Directs the executive office on aging to coordinate a statewide system of family caregiver support services and policies. Appropriates funds to provide for the coordination and development of family caregiver support services and to expand the kupuna care services program. (SD1)

A BILL FOR AN ACT

PART I

SECTION 1. The legislature finds that, in recognition of the critical contribution families make to the well-being of older adults who want to remain in their own homes for as long as possible, family caregiver support is a major initiative of the executive office on aging. In Hawaii, such care translates into an estimated $875 million annually in long-term care costs borne by family and informal caregivers.

In recent years, the Older Americans Act has enabled a specific program along with federal dollars for states to support family caregivers. The executive office on aging was awarded $800,000 over a three-year period by the U.S. Administration on Aging and Centers for Medicare and Medicaid Services to establish aging and disability resource centers. The goal of these centers is to create access to a single source of information and assistance for individuals and caregivers navigating the array of long-term care services. Sites will be developed to centralize and streamline access to medicare, medicaid, aging network, disability, and other public and private long-term care resources. The sites also were meant to centralize access for individual and family caregivers.

Furthermore, the executive office on aging executes the caregiver's resource initiative project. The objectives of this project are to:

State policy requires the executive office on aging to be the lead agency to serve all adults sixty years of age and older and their family caregivers. As authorized by the U.S. Administration on Aging and chapter 349, Hawaii Revised Statutes, the executive office on aging is responsible for ensuring information and access to opportunities and services for its constituents.

The legislature further finds that people who need the assistance of family caregivers typically have complex, chronic medical conditions and functional limitations. As a result, they require services from many parts of the medical and long-term care system. Unfortunately, coordination of information and services within each system, and between these systems, rarely occurs. Eligibility requirements, service complexity, and fragmentation are the top barriers to coordinating caregiver support programs with other home and community-based services.

The legislature further finds that family caregivers and their loved ones must have accessible, affordable, readily available, high quality, comprehensive services and policies that are coordinated across all care settings.

The purpose of Part I is to provide for the coordination and development of family caregiver support services and policies statewide.

SECTION 2. Chapter 349, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§349-   Family caregivers; coordination of resources. The executive office on aging shall implement a system to coordinate federal, state, county, and community resources and policies that will sustain family caregiver contributions for long-term care support for families providing elder and grandfamily care by:

SECTION 3. There is appropriated out of the general revenues of the State of Hawaii the sum of $230,000, or so much thereof as may be necessary for fiscal year 2006-2007, for the executive office on aging to coordinate a statewide system of family caregiver support services and policies.

SECTION 4. The sum appropriated in Section 3 shall be expended by the department of health for the purposes of Part I of this Act.

PART II

SECTION 5. On July 1, 1999, the executive office on aging launched its statewide long-term care program called kupuna care. Kupuna care was developed in partnership with the county area agencies-on-aging to address the growing numbers of elders with long-term care needs.

Services provided by kupuna care are intended to help meet the needs of older adults who cannot live at home without adequate help from family or formal services, and includes services such as adult day care, assisted transportation, attendant care, case management, chore, home delivered meals, homemaker, transportation, and personal care.

Kupuna care was designed to assist, not totally support, Hawaii's older adults live independently, safely, and healthy for as long as possible. United States citizens or legal aliens sixty years or older who are not receiving other comparable government assistance, who need help with activities of daily living (eating, dressing, bathing, toileting, transferring, mobility) or because they have reduced mental capacity, and who are not residing in an institution, may qualify for the program.

State funds cover the cost of services for those who cannot afford to pay. Kupuna care offers a reduced rate for those who can afford to pay only a portion of the service. Voluntary donations to the service provider are welcomed for any service provided and are used to support the cost of care of additional clients.

The purpose of Part II is to ensure that this worthwhile program continues to maintain the quality of life of Hawaii's older adults and their family caregivers by appropriating funds to expand kupuna care services.

SECTION 6. There is appropriated out of the general revenues of the State of Hawaii the sum of $500,000, or so much thereof as may be necessary for fiscal year 2006-2007, to expand the kupuna care services program.

SECTION 7. The sum appropriated in Section 6 shall be expended by the executive office on aging for the purposes of Part II of this Act.

PART III

SECTION 8. The legislature finds that families, rather than institutions, are the primary providers of long-term care for older adults in the State. According to the executive office on aging, in 2003 approximately twenty-one per cent of Hawaii's adult population were providing care or assistance to a person age sixty or older, with twenty-nine per cent caring for a parent. Caregivers are motivated to provide care to family members because of their values, the preference of the elderly to remain at home with their families, and the high cost of institutional long-term care.

In Hawaii, the likelihood of becoming a caregiver is similar across different demographic groups and among persons with varied socioeconomic characteristics. Adults of any household income have a similar likelihood of providing care to an elderly person. Married persons in Hawaii are just as likely to provide care to an older adult as their unmarried counterparts.

Among the different ethnic groups in Hawaii, native Hawaiians are most likely to provide regular care to an older adult, followed by Filipinos, Japanese, and Caucasians. Twelve per cent of men and sixteen per cent of women provide care or assistance to someone age sixty or older, according to the executive office on aging. In national studies, women are more likely than men to be primary caregivers, providing higher intensity and frequency of care.

According to the executive office on aging, sixty-five per cent of Hawaii's caregivers are employed. To balance their employment and eldercare roles, working caregivers take leaves of absence, report to work late or leave early, change from full-time to part-time employment, change to less demanding jobs, retire early, or give up work completely. As a consequence, caregiving may reduce a caregiver's retirement income since reduced hours on the job or fewer years in the workforce may mean fewer contributions to pensions, social security, and other retirement savings.

By 2020, more than one in four individuals will be sixty years old or older. The need for personal care due to physical, sensory, cognitive, and self-care disabilities increase with age. As Hawaii's population ages, many more families will be providing higher levels of long-term care to frail and disabled older adults at home.

The purpose of Part III is to provide for the coordination and development of family caregiver support services.

SECTION 9. The executive office on aging shall coordinate a statewide system of caregiver support services by, among other things:

SECTION 10. There is appropriated out of the general revenues of the State of Hawaii the sum of $80,000, or so much thereof as may be necessary for fiscal year 2006-2007, for the executive office on aging to coordinate a statewide system of family caregiver support services.

SECTION 11. The sum appropriated in Section 10 shall be expended by the department of health for the purposes of Part III this Act.

SECTION 12. New statutory material is underscored.

SECTION 13. This Act shall take effect on July 1, 2006.