& 2015&&Aging Disability Issues&Aging Disability IssuesAging Disability Issues&Aging Disability Issues&A Guide for Hawai‘i’s Legislators, Organizations & Citizens

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As caregiving touches everyone, the mission of the Hawai‘i Family Caregiver Coalition is to improve the qual-ity of life of those who give and receive care by increasing community awareness of caregiver issues through con-tinuing advocacy, education, and training.

Over the years, the Hawai‘i Family Caregiver Coalition has supported our community by sponsoring the follow-ing projects:

• Holo Imua Kakou Legislative Reception

• Family Caregiver Awards Program – a joint venture with KHON2’s Elderhood Project

• Aging and Disability Issues Report

• Family Caregiver Awareness Day

• Education/Resource Fairs

• Family Caregivers Speakers’ Bureau

• Family Caregiver’s Kit for Businesses

For more information, please contact HFCC at P.O. Box 3088, Honolulu, Hawai‘i 96802, or at hawaiifamilycare-givercoalition@yahoo.com.

Organized in 1979, the Hawai‘i Paci� c Gerontological So-ciety (HPGS) is a not-for-pro� t organization whose mis-sion is “to provide professionals and students in the � eld of aging with vital information, workshops, networking, and scholarships to enhance the gerontology workforce; to support the creation of needed policies and programs; and to deliver excellent service to the aging population in Hawai‘i and the Paci� c.”

If you are interested in pursuing this mission, you are invited to join the Hawai‘i Paci� c Gerontological Society.

Please visit the Hawai‘i Paci� c Gerontological Society online at http://www.hpgs.org/ or mail your inquiry to: P.O. Box 3714, Honolulu, Hawai‘i 96812.

� e Maui County O� ce on Aging (MCOA) takes the lead role in aging issues on behalf of older persons in Maui County. As the designated lead agency at the local level, MCOA promotes and protects the well-being of elderly individuals in Maui County.

For more information about MCOA, please call Debo-rah Stone-Walls, Director, at (808) 270-7774. MCOA’s mailing address is: 2200 Main Street, Suite 547; Wailuku, Hawai‘i 96793.

About the Hawai‘i Family Caregiver Coalition, the Hawai‘i Paci� c Gerontological Society, the Disability and Communication Access Board, and the Maui County O� ce On Aging.

� e Disability and Communication Access Board (DCAB) is a governor-appointed state agency whose mission is to promote the independence and civil rights of individuals with disabilities. DCAB supports family and caregiving programs as well as universal and accessible design to allow individuals to live in the community versus institutional settings.

For more information, contact Francine Wai, Execu-tive Director, at Francine.wai@doh.hawaii.gov, or at (808) 586-8121. DCAB’s mailing address is: 919 Ala Moana Boulevard, Room 101; Honolulu, Hawai‘i 96814.

DI SABILITY AND COMMUNICATION ACCESS BOARD

Contributing AuthorsEldon Wegner

Anthony Lenzer

Gary Simon

Francine Wai

Heather Chun

Cullen Hayashida

Suzie Schulberg

Aging & Disability Issues 2015

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Table of Contents

& 2015&Aging Disability IssuesA Guide for Hawai‘i’s Legislators, Organizations & Citizens

Inside CoverAbout the Sponsors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Section 1

Introduction & Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Section 2Priority Aging & Disability Issues in 2015 & Related Legislative Proposals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

2.1 Kupuna Care Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

2.2 Aging & Disability Resource Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

2.3 Alzheimer’s Disease & Related Dementias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2.4 Family Caregiving Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

2.5 Financing Long-Term Care Services & Supports. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

2.6 Legislative Issues of the Disability Community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Section 3Other Bills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Section 4Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Section 5Information, Education & Research Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

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rewards experienced in caregiving, and describe the di� culties any of us could ex-perience when faced with aging or disabil-ity. � ese stories provide a human face to legislative issues by illustrating how they are embodied in the very human experi-ences of individuals and families.

� e Political Context of 2015In many respects, 2015 is a year of transi-tion, but one in which there is reason to be hopeful that the needs of our elderly and disabled populations will continue to receive attention. At the same time, we must acknowledge that there are chal-lenges ahead. � e economic recovery, both nationally and in Hawai‘i, has continued to progress. Hopefully, more resources will become available to continue building a safety net of services and � nancial as-sistance to support the vulnerable. At the federal level, the Administration on Com-

munity Living has continued to channel resources into elderly and disabled servic-es, and the Veteran’s Administration has launched aggressive new supports for the aging veteran population.

However, after the November 2014 election, Republicans now control both the House and the Senate, and it remains to be seen how well they will be able to work with Democrats, as well as the president, in continuing the expansion of services to address the rapidly aging population. � e Federal Older American’s Act authoriza-

� is issue of the Aging and Disability Issues Report 2015 is the 10th annual publication that o� ers an overview of legislative is-sues dealing with aging, disability, care-giving, and long-term services and sup-ports in Hawai‘i. � e purpose is to call at-tention to the priority issues that deserve the serious attention of our lawmakers, advocates, and the public. It is a joint proj-ect of the Hawai‘i Family Caregiver Coali-tion (HFCC), the Policy Advisory Board for Elder A� airs (PABEA), the Executive O� ce on Aging (EOA), the Hawai‘i Pa-ci� c Gerontological Society (HPGS), the Hawai‘i Disability and Communication Access Board (DCAB), the Hawai‘i State Department of Health, and the Maui County O� ce on Aging (MCOA). � eir support is gratefully acknowledged.

� e report has � ve sections. Section 1 o� ers an overview of the report, as well an introduction of some general observa-tions of the political and economic chang-es in Hawai‘i in 2015. Section 2 describes the priority issues for the legislature in the 2015 session as designated by the ma-jor groups that advocate for the frail elder and disabled populations and their care-givers. � e section explains why these are important issues and o� ers background information concerning these issues. Section 2 also discusses the speci� c bills that address these priority areas and their status at the time of writing this report. Section 3 provides information about sev-eral other measures before the legislature that are important to the quality of life of the disabled and elder population and their caregivers. Section 4, the Conclu-sion, provides a brief summary, as well as a look ahead. Section 5 contains a listing of available information, education, and research resources relevant to aging and disability issues that may be helpful to those seeking additional information and education on these topics.

In addition, personal stories from care-givers regarding the issues they face and the importance of public policies in en-abling them to care for their loved ones will be found throughout the report. � ese stories convey the emotional strains and

Caregiver Parents Need Support Too

&&Section 1: Introduction Overview

Amanda Ka‘ahanui, 47, knew that raising a child would require a lot of energy. And when her son, Ikaika was born with multiple medi-cal challenges, those energy requirements jumped to a new category. By four months of age, Ikaika survived a life-threatening surgery, needed a tracheotomy tube for breathing, a gastrostomy tube for feeding and nourish-ment, and two tiny hearing aids to correct his moderate to severe hearing loss.

Amanda was unable to work for the � rst three years of his life because Ikaika needed round the clock care, and of course, they couldn’t leave him at a daycare or with a babysi� er. � ankfully, the Medicaid system provided home nursing that allowed Amanda to re-turn to work for some much needed family income and adult conversation. When Ikaika’s trach tube was � nally removed at age 8, he lost his home nursing care, which consisted of a core of dedicated ladies who knew Ikaika since he was a baby. “My husband and I don’t have any family le� in Hawai‘i, and these la-dies became our second ‘ohana, taking care

of our son like he was their own,” says Aman-da, who at � rst was hesitant to leave her son in someone else’s care. “� ey not only cared for his medical needs, but they played with him, helped with his homework, and worked on his OT, PT, and speech goals, helping him to overcome his physical obstacles and grow into a playful, though� ul, inquisitive youth.”

