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Aging (with dignity?) in Hawaii

The stressful, anxiety-provoking topics of aging, adaption and change

We as a species have always grown old and died, so why is such a time-tested scenario becoming so difficult for our society to address?

Today’s average caregiver, according to Colette Browne from the Center on Aging at the University of Hawaii, is a 57 year-old woman who is struggling to provide care to an elder while still working and raising her own children.

Families are increasingly burdened because “care for seniors is ridiculously expensive,” says Scott Spallina, Deputy Prosecuting attorney supervising Hawaii’s Elder Abuse Justice Unit. The average home-care aide agency charges $22 an hour, while senior living facilities with assisted care can run over $120,000 a year. At the same time, availability of low-income housing for seniors and the disabled may be reduced, many fear, if already-limited Section 8 housing units become privatized. “The state doesn’t want to be in the property management business,” Spallina says, “and there’s anxiety right now.”

With Medicaid and Medicare on the chopping block, along with many other social welfare programs, the anxiety goes well beyond affordable housing. Spending has decreased over the last few years, meaning income and sales taxes are no longer dependable sources for funds allocated to provide benefits for an aging population. The 2011 fiscal year saw a $25 million cut to Medicaid, followed by Abercrombie’s proposed $50 million in additional cuts for 2012. This past March, the governor also proposed taxing the pension funds of some retirees.

Currently, about 52,000 seniors in Hawaii rely on Medicaid to get by, but “Medicare does not pay for long-term care,” says Laurie San Nicolas, office manager for Kokua Nurses, a private organization that offers home health care services and private duty nursing to residents on Oahu and in Hilo.

According to Lei Shimizu, information and assistance coordinator at Hawaii’s Committee on Aging, “Many states on the mainland have better services than we do… They have full-service homecare attendants, and we don’t have programs like that.” Part of the problem, she adds, is that funding has remained flat over the past decade despite a rise in demand due to an ever-growing population. “[The state] has felt a financial punch,” Shimizu says.

Because expenses can be a determining factor when deciding how to care for aging loved ones, some leave their jobs to pursue home care rather than hire home care attendants. In addition, the alternative of institutionalization is, for many, disheartening. According to Karen Koles of Eldercare Hawaii, a community of individuals and agencies committed to eldercare planning and support, those who are put in a care facility usually die within two years due to depression or exposure to germs in an enclosed population. Seniors who remain at home can expect to live for another decade. According to the Family Caregiver Alliance, individuals who stay at home to care for their disabled parents make up for an estimated $200 billion in caregiver services annually.

“We live in a society where it is becoming more and more acceptable to warehouse our seniors and forget about them,” Spallina says. “There are resources out there, but they are scattered. There are four-star luxury retirement homes with excessive amenities, but most people can’t afford those services even in a good economy.”

As of 2010, the prosecutor’s office saw a 110 percent increase (from 2008) in elder abuse cases, ranging from fraud and theft to physical abuse. “Every year we get more and more cases,” Spallina says. “We aren’t even scratching the surface.”

Spallina says he thinks the increase is associated with a lack of resources for those who are overwhelmed by and undereducated about senior care. More often than not, he says, one sibling within a family ends up caring for the aging parent or parents, but the law doesn’t grant them any special portion of their parents’ estates.

“Sometimes people’s siblings will not contribute time or money…They won’t offer anything, but as soon as the father or mother dies everyone wants in [on the estate],” says Koles. “Families break up over that.”

Attempts to provide incentive for family members to care for their elders include a $1,000 tax credit proposed by UH’s Public Policy Center, but that was shot down because it was seen as an opportunity [for some] to collect while neglecting their elders.

Other homecare costs include home renovations to make homes wheelchair friendly and the installation of hospital beds, Shimizu says. Adding to renovation, medical and caregiver costs, the cost of living on Oahu, which is home to 73 percent of the state’s residents who are 60 and older, is higher than on the other islands.

“A lot of people think of caregivers as the young taking care of the old,” Spallina says. “That’s not true. These are [often] husbands taking care of their wives, or vice versa.” The problem, he emphasizes, is that those who suddenly find themselves thrust into the role of caretaker “don’t get training…in regards to how to move somebody, or how to hold somebody who [can’t control him or herself].

As one resident of Hawaii who found herself caring for her father who is suffering from dementia wrote on a chat board, “I am doing nothing short of a miracle, and I have to say, I will be needing more miracles to come my way.”