SB1916 HD3

PART I

JOINT LEGISLATIVE COMMITTEE ON FAMILY CAREGIVING

SECTION 1. The legislature finds that, due to a shortage of care providers in Hawaii, family caregiving has become a critical element of our healthcare and long-term care systems. By 2020, more than one in four individuals is expected to be sixty years old or older. The need for personal care assistance due to physical, sensory, cognitive, and self-care disabilities increases 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.

A comprehensive public policy to strengthen support for family caregivers is essential. The joint legislative committee on family caregiving was established under Act 285, Session Laws of Hawaii 2006, to develop a comprehensive public policy to strengthen support for family caregivers in Hawaii.

The committee held numerous meetings during the fall of 2006 and submitted a special committee report to the legislature outlining its proposal for the establishment of a comprehensive, sustainable, community-based family caregiver support system that will maximize resources in all communities. However, more information must be gathered on this subject to enable the State to apply resources and services in a more efficacious manner. The committee should continue its work on its proposal for the establishment of a comprehensive, sustainable, community-based family caregiver support system.

A crucial element in the design and implementation of a comprehensive, sustainable, community-based family caregiver support system is an assessment of the needs of family caregivers and the care recipients. A thorough needs assessment is imperative to appropriately encourage, support, and strengthen family caregiving.

Family caregivers who provide care to recipients with chronic or disabling conditions are themselves at risk for physical, emotional, and financial problems. The daily challenges and health risks that a family caregiver faces can impede the family caregiver's ability to provide care, lead to higher healthcare costs, and affect the family caregiver's quality of life and the quality of life of the care recipient.

For many, their role as family caregiver arises as suddenly as the care recipient's health declines, leaving the family caregiver with an immediate need for services but little preparation or knowledge regarding who to contact for assistance or what services are available to them. Family caregivers themselves need support services, including respite services and training, education, and counseling, in areas such as caregiving and dealing with end-of-life issues.

Kupuna care is a statewide long-term care program, administered by the executive office on aging, which was developed in partnership with the county-area agencies on aging to address the growing number 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 caregiving services, and include services such as adult day care, respite care, assisted transportation, attendant care, case management, homemaker services, home delivered meals, transportation, and personal care.

In addition to the services provided to the elderly, the family caregiver support program, also administered by the executive office on aging, offers services for the family caregivers of their elderly clients. This program can be expanded to provide additional services to family caregivers to educate and assist them in coping with their roles as a caregiver.

The purpose of this part is to strengthen support of family caregiving by:

(1) Authorizing the joint legislative committee on family caregiving to continue its work until June 30, 2008;

(2) Adding an additional responsibility for the joint legislative committee to explore establishing a paid family leave program under the state temporary disability insurance law; and

(3) Providing a broader definition of "family caregiver".

SECTION 2. Act 285, Session Laws of Hawaii 2006, is amended by amending section 2 to read as follows:

"SECTION 2. (a) There is established a joint legislative committee on family caregiving. The committee shall be composed of eight members as follows:

(1) Four members of the house of representatives, consisting of three members from the majority party and one member from the minority party, who shall be appointed by the speaker of the house of representatives; and

(2) Four members of the senate, consisting of three members from the majority party and one member from the minority party, who shall be appointed by the president of the senate.

The committee shall select a chairperson from its membership.

(b) The joint legislative committee shall develop comprehensive public policy to strengthen support for family caregivers [~~who provide unpaid, informal assistance to persons age sixty and older with physical or cognitive disabilities~~]. For purposes of this Act, "family caregiver" means:

(1) A person, including a non-relative such as a friend or neighbor, who provides unpaid, informal assistance to a person age sixty and older with physical or cognitive disabilities; and

(2) A grandparent who is a caregiver for a grandchild who is age eighteen years or younger or who is nineteen years of age or older with physical or cognitive limitations."

(1) Consider providing support in categories, including [~~but not limited to~~]:

[~~(1)~~] (A) Coordinated services and policies;

[~~(2)~~] (B) Training and education;

[~~(3)~~] (C) Respite services;

[~~(4)~~] (D) Financial incentives; and

[~~(5)~~] (E) Balancing work and caregiving[.];

and

(2) Explore establishing a paid family leave program under the state temporary disability insurance law, similar to the California Paid Family Leave Program, to provide wage replacement benefits to employees who take time off from work to care for a seriously ill family member.

(d) The joint legislative committee shall seek input from the department of health, the department of human services, the department of taxation, the University of Hawaii, the executive office on aging, and the elderly, disability, business, and faith-based communities.