Now at age 11 and a 5th grader at Aikahi Elementary School, Ikaika has had 15 surger-ies and is thriving due to medical supports, excellent nursing care both at home and school, and dedicated parents who trade o� taking time from work when a simple cold can cause his asthma to � air and require Ikaika to stay home for 5 to 10 days at a time with occasional stints in the hospital. “� e nursing care made a huge di� erence in our lives. � ey shared their knowledge and skills with us so we, as his parents, could become Ikaika’s best caregivers and advocates.”

Amanda Ka‘ahanui with son Ikaika

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tion expired in 2011, and the Administra-tion on Community Living is proceeding on a year-by-year extension. Republicans have expressed an intention to address a re-authorization, but it is unclear whether they will also shift funding priorities.

Over the past four years—despite the impact of the recession on the State’s rev-enue—the governor and legislature were committed to maintaining the safety net of programs and services for vulnerable populations. Faced with expanding needs and fewer resources, the Executive O� ce on Aging has been working with public and private agencies in innovative e� orts to restructure the service delivery system and to develop more e� cient operations by adopting data systems that enable

them to target resources to the greatest need. � e governor and legislature also generously supported innovations such as the development of Aging and Dis-ability Resource Centers (ADRCs) by the counties. ADRCs have improved access to services, enabling persons to obtain ap-propriate services in a timelier manner, and have consequently reduced costly events such as hospitalizations, emergen-cy room visits, and nursing home place-ments, and in other ways have shown themselves to be very cost-e� ective.

� e recent gubernatorial election has brought Hawai‘i a new governor, David Ige. As Chair of the Senate Ways and Means Committee, then-Senator Ige was very supportive of the initiatives and pro-grams of the Executive O� ce of Aging.

He has also stated that despite a commit-ment to holding the line on expenditures, he is determined to preserve the safety net of services for our vulnerable popu-lations. No doubt his style of leadership and priorities will result in some changes. One such change is the appointment of Terri Byers as director of the Executive O� ce on Aging following the resignation of Dr. Wesley Lum, who was successful in securing numerous grants and expanding programs. Terri Byers has a substantial history of working in both public and pri-vate health care sectors in Hawai‘i, as well as on legislative issues in the U.S. Senate. Transitions always usher in some changes and uncertainty, but it appears that the positive directions that have been estab-lished over the past years will continue.

References 1. Katherine Bridges and Erin Pinkus, Pre-pared to Care? Hawai‘i AARP Members’ Opinions on Caregiving and Long-Term Care. AARP, Research and Strategic Analy-sis, 601 E Street NW, Washington, DC, 2011.

2. Lynn Feinberg, Susan Reinhard, Ari House and Rita Choula. Valuing the Invaluable: 2011 Update: � e Growing Contributions and Costs of Family Caregiving. Insight on the Issues, AARP Public Policy Institute. 2011.

3. Genworth Financial, Cost of Care Survey, April 2013.

4. Fox-Grange, Wendy and Ari Houser. Fact Sheet: Long-Term Care in Hawai‘i. AARP Public Policy Institute, Washington, DC. November 2007.

5. National Clearinghouse for Long-Term Care Information, U.S. Dept. Of Health and Human Services, h� p://www.longtermcare.gov/the-basics/.

6. Reinhard, Susan, Houser, Ari. Long-Term Care in Hawai‘i: A Long Way to Go for People Who Need Services and Supports. AARP Public Policy Institute, Washington, DC. September 2011.

7. Donald Redfoot, Lynn Feinberg, Ari Houser, AARP Public Policy Institute, � e Aging of the Baby Boom and the Grow-

ing Care Gap: A Look into Future Declines in the Availability of Family Caregivers. In brief 1B 213, August 2013.

8. Evercare Study of Caregivers in Decline: A Close-up Look at Health Risks of Caring for a Loved One, September, 2006, www.EvercareHealthPlans.com, National Alliance for Caregiving, www.caregiving.org.

9. Suzanne Fox, Maeve Duggan, Kristen Pur-cell, Family Caregivers are Wired for Health. H� p://perinternet.org/Reports/2013/Famil-lyu-Caregivers.aspx. Pew Research Center, June 20, 2013. h� p://pewinternet.org/Re-ports/2013/Family-Caregivers.aspx.

10. S.C. Reinhard, C. Levine, and S. Amis, Home Alone: Family Caregivers Providing Complex Chronic Care. Washington, DC: AARP; New York: United Hospital Fund; October 2012.

11. National Alliance for Caregiving (NAC) and AARP, Caregiving in the U.S. 2009. Bethesda, MD: NAC, and Washington, DC: AARP, November 2009. Funded by the MetLife Foundation.

12. AARP Public Policy Institute. Valuing the Invaluable: 2011 Update: � e Economic Value of Family Caregiving.

13. MetLife Mature Market Group ( June 2010) and National Alliance for Caregiving, Study of Working Caregivers and Employ-

er Health Costs: Double Jeopardy for Baby Boomers Caring for their Parents.

14. AARP Public Policy Institute. Valuing the Invaluable: 2008 Update. � e Economic Value of Family Caregiving.

15. Gallup Healthways. Wellbeing Survey, In U.S., Caregivers Su� er From Poor Physi-cal Health, February 2011.

16. Martire, L.M., Stephens, M.A.P., & Atien-za, A.A. (1997). “� e Interplay of Work and Caregiving: Relationships between Role Satisfaction, Role Involvement, and Care-givers’ Well-being”; � e Journals of Geron-tology Series B: Psychological Sciences and Social Sciences, 52B(5), S279-S289.

17. Gallup Healthways, Wellbeing Survey, Caregiving Costs U.S. Economy $25.2 Bil-lion in Lost Productivity, July, 2011.

18. Joan C. Williams, Robin Devaux, and Pa-tricia Petrac, Center for Work Life Law, Uni-versity of California, Hastings College of the Law, Lynn Feinberg, AARP Public Policy Institute. Protecting Family Caregivers from Employment Discrimination; AARP Care-giving (August, 2012).

19. National Alliance for Caregiving and AARP (2209), Caregiving in the U.S., Bethesda, MD, National Alliance for Care-giving, Washington, DC.

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Section 2: Priority Aging & Disability Issues in 2015 and Related Legislative Proposals

Each year, hundreds of bills are intro-duced in the early weeks of the legisla-tive session. � ese bills are sponsored by legislators, but often at the request of many agencies and interested com-munity organizations. Advocacy groups, such as the Policy Advisory Board for El-der A� airs (PABEA), the Hawai‘i Family Caregiver Coalition (HFCC), AARP, the Kokua Council, and the Hawai‘i Alliance of Retired Americans (HARA) do their best to stay abreast of proposed legisla-tion impacting vulnerable disabled and frail elderly citizens. Other groups, such as those concerned with speci� c diseas-es, disability, and end-of-life issues, also have important advocacy agendas. � e mission of these organizations is to iden-tify and advocate for bills that address these needs. Disabled and frail elderly persons typically are not able to partici-pate in the political process directly, and so these advocacy groups are critical in giving voice to their concerns and needs.

