Our Mission
The Hawaii Long Term Care Association (HLTCA) is the full-spectrum professional, political and policy voice for community-based long term care in the State of Hawaii. It is committed to:
- Setting the standard for ministering to the healthcare, emotional, social and spiritual needs of our kupuna, convalescent disabled and infirm;
- Being the most inclusive forum for developing progressive, cooperative approaches and the most effective force for implementing them - through legislative advocacy, professional and community education and regulatory representation;
- Enhancing public understanding that a sound, integrated care continuum affects not only those that we serve but impacts directly and significantly upon the well-being of our community as a whole.
How we provide for Hawaii's kupuna (elderly), chronically ill and convalescent disabled is a measure of the respect and compassion we have for them....a reflection of our dignity as a society.
Long Term Care in Hawaii: Age is the single most important factor in understanding health status and the need and demand for health care resources. For the elderly, there is a clear relationship between age and mortality, prevalence of chronic conditions, and level of disablility. Similarly, the elderly are the heaviest users of health care resources.
Hawaii vs. U.S. Elderly Trend: Until 2000, Hawaii's elderly population, aged 65 and older, was growing at a much faster pace than the nation's elderly population. Since 2008, Hawaii's growth has leveled off. Consider these facts:
- Since statehood, Hawaii's proportion of elderly to total population has increased three-fold, from roughly 5 percent in 1960 to 15 percent in 2008. During this same period, the elderly segment of the nation's population increased by one-third, from 9 percent to 13 percent.
- Between 1990 and 2008, the number of elderly aged 75 and older increased 40 percent nationally compared to a 120 percent increase in Hawaii.
- Average life expectancy of males is 77.5 years and females 83.6 years.
Elderly Trend in the Counties: All counties exprienced signifcant growth (13-15 percent) in their elderly populations since 1970.
Projections: By 2030, the elderly population will represent 20 percent of the populations for each county, the state, and the nation as a whole; that is, one out of every five individuals will be aged 65 or older. In comparison, in 1970, one out of every 17 individuals was aged 65 or older.
As life expectancy increases, it is very evident that there is and will continue to be a need for long term care services in different areas, provided by family, but increasingly, by others, such as health care providers to support our kupuna in the various models of care available.
Long Term Care Options:
The continuum of care provides various venues for the provision of care services, all dependent on the needs, choice, financial capabilities of the individual requiring care and services, and the availability of such services.
Of the myriad of setting available, HLTCA members provide the following, which includes a very critical component of care coordination:
1. Care in own home setting with care provided by:
- Home care services which would include some personal care and chore services (transportation, housekeeping, shopping, etc.)
- Home Health services which would include skilled nursing and/or rehabilitative services (physical, occupational, or speech therapy)
- Hospice service agency providing hospice or end of life care/services.
2. Outside of home assistance for working families or for respite:
- Adult Day Health Care which is an organized day program of therapeutic, social, and health services provided to adults with physical, or mental impairments, or both, which require nursing oversight or care, for the purpose of restoring or maintaining, to the fullest extent possible, their capacity for remaining in the community.
- Adult Day Care services for a person who requires minimal assistance in the activities of daily living and does not need the professional health services of an intermediate, skilled nursing, or acute care facility and needs the oversight and supervision of an organized setting during the hours that the family is not available or at work.
3. Independent Living Retirement Housing:
These complexes are designed for people who are able to live on their own, but want the convenience of a comprehensive service package. Meals, housekeeping, activities, transportation and security are provided to active older adults.
4. Residential settings:
- Adult Residential Care Home (ARCH) provide twenty-four hour living accommodations, for a fee, to adults unrelated to the family, who require at least minimal assistance in the activities of daily living, personal care services, protection, and health care services, but who do not need the professional health services provided in an intermediate, skilled nursing or acute care facility.
- Expanded Adult Residential Care Home means any facility providing twenty-four hour living accommodations, for a fee, to adults unrelated to the family, who require at least minimal assistance in the activities of daily living, personal care services, protection, and health care services, and who may need the professional health services provided in an intermediate care or skilled nursing facility.
5. Assisted Living Facility:
These facilities provide a combination of housing, health care services, and personalized supportive services designed to respond to individual needs, to promote choice, repsonsibility, independence, privacy, dignity, and individuality. Individuals opt to enter into the setting when they are independent and continue to reside in their own unit receiving necessary care and services as determined.
6. Nursing Facility:
- Intermediate care facility provides appropriate care to persons referred by a physician. Such persons are those who:
- Need twenty-four hour a day assistance with the normal activities of daily living;
- Need care provided by licensed nursing personnel and paramedical personnel on a regular, long-term basis, and;
- Do not need skilled nursing or paramedical care twenty-four hours a day.
- Skilled nursing facility provides skilled nursing and related services to individuals whose primary need is for twenty-four hours of skilled nursing care on an extended basis and/or regular rehabilitation services.
7. Hospice:
These services can be provided in-home, at residential or nursing facility or in a hospice setting, which includes a program of palliative and supportive care for terminally ill persons and their families or caregivers.
8. Continuing Care Retirement Communities (CCRC):
These facilities are sometimes called Life Care Communities and they combine all three levels of care -- independent living, assisted living and nursing home care in a single setting. "Aging in Place" is a term often used to describe these facilities. Such communities usually require a sizeable entry fee, plus monthly maintenance fees, in exchange for a living unit, meals and eventual health care coverage to the nursing home level. Services are available on a regular basis, as well as the shared-risk basis of the traditional life care endowment.
Making the Decision:
When asked about their preference for receiving care, most elderly persons answer, "What I would really like to do is to stay on my own home." The person's own home represents security, familiarity and independence. To live at home, one must be able to perform the activities of daily living which includes personal care (toileting, bathing, ambulating, taking own medications, etc.) as well as the ability to drive a car, go shopping, cook, manage finances and do household chores. Many people lose one or more of these abilities as they grow older and may require the assistance of someone to be able to safety live in their own home setting.
Due to a number of reasons, residing safely in one's home may not be feasible and a decision may need to be made to either obtain in-home support and assistance or find a setting that would be safe and provide a home-like environment.
A decision is not easy, and needs to be well coordinated/planned. In many instances, the kupuna or family members do not discuss what may need to be done when the need arises to obtain care, support and health care services for the kupuna. Planning needs to be done to:
- Determine the wishes of the kupuna when and if they are no longer able to make decisions on their own behalf;
- Where would they prefer to be cared for if such services are needed. Map out Plan A, B, C and so forth with different scenarios and situations;
- Look at the finances of the kupuna and what they are able to afford, if they have long term care insurance, if the family is willing and able to supplement the costs. If the elder has limited financial resources, research the options for Medicaid assistance (keeping in mind a 5 year look-behind of finances);
- Look at the various settings ahead of time, so at the time of need, and informed decision can be made if placement is necessary in a health care setting, depending on the needs of the elder; and
- Reach out to credible agencies/resources for information for example: