Long Term Care for the Elderly in Hawaii Long Term Care Concerns Affect Everyone Few families are untouched by the need to provide care for an aging family member at some time. As the baby boomer generation ages, the demand for services to meet their long term health care needs will become more pressing. Long Term Care Options Are Changing The cornerstone for care in the United States has been the nursing facility. Now that is changing. Institutional care is viewed by some as too costly, too consumptive of scarce public dollars, confining and uncaring. Though newer services are being developed to meet consumer demand for choice, most of the public is not familiar with the options currently available. Many are concerned about the quality of care provided in alternative settings, while others feel the total cost of this care has yet to become clear. Why the Need for Nursing Facilities? Individuals residing in nursing facilities in Hawaii are there because the level of physical and nursing care they need exceeds their families' ability to provide it. The vast majority are the elderly, although some residents in nursing facilities are younger and disabled. Adults with aging parents make every effort to keep them at home, and many offer financial support as well, though this may place a burden on their own family. Frequently, they are employed full time and may not be able to provide help with activities of daily living or the personal care and chore services that are so important to maintaining an individual's sense of well being and independence. When Skilled Care Is Required Often, the aging process is accompanied by chronic conditions, including dementia, or an acute illness, that may necessitate skilled care around the clock. When intensive services are needed, families turn to nursing facilities to provide qualified, competent care including medical, nursing, social work, dietary, rehabilitation therapy, activity and pharmacy services. They look for a nursing home where the quality of care and the quality of life will actively benefit their loved one and comfort the family in their choice. Government programs usually pay for the care in a nursing facility once the person has exhausted their private resources. Adult Residential Care Homes For adults who need only some assistance, custodial care and/or supervisory oversight and whose family is not able to provide it, Hawaii has two types of Adult Residential Care Homes (ARCHs). Smaller, Type I ARCHs care for up to 5 residents in a private home; Type II ARCHs care for 6 or more residents in larger, more institutional like settings. Extended Care ARCHS & Foster Homes Some qualified ARCH operators who meet certain standards are allowed to offer expanded services and accept nursing home level of care residents. Both Medicaid and private sources pay for the care in Expanded Care (EC) ARCHs. In addition, the Adult and Community Care Services Branch of the state Department of Human Services has a Residential Alternatives Community Care Program (RACCP) which places nursing home level residents in foster homes that are qualified and able to meet the person's care needs. As a result, these two programs are beginning to meet the need for Home and Community Based Services (HCBS) in Hawaii. Medicaid pays for these programs. EC-ARCHs and RACCP are able to provide care at lower cost because they do not have the wide variety of skill sets on staff, the overhead of a large building nor the need to adhere to the very stringent regulations, set by the federal government, which sets nursing facilities apart. Assisted Living Facilities Assisted Living Facilities (ALFs) are emerging as another answer to the concern about adequate and affordable long term care services. ALFs are designed for those individuals who are able to live independently if some support services are available. While only a few such facilities have been built in Hawaii to date, some existing retirement facilities are converting a section of their buildings to accommodate those needing assisted living services. ALFs are licensed and regulated by the state, and not by the federal government, as yet. ALFs can be expensive and government funding for assisted living is usually on a very limited basis only. Adult Day Centers & Home Health Agencies Other services such as adult day centers provide both social and skilled care while home health agencies provide skilled, personal and chore services in the person's home. Government funding is limited. The Healthcare Association of Hawaii represents the full spectrum of health care, including acute care hospitals, two thirds of the long term care beds in Hawaii, as well as home care and hospice providers. NURSING FACILITY DATA SOURCES: AHCA's 2001 Facts and Trends: The Nursing Facility Sourcebook; Healthcare Association of Hawaii's Trends for Action 2002; SHPDA's Inpatient Facilities Utilization Report 2001; and the State of Hawaii Data Book 2001. Working together for the health of Hawaii's people since 1939. Home | Acute Care | Long Term Care | Legislative Watch | Members | Emergency Management About HAH | Programs & Publications | News | Calendar | Patient Safety Contact us