� is section provides background on a set of priority aging and disability is-sues for the 2015 session and discusses the bills that deal with these issues. Pri-ority issues are those which are believed to have importance for many persons in the community and where there seems to be political feasibility in addressing these issues through public policy. � e issues identi� ed below are those where there is substantial agreement among the various advocacy groups regarding the importance of these issues, although some di� erences exist in how each group prioritizes its advocacy e� orts.

2.1 Kupuna Care ProgramEstablished in 1999, Hawai‘i’s Kupuna Care Program provides long-term services and supports to frail and vulnerable older adults who do not have access to other comparable services. Kupuna Care ser-vices include personal care, chore services, attendant care, case management, house-keeping, assisted transportation, home-delivered meals, and day care programs.

With an annual base budget funding of $4.8 million, the State has supported older adults throughout Hawai‘i to receive services that enable them to remain living in their homes and communities, delaying premature placement in costly residential care facilities. Annual base budget fund-ing is allocated to the Executive O� ce on Aging (EOA). EOA then allocates the funding to the county o� ces on aging, which administer the program in their counties and contract for services with private non-pro� t and for-pro� t agencies.

As Hawai‘i’s older adult population in-creases rapidly, with the largest increase being those age 85 years and older, en-suring the availability of adequate and economical care in the least restrictive environment is crucial. EOA’s base bud-get for the Kupuna Care Program has re-mained at $4.8 million since 2002, while the older adult population in Hawai‘i has increased signi� cantly. Although the legislature has made generous additional annual appropriations in recent years, securing the funding in the base budget would ensure a consistent foundation to meet the increasing needs of older adults throughout the State. � e Ige ad-ministration has identi� ed Kupuna Care as a priority for 2015, with an increase of $4,145,696 in EOA’s base budget. An additional vehicle for a biennium appro-

priation for FYs 2016 and 2017 via Sen-ate Bill 964 and House Bill 497 would enable Hawai‘i to serve, at minimum, an additional 800 older adults in need of long-term services and supports.

2.2 Aging & Disability Resource CentersOlder adults, people with disabilities, and their families are often unprepared when the sudden onset of a serious health con-dition or abrupt decline in functioning occurs. Adding to the complexity of these situations, families often have not made the decisions necessary to prepare for their care into the future. Once faced with the need for long-term services and sup-ports, families can � nd it challenging to navigate the complexities of care systems. Aging and Disability Resource Centers (ADRCs) are designed to simplify the pro-cess of obtaining information and access-ing supports and services by being a highly trusted and visible resource for individu-als and their families. In addition, ADRCs are an e� ort to reduce the fragmentation of care systems, recognizing that the care needs of older adults and people with disabilities are often similar. � rough a single coordinated system, the develop-ment and implementation of ADRCs will ensure that the community has access to high quality care through person-centered services, which among other criteria, opti-mize choice and independence, encourage personal responsibility, and provide sup-port so that individuals and their families are able to make informed decisions.

ADRCs are an integral component of health and long-term care reform, and es-sential in the development of e� ectively managed person-centered service sys-tems. Hawai‘i’s ADRC initiative is a pro-cess that is being administered by the Ex-ecutive O� ce on Aging (EOA) and imple-mented by and through each of the county Area Agencies on Aging (AAAs). Improv-ing access to long-term services and sup-ports, Hawai‘i’s ADRC initiative is de-signed to ensure that individuals and their families receive the right services, when

7

Services for Seniors Supports Family’s Fight Against Cancer

Section 2: Priority Aging & Disability Issues in 2015 and Related Legislative Proposals

needed, in the right setting. � rough two broad strategies, ADRCs strive to divert individuals from unnecessary and costly long-term institutional care by: 1.) inter-vening with options counseling at critical pathways; and 2.) expediting the eligibility determination process for publicly funded long-term services and supports.

Since 2006, Hawai‘i’s system change has been underway, planning and imple-menting ADRCs in each county statewide. � rough support from federal competitive discretionary grants and the Hawai‘i State Legislature, the continued development of the statewide ADRC has been enabled and strengthened. � e Ige administration has identi� ed Hawai‘i’s ADRC as a prior-ity for 2015. If appropriated, Senate Bill 964 and House Bill 497 would allocate $1,052,600 for the continued develop-ment of ADRCs in addition to the $1.4

million already included within EOA’s base budget. � e continued development of Hawai‘i’s ADRCs is crucial, and if ap-propriated, the additional funding will enable EOA and the county AAAs to ex-pand upon successes, such as: 1.) ADRCs will be able to measure (quantitatively and qualitatively) the e� ectiveness of service delivery in order to ensure the best use of public funds; 2.) each AAA will increase its capacity to target e� ective levels of sup-port to those most functionally and � nan-cially in need; 3.) comprehensive and in-dividualized service planning will help to ensure that consumers access their most relevant and useful services and supports; and, 4.) state and county governments will be able to manage resources and monitor program quality through centralized data collection, evaluation, and identi� cation of unmet needs.

2.3 Alzheimer’s Disease & Related Dementias Alzheimer’s disease and related demen-tias (ADRD) have become a major cause of death in the older population. ADRD patients frequently require extensive care in the home or in an institutional setting. � e Hawai‘i Executive O� ce on Aging published Hawai‘i 2025: State Plan on Alzheimer’s Disease and Related Dementias to address this critical issue, which may ultimately a� ect as many as half of the 85 and over population.

� e State Plan is a blueprint created to greatly improve the way individuals with ADRD and their families will live in and be served by their communities and includes � ve recommendations, or goals1:

In September 2015, Amadeo Bermudez, 62, was diagnosed with a Stage IV glioblas-toma brain tumor. His many doctors gave him a poor prognosis, which came as a shock to his wife Elizabeth and her entire family. “[� ere were] so many questions to ask, but the one that we pondered the most was, ‘how could a man, my husband, father to four children, grandfather to � ve, who was healthier than anyone we knew and worked seven days a week to provide for his family as a farmer, a job that he was pas-sionate about and loved, come to be a man who now had to � ght for his life [against] this terminal illness?’” said Elizabeth.

In a ma� er of days, the entire lives of Amad-eo’s family were turned upside down. “� rough it, we have always had a strong faith and trust in God that everything was just as it should be and that a miracle for healing and comfort will be answered,” said Elizabeth, in spite of the di� culties. “My husband’s health

declined from his cancer. He is now unable to walk, and his speech and memory is a� ected. As we pray and stand beside my husband in healing, we have had the blessing of help from our family, friends, and community.”

Community help came from Services for Se-niors, Inc., a non-pro� t program that operates out of the Aging and Disability Resource Cen-

ter (ADRC) in Hilo. “From the time of our ini-tial contact, we have had the assistance of Kim Takehiro-Jack, Social Service Specialist,” says Elizabeth. “Kim explained to me what Services for Seniors would be able to provide to us in assisting with the day-to-day care of my hus-band. From the beginning, Kim has been un-believably helpful. She is always available and answers my calls promptly. I have always felt that her sincerity and concern in dealing with my husband’s care is genuine. She goes out of her way to reach out to me even during a� er hours, which I appreciate.”

Services for Seniors provided Amadeo with care at home and several hours of respite for Elizabeth. “Ivan, who is a CNA, was introduced to our family by Services for Seniors,” she says. “He has been a huge help and relief during the times of his visit. Ivan is truly a caring in-dividual towards my husband and his needs.”

Still, it has been an uphill climb for Elizabeth. “We have a long road ahead of us, but we are hopeful that God’s shining light is blessing us through the comfort and help of everyone around us,” she says. “I [have] great apprecia-tion for Services for Seniors—they have de� -nitely been one of those shining lights!”