(e) The joint legislative committee shall submit its findings and recommendations to the legislature no later than twenty days prior to the convening of the regular [~~session~~] sessions of 2007[.] and 2008.

(f) The joint legislative committee shall cease to exist on [~~June 30, 2007.~~] June 30, 2008."

PART II

NEEDS ASSESSMENT

SECTION 3. (a) The executive office on aging shall conduct a comprehensive assessment of the needs of care recipients who are age sixty and older with physical or cognitive disabilities and the needs of their family caregivers. The needs assessment shall include an evaluation of:

(1) The extent of the unmet caregiving needs of persons age sixty and older with physical or cognitive disabilities;

(2) The size of the current family caregiver population;

(3) The percentage of care recipients' needs being met by paid versus unpaid caregivers; and

(4) The impact of caregiving on family caregivers' employment and income.

(b) In conducting the needs assessment, the executive office on aging shall identify and review past surveys, such as the 2003 Hawaii Health Survey, include focus groups, and develop policy questions to guide the focus of the needs assessment.

(c) In conducting the needs assessment, the executive office on aging may use telephone surveys or other methods of gathering reliable data regarding care recipients' needs and the needs of their family caregivers, including purchasing additional questions for the upcoming Hawaii Health Survey.

(d) The executive office on aging shall submit the completed needs assessment to the joint legislative committee on family caregiving no later than twenty days prior to the convening of the regular session of 2008 to facilitate the development of a comprehensive, sustainable, and community-based family caregiver support system.

(e) For purposes of this part, "family caregiver" means a person, including a non-relative such as a friend or neighbor, who provides free and continuing day-to-day care in the home to a care recipient.

SECTION 4. The executive office on aging shall submit a report, including the completed needs assessment and any proposed legislation, to the legislature no later than twenty days prior to the convening of the regular session of 2008.

PART III

SERVICES

SECTION 5. There is appropriated out of the general revenues of the State of Hawaii the sum of $ , or so much thereof as may be necessary for fiscal year 2007-2008, and the same sum, or so much thereof as may be necessary for fiscal year 2008-2009, to expand the kupuna care program's in-home and access services to qualified care recipients.

The sums appropriated shall be expended by the executive office on aging for the purposes of this section.

SECTION 6. There is appropriated out of the general revenues of the State of Hawaii the sum of $ , or so much thereof as may be necessary for fiscal year 2007-2008, and the same sum, or so much thereof as may be necessary for fiscal year 2008-2009, for direct services to family caregivers.

The sums appropriated shall be expended by the executive office on aging for the purposes of this section.

PART IV

GRANDPARENTS CARING FOR GRANDCHILDREN

SECTION 7. The number of grandparents raising grandchildren is growing rapidly, both statewide and nationwide. According to the United States Census Bureau, between 1990 and 2000, there was an over thirty per cent increase in the number of children under age eighteen living in grandparent-headed households in Hawaii. Of the fourteen thousand twenty-nine grandparents in Hawaii who report that they are responsible for their resident grandchildren, over one-fifth also report that the children's parents are not present in the household.

The rapid increase in the number of grandparents raising grandchildren is attributed to both demographic trends and social issues. Grandparents today have an increased life expectancy and relative good health compared to previous generations. As a result, they are better able to assume the responsibilities of custodial caregiving. Broad social issues such as divorce, substance abuse, incarceration, mental illness, and abuse or neglect of the grandchildren are among the reasons that grandparents take the role of primary caregivers from their children.

Custodial grandparenting has emotional, physical, and financial costs. Grandparents often report feeling guilt or shame resulting from the situations that lead to their acquiring custody of their grandchildren. They report more anxiety, depression, and physical health problems than their non-caregiving peers. Many of these grandparents are single, female, and living in poverty. Their problems are often exacerbated if they do not have legal custody of their grandchildren, since they may not receive financial or educational support or healthcare for their grandchildren.

Custodial grandparents need accurate and accessible information on a myriad of issues, including legal aid for custody or guardianship, financial assistance, counseling, respite care, housing, healthcare, and education regarding parenting for the second time.

It is important to have a clear understanding of the issues facing, and the needs of, grandparents raising grandchildren in Hawaii to formulate policies and programs to better assist this population.

SECTION 8. The executive office on aging shall conduct an assessment of the issues facing, and the needs of, grandparents raising grandchildren in Hawaii. A report of this assessment shall be submitted to the legislature no later than twenty days prior to the convening of the 2008 regular session.

