An Overview of Long-Term Care in Hawaii

1 March 2011. An Overview of Long-Term care in Hawaii Final Report Prepared for Hawaii Long-Term care Commission 2424 Maile Way Saunders 723. Honolulu, HI 96822. Prepared by Janet O'Keeffe, RN, DrPH. Joshua M. Wiener, PhD. RTI International 701 13th Street, NW. Suite 750. Washington, DC 20005. RTI Project Number Table of Contents Long-Term care Services and Funding in Hawaii .. 1 Introduction .. 1 Demographic Characteristics of Older People .. 2 Long-Term care Services .. 3 Nursing Homes .. 3 Residential care Homes/Facilities .. 5 State Supplemental Payments .. 8 Adult Day care and Adult Day Health Centers .. 8 Case Management Services .. 9 Licensed Nursing Services.

2 9 Nurse Aides, Home Health Aides, Personal Assistants/Personal care Aides .. 9 Homemakers, Companions, and Attendants .. 10 Other Home and Community-Based Services .. 10 Public Funding for Long-Term care Services .. 10 Medicaid .. 11 QUEST Expanded Access .. 13 Programs of All-inclusive care for the Elderly .. 15 Medicaid Home and Community-Based Services (HCBS) Waiver Programs .. 15 HIV/AIDS Community care Waiver Program .. 16 Medically Fragile Community care Waiver Program .. 16 State Programs .. 17 Department of Human Services .. 17 Chore Services for Community Long-Term care Program .. 17 Senior Companion 17 Department of Health, Executive Office on Aging.

3 17 Kupuna care .. 17 Administration on Aging-funded Programs .. 18 Aging and Disability Resource Center .. 19 Adult Mental Health Division, Department of Health .. 20 Developmental Disabilities System .. 21 Intermediate care Facilities for Persons With Intellectual Disabilities .. 21 Residential care Settings for Persons With Developmental Disabilities .. 22 Developmentally Disabled Medicaid Home and Community-Based Services Waiver Program .. 22 Summary .. 23 i List of Exhibits Exhibit 1. What Is Long-Term care ? .. 1 Exhibit 2. Elderly Population in Hawaii , 2007 and 2030 .. 2 Exhibit 3. Estimated Number of People Requiring Long-Term care , 2007.

4 2 Exhibit 4. Nursing Home Beds per 1,000 Persons Aged 75 and Older, Hawaii and , 1997 to 2009 .. 4 Exhibit 5. Nursing Home Resident Payment Sources, 1997 2010 .. 5 Exhibit 6. Monthly Supplemental Security Income Payment Amounts in Hawaii , 2010 .. 8 Exhibit 7. Cost of Private-Pay Long-Term care Services in Hawaii , 2010 .. 10 Exhibit 8. Medicaid Long-Term care Expenditures for Older People and Younger Persons With Physical Disabilities in Hawaii , by Service, 11 Exhibit 9. Percent of Medicaid Long-Term care Expenditures for Older People and Younger Persons With Physical Disabilities for Home and Community-Based Services, 1995 to 2008 .. 12 Exhibit 10.

5 Medicaid Home and Community-Based Services Expenditures per 1,000. People Aged 75 and Over, 1997 to 2008 .. 13 ii Long-Term care Services and Funding in Hawaii Introduction This report provides a primer or Overview of Long-Term care services in Hawaii and the public programs that pay for those services. It aims to provide a basic understanding the state of long - term care in Hawaii . It relies mostly on publicly available information, which is limited. Exhibit 1 defines Long-Term care . Long-Term care services for persons with serious mental illness are discussed only in passing in this Overview . Like every other state, Hawaii has a range of Long-Term care services.

6 Although these services could be considered to make up a state Long-Term care system, with few exceptions they are standalone services and are not integrated into a coherent whole. Exhibit 1. What Is Long-Term care ? Long-Term care includes a wide range of services and supports: Assistance with activities of daily living (ADLs). ADLs include eating, bathing, dressing, transferring from bed to chair, controlling bowel and bladder function, and moving about the house safely. Assistance with instrumental activities of daily living (IADLs). IADLs include preparing meals, shopping for food and personal items, managing medications, managing money, using telephones, doing housework, and using public transportation.

7 Assistance with other activities needed to maintain community living, such as heavy chores. Supervision to safeguard health and safety. Skilled and unskilled nursing services and rehabilitation services such as physical and occupational therapy to maintain or improve functioning. A range of other services and supports needed to function in community settings, such as habilitation and supported employment for persons with developmental disabilities or serious mental illness. The first section of this report provides basic information on the size of the elderly population in Hawaii and how it is projected to increase in the future. It also includes an estimate of the number of people who need Long-Term care .

8 The second section describes the types of Long-Term care services available in Hawaii . The third section describes the public programs that pay for these services for some individuals under certain circumstances, primarily those with low income and few assets. The fourth section of this report very briefly describes the developmental disabilities services system. Finally, the report concludes with a brief summary of the Long-Term care system in Hawaii . 1. Demographic Characteristics of Older People The elderly population in Hawaii is projected to increase significantly over the next two decades (Exhibit 2).1 The increase in the population aged 65 and older and particularly people aged 85.

9 And older will lead to an increase in the number of people needing Long-Term care because older people have a higher prevalence of disability than younger people. Exhibit 2. Elderly Population in Hawaii , 2007 and 2030. Population 2007 2030. Total Population 65+ 185,622 326,957. Percent of Overall Population Total Population 85+ 26,294 48,254. Percent of Overall Population Source: American Health care Association. (2010). The state Long-Term health care sector, characteristics, utilization, and government funding: 2010 update. Washington, DC: American Health care Association. Available at Accessed December 19, 2010. Adjusting earlier estimates of the number of people with disabilities in Hawaii , Nixon estimated that there were 21,789 people needing Long-Term care in Hawaii in 2007 (Exhibit 3).

10 2 The criteria for needing Long-Term care were that individuals had (1) two or more ADL limitations lasting 90 days or more or (2) a cognitive impairment (including Alzheimer's and senility). Exhibit 3. Estimated Number of People Requiring Long-Term care in Hawaii , 2007. Total Persons Requiring Percent of Population Age Total Population Long-Term care in Age Requiring Long-Term Range in Age Range Range care in Age Range 25+ 783,372 21,789 25 64 639,597 5,097 65+ 143,775 16,692 Source: Nixon, D. (2009). Long-Term care population. Unpublished Memorandum. Honolulu: University of Hawaii at Manoa. 1. American Health care Association. (2010). The state Long-Term health care sector, characteristics, utilization, and government funding: 2010 update.