Amadeo Bermudez with his wife Elizabeth

(Continued on next page.)

8

EOA & County O� ces on Aging a Lifeline for Joy Ah Yee

Section 2 (continued)

Goal 1: Prevent and E� ectively Treat Alzheimer’s Disease by 2025

Hawai‘i will seek to expand and support local research e� orts, as well as keep Hawai‘i health care professionals and the public informed on the most current dementia research, both nationally and worldwide. Hawai‘i’s diverse cultural and ethnic environment can be a laboratory for studies unique to Hawai‘i, which could contribute to the growing worldwide body of research. E� orts will be made to exam-ine the role culture plays in the perception and care of persons with ADRD.

Goal 2: Enhance Care Quality and E� ciency

By 2025, primary health care provid-ers will be fully engaged in dementia diagnosis and treatment supported by a clear understanding and availability of care options. Every primary care physi-cian will be trained in memory and de-mentia screening and will have access to referral resources.

Goal 3: Expand Supports for People with Alzheimer’s Disease and � eir Families

Quality professional health care for peo-ple with dementia should be balanced with community supports necessary to help caregivers and families coping with the disease. Upon diagnosis, there should be easy and a� ordable access to a multi-tude of services and training, including respite, legal, and � nancial counseling, advance care planning, and safety mea-sures.

Goal 4: Enhance Public Awareness and Engagement

By 2025, the public will be well-educated about brain health and dementia, risk fac-tors, recognition of early signs of demen-tia, and behavioral issues – and are able to maintain good health practices and appro-priately access resources when necessary.

Public awareness of ADRD is one of the most recommended goals of all state, national, and world plans. � e fear and stigma associated with dementia are com-pounded by a lack of knowledge and pub-lic education about the disease, its stages, the treatments, how to support caregiv-ers, and where to get services. Conse-

quently, the disease and how to commu-nicate with someone living with dementia are misunderstood by many. Awareness and education should start with young people in schools and universities.

Goal 5: Improve Data to Track Progress

By 2025, Hawai‘i will have identi� ed measurable indicators to track its prog-ress in reaching its goals and objectives, and have in place a system for collecting the data and monitoring the implemen-tation of its action plan.

� ere is a general lack of data speci� c to dementia in Hawai‘i. Recent sources include the 2011 Behavioral Risk Factors Surveillance Survey cognitive module, the Alzheimer’s Association’s 2013 Facts and Figures, the Hawai‘i Dementia Caregiver Survey, and a key informant survey con-ducted by the ADRD Task Force. � ere may be isolated data collection in Hawai‘i research studies or in hospitals and health plans, but the data is not uni� ed. Any ef-fort to seek out better data will involve a collaboration of all stakeholders.2

A coordinator is needed to develop an implementation work plan specifying the tasks required for achieving each goal, key milestones, and the timelines for achiev-

ing them.3 Senate Bill 964 and House Bill 497 propose an appropriation for an Alzheimer’s Disease and Related Demen-tia Services Coordinator position.

2.4 Family Caregiving IssuesIntroductionCaregiving is a challenging issue for families of frail or disabled persons and for society. � e scope of this challenge was summarized in the Aging & Disabili-ties Issues 2014 report:

“According to an AARP report based on

Joy Ah Yee would like to see funding con-tinue for the Executive O� ce on Aging and the county o� ces on aging. She signed her father up with Naalehu Elderly Recreation Services where he bene� ted until his health took a turn for the worst with a minor heart a� ack, dementia, and Parkinson’s disease rendered him bed-bound.

“I used to pride myself on being a patient person until I took on the caregiving of my dad,” said Joy. “� e hot bu� ons that were biologically installed by my dad were mer-cilessly and continuously hit by him.” Joy has siblings that live close by, but because Joy felt she was given the responsibility of car-ing for her dad by default, she felt she had

to do her best to take care of him by herself. Joy’s siblings have children and other family; she had just her husband and herself.

However, out of complete frustration, Joy � -nally accepted the fact that she needed help caring for her dad. She saw an ad for Hale Anuenue, which prompted her to call last October, and they directed her to the Of-� ce on Aging. � ere were snags along the way, she says, but her experience was exem-plary. “One thing is for sure,” says Joy, “I am a bit more sane thanks to the help they have given my dad and I—I no longer feel that I have to go it alone. So please, on behalf of my dad and other caregivers, I’d like to see the House Finance Commi� ee and the Sen-ate Ways and Means Commi� ee decide to allocate funding to Executive O� ce on Ag-ing and the county o� ces on aging.”

Joy Ah Yee and her dad Herman.

1 Executive O� ce on Aging, Department of Health, State of Hawai‘i, Executive Sum-mary, Hawai‘i 2025: Hawai‘i State Plan on Alzheimer’s Disease and Related Demen-tias, December, 2013.2 Ibid.3 Ibid.

9

a 2009 survey, on any given day in Hawai‘i there are 247,000 family caregivers who provided 162 million hours of unpaid care, or an estimated 80% of all care for disabled persons. � is unpaid care would have an annual cost of $2 billion had it been provided by paid caregivers and health care providers. Without the e� orts of family caregivers, it is inconceivable that providing care would be a� ordable to the state or to the families themselves. For example, the average annual cost in Hawai‘i in 2012 for homemaker services was $53,768; for a licensed health aide, $57,200; and for an assisted living facility, $50,400. � us, unpaid family caregivers play a critical, often unappreciated and irreplaceable role in the care of the most vulnerable members of our population.”

Family members who provide care for loved ones face many obstacles. One is the fact that there are fewer family members available to provide care than in former years. Families themselves are smaller, and many of Hawai‘i’s children leave home for school or jobs on the mainland and do not return. � us, caregiving re-sponsibilities fall on a smaller number of persons. � is, combined with the fact that over half of all family caregivers are em-ployed full-time, creates serious demands on caregiver time and energy. Additional-ly, most caregivers are middle-aged wom-en, many of whom also have children at home, and thus have additional responsi-bilities. � ese realities, plus di� culties in obtaining professional assistance when needed, are the sources of caregiver stress.

Caregiving issues thus include: coping with the stresses and time demands of caregiving; learning the skills needed to perform critical medical and nursing tasks at home; risks to family � nances, health, and well-being when trying to balance job demands and the care of loved ones; � nd-ing appropriate professional resources to assist in caretaking when needed; and paying for expensive in-home and/or in-stitutional care. � is section of the report will focus on two aspects of caregiving: 1.) helping caregivers obtain needed training and skills to assist their loved ones after discharge from a hospital; and 2.) provid-ing � nancial support for employed care-givers who must take time o� from their jobs to care for a family member at home.

Other sections of the report will focus on the types of services needed by caregivers and the broader issue of paying for long-term care.

Caregiver Recognition, Support, & TrainingHawai‘i’s population is aging rapidly, and many older people have chronic health conditions which necessitate a hospital stay. Following discharge, most care of such patients is provided by family mem-bers. Traditionally, family caregivers have assisted with bathing, dressing, eating, household tasks, and other activities of daily living. However, it is now common for caregivers to perform complex medi-cal and nursing tasks that formerly were provided in hospitals and long-term care facilities. At the 2014 legislative session, a bill was introduced to recognize the role of caregivers and provide the training necessary to assist loved ones following hospital discharge. � e bill did not pass. Instead, the legislature did pass a resolu-tion (House Concurrent Resolution 78) to create a Working Group to study the issues raised by the 2014 legislation and to report back to the legislature on its � ndings. � e Working Group agreed on the number of questions, but did not support legislation requiring hospitals to provide the training described above.

