CIRA de CASTILLOTGI Staff Writer
LIHU’E — Quality of life and allowing for self-reliance is what older adults
and their families say is most important to them when it comes to considering
long term health care options, said John McDermott, state long term care
“In the simplest terms people want care options that are
accessible and affordable,” he said.
As life expectancy is extended, older
adults experience phases of aging. During the first phase, many older people
are healthy and independent .
But as the years go by, seniors generally
begin to notice a diminished capacity that leads into a semi-independent phase.
This may be that they are no longer able to drive, shop and prepare meals for
themselves but are still able to take care of personal hygiene and have no
acute medical needs.
Often a family member or spouse is able to provide
the additional support. If necessary community-based programs are available
providing services to support the existing informal support network.
third phase of aging, dependency begins and the elderly person becomes more
homebound and less able to participate fully in the community, services shift
to the home setting, community based care and long-term residential
Home and Community Based Care
Home Care health services are the
growing trend in elder health care services. Home care services promote,
maintain or restore health and minimize the effects of injury or illness says
Dardanelle Ka’auwai, coordinator for St. Francis Medical Services on
Many older persons don’t require around the clock care in a
hospital or nursing home. For that reason, home care is often an effective,
less costly alternative to hospitalization.
Today services that are
traditionally delivered in a clinic setting are being provided to homebound
Dr. Rand D. Mundo, Kaua’i podiatrist, makes regular visits to
homebound elderly and the care is covered by insurance. Other Kaua’i physicians
who care for the elderly as part of their general practice are returning to a
“country doctor” style of practice.
Dr. Thomas Williamson, with the Ohana
Physicians Group, has several patients who he visits at home. Both doctors say
they do it because the need is there.
The economics that make home care
attractive to insurance providers are that the elder’s food, shelter and
personal expenses are already covered.
Although providing medical services
at home may be costly, it is more practical than institutional care, said Terry
Hill, social worker for Wilcox Hospital.
Hill says even more important to
many older adults is the desire to be at home with their families. While family
members may want to be involved in the care of their loved ones, they may need
On Kaua’i, St. Francis Medical Center has been providing home
skilled health care services for 22 years. The center provides post hospital
care, rehabilitative services or other treatments for a specified period of
Home care is a growing choice for elders and their families said
Ka’auwai who believes the service is under utilized. “Education is the key to
receiving and maximizing the services that are available,” said Ka’auwai.
Home care covers a wide range of services which allow a person to remain
at home despite their infirmity. Skilled nursing services such as inserting
feeding tubes, catheters or breathing devises can now be done at home. In some
cases, physical and occupational therapists provide care for patients at
Transportation to doctor appointments, providing assistance with
dressing or toileting, and sending someone into the home for a few hours just
to give family members caring for an elderly person a break are some of the
kinds of services available.
Frail older adults who are unable to remain
at home alone during the day can receive proper care and attention at Adult Day
Care Centers which expands the ability of many to keep a loved one in a family
One of the newest options in community-based care is the Adult
Residential Care Home. An ARCH is a family home or facility licensed by the
Department of Health. The facilities offer 24-hour living accommodations.
For an older adult who is no longer able to remain at home, there are a number
of alternatives which may be appropriate, depending upon the degree of frailty,
the availability of the alternative, and the extent to which the costs can be
One of the alternatives is the adult residential care homes which
provide live-in, around the clock care for elders who need help with their
daily activities. Most ARCHs are single family residential units.
board, supervision and assistance with activities of daily living such as
personal care, supervision of medication, transportation to medical and dental
offices, and planned activities are usually provided in an ARCH.
be as small as housing 1-5 residents. ARCH generally cost $3,000 per
Mary Marquis, of TIMAO Health Services, a company that handles ARCH
placements, said the idea is to keep the elder within the community.
try to place people as close to their original home as possible, that way
friends and family are able to stay in touch.”
Skilled nursing facilities
like Wilcox Hospital Day Care also offer all day nursing care, health and
social services and provide a place where families can place their elders while
Cost of long-term care
Sometimes, a nursing home is the
best option for an older adult who can no longer be cared for at home.
Intermediate care facilities (ICF) provide skilled nursing care eight hours a
day and other personal and supportive care on a 24 hour basis.
Intermediate care becomes an option when the community-based home care
service becomes impractical or no longer feasible. This type of facility will
cost close to $10,000 a month.
In facing Long Term Care issues what a
family or individual can afford and what is covered by medical insurance
becomes an issue for many.
Medicare is a federal health insurance program
that pays medical bills for almost all people age 65 or older who have worked
under the Social Security system.
Over the years reduction in Medicare
reimbursement has becomes a major issue for older citizens. Because of the
insurance limits many older adults opt to purchase a supplemental policy like
HMSA 65+ provides a gap coverage insurance. The cost is about $65 a
Medicaid is a medical assistance program which pays for medical care
for people receiving welfare benefits and for people with low incomes
regardless of age.
Michael Ratcliffe, county Senior Law Program attorney,
said it’s important for older adults and their families to be informed about
the financial and legal issues related to paying for long-term health care.
The issue of assets and responsibility for payment of long-term health
care can be upsetting for seniors who find that they will have to use all of
their assets to pay for their care.
Many seniors on Kaua’i have really no
other assets than their home, which they had planned to pass on to their
children after their death, said Ratcliffe. But new laws allow for the
government to place liens against the property as a reimbursement for the cost
of long term care.
Ratcliffe said that federal regulations require the
state to recover Medicaid payments from medically institutionalized recipients.
The recovery cost amounts are based on the long-term care expenses, but at
$10,000 a month within a year most all of the home’s assets will be used to
cover the medical care.
A Kalaheo family is still paying on their mother’s
medical bill from extended hospital and rehabilitation care four years ago. The
89-year-old woman had only Medicare insurance and the coverage did not last as
long as the need for service.
Families or older adults who need legal
advise on Long Term Care liabilities should contact the Senior Law Program at
246-0573. The service is free.
The Executive Office on Aging has a very
useful web site that address may issues around long term care at