The Short And Long Of Health Care
Call this column a report from my other life.
On Thursday evenings at 8 p.m. I moderate Insights on PBS Hawaii, an hourlong public affairs program on which we gather four knowledgeable people around a table to discuss an issue of the day.
Sometimes the discussions grow heated – for example, when the topic relates to same-sex marriage or civil unions, super ferries, Furlough Fridays, taxing retirement income, gun control, rail transit, Hawaiian sovereignty, legalized gambling … the list is long.
More often, the discussions educate, or so we hope.
But sometimes Insights both educates and alarms. Such was the case recently, when long-term care was the topic of conversation. The guests included two of the 15-member legislatively mandated long-term care commission, chairman Stuart Ho and economist Paul Brewbaker; Suzanne Chun-Oakland, chairwoman of the Senate Human Services Committee, and Laurie Kaneshiro, an interior designer who quit her job to care for an aging parent and, $40,000 later, was forced to put her mother in a nursing home.
The commission delivered its report to the Legislature in mid-January. Defining long-term care as “helping people unable to perform daily activities, such as getting dressed, bathing, preparing meals or eating, or taking medications, over an extended period of time,” commission members acknowledged that “people of all ages” require long-term care, but they focused their attention on older people.
And well they should. According to AARP, by 2030 an estimated 327,000 Hawaii residents, 22 percent of the Islands’ population, will be 65 or over. The number over 85, who require the most care, will grow by 65 percent. And “approximately 7 in 10 Hawaii residents will need long-term care after they reach 65.”
Commission members concluded that Hawaii is woefully unprepared: “The long-term care system in Hawaii is broken,” reads its report.
“That’s being kind,” says Stuart Ho. “It really isn’t a system at all. We’re dealing with two universes: the Medicaid patients who’ve run out of their own funds and have $600 million in federal and state help available. They make up 25,000 out of a population of 1.4 million. Then there’s the rest of us, 85 percent of the population who are on our own.”
Most don’t realize it. According to an AARP survey, 29 percent of its members think Medicare will take care of long-term care. It won’t, and a year in a Hawaii nursing home averages more than $110,000, by far the highest in the nation. The cost of a private home health aide in Hawaii runs $58,000 per year, one-third higher than in the rest of the country.
The commission’s recommendations include “a long-term care education and awareness campaign” and “a limited, mandatory public long-term care insurance program.”
Says Chairman Ho: “Our aging population needs an appreciation of the risk they take without some long-term care insurance. The odds of their needing long-term care are far greater than that their house will burn down or their automobile will be totaled, yet they willingly buy insurance for those eventualities.”
Such insurance won’t come cheap.
“Acute care medical insurance has economies of scale,” says economist Brewbaker. “Eighty-five percent of us buy it. Fewer economies of scale exist for long-term care insurance.”
For the time being, Chun-Oakland sees a bill for a task force to study public long-term insurance making it through the Legislature – and Medicaid funds dwindling: “We had to cut $75 million in Medicaid, and the federal government cut us $35 million more.”
Laurie Kaneshiro feels that, more than anything, families need “help in going through the long-term health care system,” or what there is of one. The commission heard her; its report recommends “strengthening aging and disability resource centers and expanding their role.”