Nonetheless, bills supporting this con-cept (Senate Bill 296 and its companion bill, House Bill 490, commonly referred

to as the CARE Act) were introduced at the 2015 legislative session. � ese bills contain three basic elements: 1.) the name of a family caregiver is recorded when a family member is admitted to a hospital; 2.) the caregiver is noti� ed when the per-son is to be discharged to another facility or back home; and 3.) the hospital must provide an explanation and a demonstra-tion of the medical and nursing tasks that the family will need to perform at home for the discharged family member.

� is legislation proved to be highly controversial, as indicated by the testi-mony for and against it presented at a joint Senate Human Services & Hous-ing and Health Committees Hearing for Senate Bill 296. Testifying in sup-port were various senior advocacy and service organizations and over 70 indi-viduals, most of whom self identi� ed as AARP members. � e testimony in oppo-sition was presented by the Department of Health; the Chamber of Commerce; several health care organizations, and sta� from � e Queens Medical Center.

Opponents of the CARE Act raised a number of objections, including 1.) the existence of very similar require-ments for hospitals to obtain Medicare certi� cation and Joint Commission ac-creditation; 2.) 30-day readmission rates to Hawai‘i hospitals are relatively low, which does not support the assumption of inadequate care in the home setting;

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10

Section 2 (continued)

3.) hospitals could require additional re-sources, which are not provided in the bill, to carry out these tasks; 4.) possible interference with the physician-patient relationship; 5.) the bill does not solve the real problem, which is “robust com-munity-based services” needed to sup-port patients in their homes; and 6.) hos-pitals are already providing these servic-es. As of this writing, it is unclear how these con� icting views will be resolved.

Paid Family Leave for Working CaregiversAt some time, nearly every worker needs time away from the job to recover from a serious illness or care for a new child or sick family member. Yet the majority of American workers cannot take the time they need without risking their jobs or � nancial security. Only 12% of private sector workers in the United States have access to paid family leave through their employers, and only 40% can take person-al medical leave through a temporary dis-ability program. Low wage and minority workers are even less likely to have access to paid leave. Just 5% have paid family leave, and 16% can access temporary dis-ability insurance through their employers.

� e federal Family Medical Leave Act (FMLA) allows up to twelve weeks of unpaid leave with job protection for em-ployees of companies with 50 or more employees. However, FMLA covers only 60% of the national workforce. Hawai‘i has its own Hawai‘i Family Leave Act, which only applies to companies with 100 or more employees and allows for job protection of up to four weeks per year. However, only 16% of Hawai‘i’s workforce is protected by our HFLA law.

� e only partial paid leave program available in Hawai‘i is temporary disabil-ity insurance, or TDI. All employers are required to provide TDI for their employ-ees. Employers may ask their workers to contribute up to half the premium cost, so long as that amount does not exceed one half of one percent of the employee’s wages. Also, under Hawai‘i family leave law, public and private sector workers who earn sick leave are entitled to use up to 10 days for the care of a newborn or to assist an ill or disabled family member.

Clearly, Hawai‘i lacks a comprehensive policy of partial wage replacement to allow any worker to take substantial amounts of time o� to care for a family member with-out fear of losing his or her job.

Paid leave is not a new issue in Hawai‘i, where studies were conducted and bills have been introduced since 2008. At the 2015 legislative session, four bills were introduced to provide 12 weeks of paid family leave, and two additional bills were o� ered with provisions for shorter leave periods. House Bill 496, and the companion bill, Senate Bill 965, togeth-er with House Bill 535, and House Bill 104, all o� ered the most comprehensive leave package. � ese bills establish a fam-ily leave insurance program that requires employees to contribute to a trust fund to be used for family leave bene� ts in or-der to care for designated persons. Partial wage replacement for up to 12 weeks of leave would be available to all employed persons in the State. Employee contribu-tions would be in accordance with contri-bution rates to the TDI fund in some of the above bills, while a di� erent system was proposed in House Bill 1049.

In addition, two bills were introduced (House Bill 1047 and Senate Bill 1025) to require employers to provide a mini-mum amount of paid sick leave to em-ployees to care for themselves or a family member who needs medical care, or who is a victim of domestic violence, sexual assault, or stalking. Of these six bills, only House Bill 496 has had a hearing at the date of this writing. At that hear-

ing, 25 organizations and individuals submitted testimony in support of this measure, and only the Chamber of Com-merce Hawai‘i testi� ed in opposition. � e Chamber stated that it would be burden-some for employers to � nd replacement coverage for workers taking 12 weeks o� ; that it expands the de� nition of what quali� es for leave; and it increases the number of people – beyond the family – for whom one can take paid leave.

Whatever the issues with the pro-posed legislation, we strongly support the principle that workers deserve and need paid leave to care for themselves or loved ones, and we believe that this is especially true in Hawai‘i, where the cost of living is the highest in the nation.

2.5 Financing Long-Term Services and SupportsOur families and communities are fac-ing seemingly insurmountable chal-lenges in addressing the growing care needs of Hawai‘i’s kupuna, and in � nding the resources to address those needs. In Hawai‘i, the population over 65 is pro-jected to increase to more than 1 in 5 (22%) by the year 20304. � e most rapid expansion will be among the population 85 and over, which is projected to grow by 65% over the next 20 years.6 More than half of those 85 and older su� er disabling chronic conditions and require assistance with some of their activities. Some form of long-term care will be required in the future by about 70% of persons who reach the age of 65.5 � e increasing longevity of our population into older age groups will result in the need for care exceeding the existing resources for providing care.

Traditionally, family members pro-vided care to their own members, and indeed, they continue to provide about 80% of all the care for our frail elderly and disabled population. Nevertheless, the capacity of families to provide care is facing limits. Many families are able to o� er care only if long-term supports and services are provided to supplement the informal care of the family.

Persons who are genuinely impover-ished can qualify for Medicaid-� nanced services. However, this is a welfare pro-

11

Caregiver Cares for Daughter & Husband

gram, with 50% of the cost borne by the state and the remainder by the federal government. � e � nancial burden on state revenue is already highly problem-atic, and any increased reliance on Med-icaid is not viable. Both federal and state policies are emphasizing the importance of aging in place, assisting families with home and community-based services, and reducing the use of more expensive institutional/residential care settings.

However, these home and community-based services are beyond the � nancial means of most families to pay out-of-

pocket, as previously demonstrated with the average annual costs of professional caregiver services (listed in 2.4). State rev-enues and Title III funds from the Federal Administration on Aging provide signi� -cant help to a limited number of persons through Kupuna Care and similar pro-grams; however, the general revenue of the state falls far short of being able to meet all the needs of our vulnerable popu-lation and will be become even more inad-equate as that population grows.

� e Hawai‘i State Legislature appoint-ed a Long-Term Care Commission in 2008

(Act 224) to take a long-term and compre-hensive approach to addressing this grow-ing challenge. As one step, the Commis-sion conducted a statewide survey among adult residents to assess the type of plans people had for their care; knowledge about who pays for long-term care; and prefer-ences for di� erent options to pay for their care. � e results showed that the major-ity of adults had engaged in little plan-ning, had no idea about their future risk for needing services, and had inaccurate knowledge. For example, they believed their health insurance or Medicare would

Kathleen Phillips, 69, is a lov-ing wife, mother, and care-giver to both her husband Al and daughter Desiree. She is a very active community mem-ber as well, serving as presi-dent of the Kula AARP, Maui’s Outreach Coordinator, and volunteer advocate to the state legislature and County Council for Senior Concerns. She is also a retired USER sup-port tech for the DOE.