PART V

AGING AND DISABILITY RESOURCE CENTER

SECTION 9. The delivery of long term care in Hawaii has characteristically been uncoordinated, making it difficult for consumers to obtain information about long term care options and services. Much of this has to do with the fact that different programs have their own eligibility requirements, funding mandates, care benefits, provider participation regulations, administrative structure, and service delivery mechanisms. Consequently, it is difficult to coordinate a comprehensive continuum of long term care (ranging from nursing homes to home- and community-based services) for the elderly and the disabled.

In 2005, Hawaii was selected to receive a grant from the United States Department of Health and Human Services to develop an aging and disability resource center program. The grant is intended to help Hawaii develop "one-stop shop" programs at the community level that can serve as the entry point to the long term services and support system. The vision is to have resource centers in every community serving as highly visible and trusted places where people can turn for information on the full range of long term care support options, and with a streamlined process for screening, intake, assessment, and eligibility determination. Long term care support refers to a wide range of in-home, community-based, and institutional services and programs that are designed to help individuals with disabilities.

The executive office on aging, in partnership with the Hawaii county office of aging and the city and county of Honolulu elderly affairs division, is already developing an aging and disability resource center in Hawaii county. The three-year project commenced in October, 2005, and is due for completion by September, 2008. A second resource center is planned for the city and county of Honolulu. A state advisory board has already been established to provide public input and feedback on the project development and to develop a statewide access plan for future replication. Each project will also have its own steering committee or advisory board at the county level to assist in the specific site development.

The Hawaii county project received additional funding from the Hawaii county council, with support from the Hawaii county mayor, to enable the project to lease the former Sun Sun Lau Chinese Restaurant in Hilo as the physical site. Renovations are currently underway at the Hilo site with a target completion date of late 2007. The Hawaii county office of aging will co-locate in this centralized facility with other aging and disability services and providers, including the department of human services' programs and the Legal Aid Society.

The city and county of Honolulu project will initially be a virtual site. It will build upon the city and county of Honolulu elderly affairs division's current senior hotline telephone information and assistance program and will develop a comprehensive resource website. The overall goal is to eventually establish aging and disability resource center sites in all of the counties to provide statewide access.

The legislature finds that the aging and disability resource center program will improve access to long term care information and options for family caregivers, the elderly, and the disabled by facilitating their search for needed services.

The purpose of this part is to support the aging and disability resource center program by appropriating funds to supplement its development. The funds shall be used to:

(1) Contract with a state management information consultant to:

(A) Identify management information system needs;

(B) Assist with vendor selection;

(D) Provide resources and technical assistance for project evaluation, intake, and database development;

(E) Troubleshoot technical problems; and

(F) Assist with systems integration;

(2) Purchase additional management information system products, including software licensing, server clusters, installation, staff training, computer hardware, and technical support;

(3) Install a statewide toll-free telephone system for the public to contact the aging and disability resource center sites. This includes the installation of the single server number, telephone equipment, cable lines, phone system upgrades, and special equipment for the blind and deaf consumers;

(4) Coordinate and implement consumer education and outreach campaigns, including outreach coordination, the production and printing of brochures and posters, media ads, presentations and exhibits at senior and disability events or focal centers, bilingual translation, and other promotional activities that will educate the consumers and general public about aging and disability resource center services;

(5) Continue the coordination and implementation of the Hawaii county site;

(6) Continue the coordination and implementation of the city and county of Honolulu site;

(7) Continue the state-level coordination and evaluation activities of the project; and

(8) Provide training to aging and disability resource center staff.

SECTION 10. There is appropriated out of the general revenues of the State of Hawaii the sum of $ , or so much thereof as may be necessary for fiscal year 2007-2008, and the sum of $ , or so much thereof as may be necessary for fiscal year 2008-2009, to support the continuous development of the Aging and Disability Resource Center Project in Hawaii.

The sums appropriated shall be expended by the department of health for the purposes of this section.

PART VI

MISCELLANEOUS PROVISIONS

SECTION 11. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 12. This Act shall take effect on July 1, 2020; provided that:

(1) Section 2 shall take effect on June 29, 2007; and

(2) Sections 5, 6, and 10 shall take effect on July 1, 2020.

THE SENATE	S.B. NO.	1916
TWENTY-FOURTH LEGISLATURE, 2007		S.D. 2
STATE OF HAWAII		H.D. 3