissatisfied with the state of long-term-care services.

Even with all the national media attention on healthcare, long-term healthcare is seldom discussed. “It’s the stepchild of healthcare, but it’s so important,” says Susan Reinhard, the senior vice president of the AARP Public Policy Institute in Washington, D.C.

That doesn’t mean people aren’t worried. According to the AARP’s 2008 Hawaii Health and Long-Term-Care Survey, 44 percent of respondents feel that health and long-term-care in Hawaii is in a state of crisis.

“With our aging population and the high longevity of our population, we can say that we’re first in the country to be facing this problem,” states Barbara Stanton, AARP state director. On top of an already high cost of living, Hawaii’s nursing homes are also more expensive than the national average. So much so, in fact, that the state distributes 83 percent of its Medicaid spending to nursing-home residents, leaving only 17 percent for home-care services. 

This runs contrary to what most people want. The survey found that most people would prefer to age in their homes. But because there is a shortage of streamlined community and home services—providing a level of care somewhere between hospitals and nursing homes—most are forced to go into a nursing home, even if they don’t want or need to be there.

“You could walk around a nursing home and find at least 10 percent, probably 20 percent, of the people could be elsewhere if they had services. Sometimes they needed that level of care when they came in, but they got better,” says Reinhard. She adds that many nursing-home patients have no other options and have already spent all of their assets on nursing-home care.  

On any given day, there are approximately 200 people waiting to be admitted into a nursing home in Hawaii. There is such a shortage that elderly patients have no other choice but to remain in hospitals longer because there are no post-hospital, long-term-care facilities available.

There are long-term-care services outside of nursing homes in Hawaii, but the state lacks a comprehensive and user-friendly long-term-care plan. “It’s a little more complicated to stay at home than to go to a nursing home, because you have to put all those pieces together,” says Reinhard. “Hawaii needs to make that easier.”

Stanton says that various organizations have convened at the Legislature for long-term-care funding, but many bills have died or been vetoed. However, this past session a Senate bill was enacted that will create a long-term-care commission. The commission, set to receive $100,000 in funding, will consist of members appointed by both chambers of the Legislature and Gov. Linda Lingle, and will assess the state’s long-term-care programs and problem areas, and produce a revised plan.

Laura Manis, a long-time activist and legislative chair of the Kokua Council—a citizen advocacy organization for senior citizens—says that the answer to the long-term-care crisis in Hawaii is for the state to come up with a better financial program that will cover everyone, healthy or sick, rich or poor.

Although her long-term-care proposals have been turned down by the Legislature for years, Manis hasn’t given up yet. “I’m still hopeful it will change, we need it to,” she says. “No matter what you plan for, you’re going to need long-term-care.”