As busy as Kathleen has been in her community, she has been even busier at home. In the fall of 2014, Kathleen’s 45 year old daughter Desiree had a massive stroke that le� her paralyzed on her entire right side and she lost the ability to read, write, and spell. Desiree al-so su� ers from aphasia and apraxia, as well as photo and noise sensitivity and headaches.

Last year, Kathleen visited the Maui County O� ce on Aging (MCOA) seeking help for her daughter. She found that there were no direct services that MCOA could o� er Desiree. MCOA provides direct services to seniors over 60, but for younger people with disabilities, they only provide informa-tion about resources and other agencies in the community that can assist with those who have physical or cognitive disabilities.

However, Kathleen found that because she is a senior who is caring for her daughter, she

could receive caregiver services. In addition, MCOA found out Kathleen had been taking care of her 74 year old husband Albert, who is not only a senior, but recovering from a series of seven heart a� acks. Albert had also come down with sepsis and blood clots that caused breathing di� culties requiring oxygen.

Kathleen was clearly going through “care-giver’s burnout.” She needed to start caring for herself as she su� ered from herniated disks in her neck and � bromyalgia. Kathleen was waiting for Medicaid and long-term coverage for Desiree, Albert was still having chest and back pains, and her energy lev-el was peaking. MCOA helped Albert and Kathleen to get homemaker services, chore services, and lunches � ve times a week.

(Continued on next page.)

Kathleen realized that we are no good to those we care for if we cannot take care of ourselves. “I think that when one becomes a caregiver, the sense of loss is similar to the grief process, and will go through several stages,” she re� ected. “I’ve been through them and repeated a few. It’s hard. Very hard to work through anger and resentment, and reconcile those feelings with the love we have for those we care for, and get to a place of ac-ceptance.” Kathleen found that her faith is a major help, and discovered that “me time” is helpful as well, though di� cult to � nd.

Rising early and going to daily mass and taking time to do devotions with her husband, Kath-leen � nds it crucial to focus on the moment, to make herself really see the lovely sunrise or sunset, and appreciate the sound of the birds. “I try not to focus on the long-term, as it is just too depressing,” she says, “but focus on what I can enjoy today, right this minute. I’m trying to cultivate an ‘a� itude of gratitude.’ I have a roof over my head, there is su� cient food and water, Desiree is happy and Al is with me. Finally knowing that my e� orts are making the world a be� er place for at least two people brings peace to my heart.”

Kathleen suggests that when we don’t have the answers, STOP and � nd someone that does. Advocate for your family even though the road ahead may seem di� cult. For those who work with caregivers and their families, it is vital that they do all they can to be sure each client is serviced properly, listened to, and supported to the best of their abilities. She concludes, “When we each strive for the best, in the end we can say it’s a job well done!”

could receive caregiver services. In addition,

Kathleen Philips and her family. In front are husband Al and daughter Desiree.

12

pay for long-term care services. � ey also did not believe they could a� ord to pur-chase private long-term care insurance or pay out-of-pocket for even a few months of care. While they resisted the idea that a tax should be levied for long-term care, a large majority believed that the govern-ment should pay for their care.

� e Public Awareness Campaign on Long-Term Care Services and SupportsIn January 2012, the Commission re-ported two recommendations to the state legislature. First, they recommend-ed a broad-based public awareness cam-paign to 1.) increase attention on long-term care planning by adult residents; 2.) communicate the high risk for needing long-term care by older adults; 3.) cor-rect the many misconceptions they had about who paid and did not pay for ser-vices; and 4.) increase awareness of the options that might be available for pro-viding and � nancing their care. Second, the Commission recommended creation of a publicly � nanced long-term care in-surance program by the State of Hawai‘i.

In 2014, the legislature passed Sen-ate Bill 2346, which was enacted into law as Act 151. Act 151 appropriated $500,000 for the public awareness cam-paign recommended by the Commis-sion, and required the Executive O� ce on Aging (EOA) to conduct the cam-paign, evaluate its e� ectiveness, and to report to the legislature by 20 days prior to the 2017 legislative session. � e EOA published a Request for Proposals on December 23, 2014 to employ a con-tracting organization for the campaign with a start date of March 2015.

� e public awareness campaign’s goals are to 1.) inform the public on the likeli-hood of needing long-term services and supports (LTSS); 2.) educate the public on how to maximize independent living; 3.) educate the public about the cost of LTSS; and 4.) provide the public with the resources needed to plan for LTSS. AARP and FACE (Faith, Action for Commu-nity Equity) began to o� er community workshops dealing with these issues in late 2014. Hopefully, the new contractor will work with these and other groups in

developing consistent messages and in making an e� ort to reach the highly di-verse populations in Hawai‘i.

A Limited Public Insurance Program for Long-Term Care� e Commission examined a number of options for � nancing LTSS: the use of tax credits as an incentive to purchase private long-term care insurance; the public-pri-vate partnership which allows individuals purchasing insurance to eventually qual-ify for Medicaid while largely waiving the need to divest themselves of assets; and the development of life insurance poli-cies that can be also used for long-term care expenses. While these options can bene� t some individuals, studies have shown that the primary bene� ciaries are the most a� uent segment of the commu-nity. � e Commission noted that forfeit-ing tax revenue to subsidize more a� uent persons was not desirable, and that open-ing Medicaid to a� uent citizens similarly amounted to a subsidy to wealthier per-sons. Studies in states that have adopted these policies have borne out these con-clusions. None of these policies are fea-sible approaches to � nancing LTSS for the majority of the adult population.

� e Commission concluded that the only feasible approach to making LTSS accessible and a� ordable was to adopt a social insurance approach. Similar to So-cial Security and Medicare, individuals would be required to make modest pay-ments throughout their adult lives so that an insurance fund could � nance their care at the time they required it. Because ev-

eryone is required to participate and pay into the fund over many years, the pay-ments can be kept a� ordable for every-one. � is option, fur-thermore, has been demonstrated to be successful in a num-ber of countries such as in Germany, Ja-pan, and Korea. Un-fortunately, although most citizens would like to receive servic-es without any cost to

themselves, this wish is only a fantasy.

� e Commission recommended a limited public long-term care insurance program be developed in Hawai‘i. � e limited insurance would provide a basic level of bene� ts to most of the popula-tion, e.g., those above the Medicaid pov-erty criterion. � e program is envisioned as a public-private partnership where in-dividuals would receive a modest bene� t ($70 per day) for 365 days. Individuals could purchase private long-term care insurance as a supplement to cover ad-ditional costs. Private supplemental poli-cies would also be more a� ordable, since the public insurance would pay expenses at the front end of the person’s need for care. � e state would continue to oper-ate the Kupuna Care program and other public services, which individuals could qualify for once their insurance bene� t is exhausted. However, even modest public insurance would have a major impact on � nancing care by paying for such services as in-home personal care, homemaker services, and adult day care, preserving family savings, and reducing or postpon-ing enrollment in Medicaid.

� e 2013 legislature passed an appro-priation to the Executive O� ce on Aging to undertake two research studies – a feasibility study and an actuarial study – as background to developing propos-als for the limited public long-term care insurance program. � e State of Hawai‘i has actually developed similar proposals over past decades. � e last e� ort led to the 2003 legislative session passing the proposal, but it was subsequently vetoed

Section 2 (continued)

13

by Governor Linda Lingle.

