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The Honolulu Advertiser
Posted on: Sunday, March 5, 2006

COMMENTARY
Elder care is Hawai'i's looming crisis

By Rep. Anne V. Stevens

FOR MORE INFORMATION

For information, support and referrals regarding people with Alzheimer's disease or dementia, contact these organizations:

  • The Alzheimer's Foundation of America: (866) 232-8484 www.alzfdn.org

  • The Alzheimer's Association: (800) 272-3900 www.alz.org

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    Our parents gave us life. They nurtured us throughout our development from infancy through to adulthood, self-responsibility and self-reliance.

    As adults, we may find ourselves in the role of parenting new and unexpected children ... our mothers or fathers.

    I am caring for my mother, now in her early 80s. In November 2002, she was diagnosed with chronic progressive dementia; Alzheimer's disease. I will likely care for her for many more years. A person with Alzheimer's disease lives from eight to 20 years beyond the diagnosis.

    My mother displayed many of the classic characteristics of this dreadful disease, beginning with memory loss and child-like patterns of inappropriate behavior: unreasoning fear, hiding things, losing things and — most worrying to me — wandering.

    One morning, when I was about to hop in the shower before leaving for work, I told my mom it was her birthday and a large parcel was waiting for her downstairs with the security guard at our condominium.

    I told her to go to the lobby and get her gift while I took my shower. There was no sign of her when I had finished my shower. She had retrieved her parcel in the lobby but instead of returning, she left the building. Fortunately, the doorman spotted her and was able to get her back on track. We found the parcel on the sidewalk, where she had left it.

    Because of my experience in caring for my mother, I want to share my story so that others can be better prepared when their parent becomes their children.

    Up to 70 percent of people with Alzheimer's disease will wander and may become lost, especially during the later stages of the disease. Of those who become lost, 50 percent will die if not found within 24 hours. Continual supervision, sometimes even round-the-clock, is essential.

    As my mother's disease progressed, there were increasing incidents of disorientation, minor combativeness and depression. Last year, she tried to commit suicide by jumping off our 10th-floor balcony. Clearly, it was time to seek full-time supervision.

    At some point, you may need to become, as I did, the financial guardian of your parent. When caring for an elder who is chronically ill, you must be vigilant about expenses and the resources available to pay for their care. Expenses are for both medical care and "social" care, which is the daily care and social interaction necessary when caring for someone who cannot care for themselves.

    The patient's own resources may not cover all expenses. And the caregiver may not be able to maintain a job outside the home, considering the amount of elder care that is required of them.

    Parents normally prefer to take care of themselves financially, and they usually don't want their adult children to be involved in their affairs. But as they grow older, chances are that they eventually will need some help.

    Adult children should discuss this matter with their parents while the parents are still rational. Assess their available financial resources, both income and savings. Make sure the parent is getting the proper Medicare or Medicaid coverage as allowed by law. Check Social Security payments and keep track of all paperwork pertaining to health-insurance claims and prescriptions. Check over all health insurance explanations of benefits when claims are paid or refused.

    This is not just a critical health issue — it's a critical social issue. Entire families may be affected by the psychological, financial and social costs of providing a parent with long-term care. As their dependency increases, caregivers frequently must reduce their work hours, adjust or abandon career or personal goals, and may need to retire earlier than intended, compromising their own financial independence.

    There is a looming crisis.

    One-fifth of the state's adult population is 60 years and older. By 2020, this category will account for more than 25 percent of Hawai'i's adult population. Nearly one-third of this population group is expected to have functional disabilities.

    Then there are the mounting costs. When nursing-home care is required, Hawai'i's families are burdened with annual charges they are unable to afford. In the case of elderly families, these charges are sometimes double their average annual disposable income. Not only are home, community-based care and nursing-home beds currently below requisite levels, the annual average cost for nursing-home care is estimated eventually to exceed $200,000 per person. And this is only one component of an array of long-term-care services.

    As a state representative with a dependent parent, I have a deep personal concern about long-term elder care. It can be horrendously expensive — particularly for nursing-home care as the estimate above indicates.

    In my mother's case, her standard long-term-care policy, at a base annual premium of almost $3,000, is limited to a maximum benefit amount of around $70,000. This provides $100 per day, each, for long-term and respite-care benefits, and a care advisory services benefit of $1,000 per year.

    As my mother's condition deteriorates, this presently affordable policy will quickly become inadequate. Our state government is particularly concerned about this impending long-term health crisis. The opening statement of House Bill No. 3129 states: "The Legislature finds that the future of long-term care for Hawai'i's senior and adult disabled population is one of the most critical health issues facing Hawai'i in the twenty-first century."

    At the direction of the governor, the state Department of Health has established a long-term-care task force comprising the departments of health, taxation, commerce and consumer affairs — combined with people in the long-term-care insurance industry and health care sector. Working together, these governmental departments will be required to submit a report annually to the Legislature addressing the status of this act's provisions.

    The purpose of the bill is to provide a tax credit to individual taxpayers and employers for premiums paid for long-term-care insurance contracts. Lawmakers need to support this bill so all of us can afford to care for the ones we love in their time of need.

    State Rep. Anne V. Stevens, R-23rd (Waikiki, Ala Moana, Kaka'ako), wrote this commentary for The Advertiser.