� e Executive O� ce on Aging con-tracted with Dr. Lawrence Nitz of the Po-

litical Science Department of the Univer-sity of Hawai‘i at Mānoa to undertake the studies and to present a report of the results. Dr. Nitz was also instrumen-tal in the development of the previous proposals in Hawai‘i. He subcontracted the actuarial study to a highly respect-ed Washington, DC, agency, which was charged with determining the speci� c parameters using conservative estimates such that the program would remain sol-vent for 75 years into the future. Dr. Nitz submitted his report of the studies in December 2014. In January 2015, Sen-ate Bill 727 and House Bill 1253 were introduced in the legislature proposing the limited public insurance program. Senate Bill 727 is still under consider-ation in the 2015 legislature. Although passage of a major program is unlikely in the � rst year it is introduced, there is an opportunity for considered discussion of the proposal, and if need be, it will be re-introduced next year.

� e speci� c provisions are too com-plex to describe in detail here and can be found in the bills. However, the most important provisions are as follows:

1.) � e public insurance program would be � nanced through an increase of 0.5% to the state’s General Excise Tax. About 33% of the revenues generated by this tax are paid by visitors to the state, and so this would be a signi� cant help to local resi-dents. � e revenues generated by this tax also closely mirror the rate of in� ation.

2.) � e revenues will be placed in an in-surance fund administered by a board of trustees. � e proposal o� ers details about the management of the fund and the ap-

pointment of trustees to assure integrity and to protect the assets of the fund.

3.) Bene� ts will be annually adjusted for in� ation, and an annual audit will determine whether the insurance fund remains within the projected param-eters, and bene� ts can be adjusted by either increasing or decreasing them.

4.) Individuals will qualify for the in-surance program by demonstrating Hawai‘i residence by having � led state income tax returns for 10 years.

5.) Individuals will qualify for bene� ts by having disabilities of two or more limitations in activities of daily life or certain other medical conditions, such as dementia. � e bene� t will be a cash ben-e� t allowing the individual freedom to select services and caregivers with pro-fessional guidance. Bene� ts are portable if someone relocates to another state.

� e community awareness e� orts of LTSS campaign will continue over the coming year to increase attention to the need for planning by families and for considering the options for � nanc-ing care. � e case will also be made to consider the limited public insurance program for long-term care as an op-tion that will create an insurance fund to pay for services for the broad popu-lation beyond continued reliance on Medicaid and the general revenues of the state. Hawai‘i could prove to be a national leader by realistically and cre-atively addressing the long-term care challenges which our aging population will pose in the future.

“On April 11, 2014, my husband’s and my life changed forever,” says LaVerne Ro-drigues. Her husband Alfred had a major stroke, which brought on dementia. “Since that day, my life has been a nightmare.”

What was so hard for La Verne was that there was no one to explain what to expect, no one to show her or tell her what she needed to do. “� ank God for Kim Takehiro-Jack of Servic-es for Seniors,” says LaVerne of the non-pro� t program that operates out of the Aging and Disability Resource Center (ADRC) in Hilo. “When [Kim] came into our life, she really ex-plained everything I wanted and needed to know and how to go about ge� ing help. She really is the most helpful and compassionate person. I’m so happy to have met her!”

Couple’s Life Changed Forever By Stroke

Alfred and LaVerne Rodrigues

(Continued on next page.)

References1. Katherine Bridges and Erin Pinkus, Pre-pared to Care? Hawai‘i AARP Members’ Opinions on Caregiving and Long-Term Care. AARP, Research and Strategic Analy-sis, 601 E Street NW, Washington, DC, 2011.

2. Lynn Feinberg, Susan Reinhard, Ari House and Rita Choula. Valuing the Invaluable: 2011 Update � e Growing Contributions and Costs of Family Caregiving. Insight on the Issues, AARP Public Policy Institute. 2011.

3. Genworth Financial, Cost of Care Survey, April 2013.

4. Reinhard, Susan; Houser, Ari. Long-Term Care in Hawai‘i: A Long Way to Go for People Who Need Services and Supports.AARP Public Policy Institute, Washington, DC. September 2011.

5. Donald Redfoot, Lynn Feinberg, Ari Houser, AARP Public Policy Institute, � e Aging of the Baby Boom and the Grow-ing Care Gap: A Look into Future Declines in the Availability of Family Caregivers. In brief 1B 213, August 2013.

6. National Alliance for Caregiving (NAC) and AARP, Caregiving in the U.S. 2009.

Bethesda, MD: NAC, and Washington, DC: AARP, November 2009. Funded by the MetLife Foundation.

7. Joshua Weiner, Long-Term Care Reform in Hawai‘i: Report of the Hawai‘i Long-Term Care Commission: Final Report. � e Hawai‘i State Legislature. January 18, 2012.

8. Executive O� ce on Aging. � e Feasibil-ity of a Long-Term Services and Supports Social Insurance Program for Hawai‘i: A Report to the Hawai‘i State Legislature. De-cember 15, 2014. h� p://www.hawaiiadrc.org/site/465/ltss_� nancing.aspx.

14

Section 2 (continued)

2.6 Legislative Issues of the Disability CommunityLegislative issues of concern to the dis-ability population often overlap with those of the elderly population, as there are many common factors of caregiving and delivery of services to seniors who are frail or have disabilities. However, there are many other issues that either impact the non-elderly population of persons with disabilities or are more civil rights-based. � e following is a non-exhaustive list of some of the key issues that have been introduced in the 2015 legislature impacting persons with disabilities.

Parking for Persons with DisabilitiesParking spaces for those with mobility issues are used by persons who either re-quire a parking space with an adjacent ac-cess aisle or a space that is closer to an en-trance. Whether the mobility is through independent travel or o� ered by a family member or caregiver, the need for acces-sible parking spaces is very real and often limited in an island state with � nite land mass. Parking spaces reserved for persons with disabilities are often at a premium and, as a result, often misused. � is pro-gram is administered at the state level by the Disability and Communication Access Board (DCAB) and implemented in con-junction with the four counties. DCAB is proposing, through House Bill 1154, to increase the motor vehicle registration fee by an as yet unspeci� ed amount, but no greater than $1.00, to cover the costs of the program. � e income would in-crease the ability of the program to issue placards with the highest level of quality assurance to reduce fraud, expand public education and enforcement, and update/automate the computer database for greater e� ciencies.

Access for Persons who are Deaf or Hard of HearingDeafness or diminished hearing is of-ten considered a hidden disability. While many seniors experience a loss of hearing as a result of the aging process, there are many others who grow up with deafness or loss of hearing their entire lives. Servic-

es for that group of individuals are often very limited. In 2014, the community was successful in obtaining start-up money to establish a comprehensive center for the deaf, hard of hearing, and deaf-blind indi-viduals. While working toward establish-ing this center, the advocacy e� orts of the community are focusing on three speci� c bills that increase access. House Bill 1272proposes to require select movie theaters (those that have two or more locations) to o� er a limited number of viewings of movies with open captioning and audio description. � is bill, if passed, would set Hawai‘i ahead of the nation and the rules of the Department of Justice. Senate Bill 962 proposes an appropriation to the De-partment of Human Services, Division of Vocational Rehabilitation (DVR), to pro-vide a robust, contracted American Sign Language Interpreter Referral Service statewide. Although the service is cur-rently o� ered, the source of funds to sup-port this e� ort has reduced direct client service money in the DVR. Senate Bill 963 proposes to require health insurance coverage in Hawai‘i for hearing aids for people with all types of hearing loss and speci� es a minimum amount of coverage and frequency for replacement of hearing aids under this coverage. It requires insur-ance companies to pay $1,500 per hearing aid for each ear and replace the aids every 36 months.

Access for Persons who are BlindIn addition to the above-mentioned bill on movie theaters that requires audio de-scription for blind patrons, House Bill 1008 and Senate Bill 608 would require drivers of vehicles to exercise due care

to ensure the safety of blind or visually handicapped persons on any roadway. It would also require the examination for a driver’s license to test the applicant’s knowledge of operating a vehicle in a manner that ensures the safety of blind or visually impaired pedestrians.

Access to Buildings, Facilities & Sites� e design and construction of accessible buildings, facilities, and sites is paramount to o� ering equal access to individuals with disabilities to the built environment, par-ticularly those with mobility issues. Al-though the Americans with Disabilities Act has been in e� ect for 25 years, there are still many barriers to the physical en-vironment due to the large inventory of old or aging facilities. House Bill 946and Senate Bill 1115 propose to amend Hawai‘i Revised Statutes §103-50 to pro-vide clari� cation on the types of construc-tion projects that must be submitted to the Disability and Communication Ac-cess Board for review. Senate Bill 762and House Bill 721 propose to require mandatory access to beaches at locations where the public is invited through the creation of public parking and restrooms.

Service AnimalsSenate Bill 760 and House Bill 738propose to establish a misdemeanor for knowingly misrepresenting oneself as the owner or trainer of a service dog. A similar bill, Senate Bill 644, proposes to establish the o� ense of false presen-tation of an animal as a necessary rea-sonable accommodation in housing.

Enhanced Community- Based Services

A variety of bills have been introduced to augment the current service delivery system for individuals with disabilities or to ensure that services are provided in a manner that o� ers more choice and qual-ity. Many are part of the aging network and kupuna package already described elsewhere in this report. � e following are additional bills not previously dis-cussed. House Bill 1236 and Senate Bill 481 propose to establish a Medicaid buy-in program within the Department of Human Services for workers with dis-

15

abilities. House Bill 119 proposes to establish the Hawai‘i ABLE Savings Pro-gram with the Department of Budget and Finance modeled after the federal legislation by creating the Hawai‘i ABLE Savings Program Trust Fund that houses savings accounts to help support individ-uals with disabilities and their families. Senate Bill 1318 repeals the require-ment that quali� ed community rehabili-tation centers pay their employees who are persons with disabilities less than minimum wage. House Bill 580 pro-poses to establish licensing requirements for durable medical equipment suppliers participating in the nationwide competi-tive bidding program through the O� ce of Health Care Assurance and requires a physical presence in Hawai‘i. House Bill 491 makes an appropriation to the Department of Health to implement the recommendations of the Task Force on

Mobility Management for persons with disabilities or who are elderly. House Bill 1108 requires health insurance carriers to cover autism spectrum disorder diag-noses and treatment with coverage for individuals up to age 18. A related bill, Senate Bill 791, provides for autism coverage for individuals under age of 11.

Education and Related ServicesEducational services for children with dis-abilities have focused on adequate funding for classroom teachers. In addition to ob-taining adequate funding, several issues are being monitored as impacting children with disabilities. � ey include a multitude of bills relating to bullying and cyber bul-lying, as children with disabilities are often the target of bullying in the school system (House Bill 819 and companion Senate Bill 845; House Bill 396 and companion Senate Bill 978; and Senate

Bill 865). E� orts to establish the Early Learning Pre-Kindergarten Program to be administered by the Executive O� ce on Early Learning through House Bill 820and companion Senate Bill 844; Senate Bill 863, House Bill 821; and companion Senate Bill 843, will also be of bene� t to young children with disabilities in obtain-ing a jump start on their education. Medi-cally, House Bill 10 and Senate Bill 846allow Department of Education employees with training to volunteer to administer EpiPen injections to a student with ana-phylaxis and assist in testing and manage-ment of student diabetes. Finally, Senate Bill 900 proposes to establish a state seal, similar to a certi� cate, of biliteracy to ver-ify students who have bilingual capability. � is bill includes American Sign Language as one of the languages that can be used in the program.

References 1. Katherine Bridges and Erin Pinkus, Pre-pared to Care? Hawai‘i AARP Members’ Opinions on Caregiving and Long-Term Care. AARP, Research and Strategic Analy-sis, 601 E Street NW, Washington, DC, 2011.

2. Lynn Feinberg, Susan Reinhard, Ari House, and Rita Choula. Valuing the Invaluable: 2011 Update � e Growing Contributions and Costs of Family Caregiving. Insight on the Issues, AARP Public Policy Institute. 2011.

3. Genworth Financial, Cost of Care Survey, April 2013.

4. Fox-Grange, Wendy and Ari Houser. Fact Sheet: Long-Term Care in Hawai‘i. AARP Public Policy Institute, Washington, DC. November 2007.

5. National Clearinghouse for Long-Term Care Information, U.S. Dept. Of Health and Human Services, h� p://www.longtermcare.gov/the-basics/.

6. Reinhard, Susan, Houser, Ari. Long-Term Care in Hawai‘i: A Long Way to Go for People Who Need Services and Supports. AARP Public Policy Institute, Washington, DC. September 2011.

7. Donald Redfoot, Lynn Feinberg, Ari Houser, AARP Public Policy Institute, � e Aging of the Baby Boom and the Growing Care Gap: A

Look into Future Declines in the Availability of Family Caregivers. In brief, 1B 213, Aug. 2013.

8. Evercare Study of Caregivers in Decline: A Close-up Look at Health Risks of Caring for a Loved One, September, 2006, www.EvercareHealthPlans.com, National Alliance for Caregiving, www.caregiving.org.

9. Suzanne Fox, Maeve Duggan, Kristen Pur-cell, Family Caregivers are Wired for Health. H� p://perinternet.org/Reports/2013/Famil-lyu-Caregivers.aspx. Pew Research Center, June 20, 2013. h� p://pewinternet.org/Re-ports/2013/Family-Caregivers.aspx.

10. S.C. Reinhard, C. Levine, and S. Amis, Home Alone: Family Caregivers Providing Complex Chronic Care. Washington, DC.:, AARP; New York: United Hospital Fund; October 2012.

11. National Alliance for Caregiving (NAC) and AARP, Caregiving in the U.S. 2009. Bethesda, MD: NAC, and Washington, DC: AARP, Nov. 2009. Funded by the MetLife Foundation.

12. AARP Public Policy Institute. Valuing the Invaluable: 2011 Update: � e Economic Value of Family Caregiving.

13. MetLife Mature Market Group. ( June 2010) and National Alliance for Caregiving, Study of Working Caregivers and Employ-er Health Costs: Double Jeopardy for Baby Boomers Caring for their Parents.

14. AARP Public Policy Institute. Valuing the Invaluable: 2008 Update. � e Economic Value of Family Caregiving.

15. Gallup Healthways. Wellbeing Survey, In U.S., Caregivers Su� er From Poor Physi-cal Health, February 2011.

16. Martire, L.M., Stephens, M.A.P., & Atien-za, A.A. (1997). “� e Interplay of Work and Caregiving: Relationships between Role Satisfaction, Role Involvement, and Care-givers’ Well-being” � e Journals of Geron-tology Series B: Psychological Sciences and Social Sciences, 52B(5), S279-S289.

17. Gallup Healthways, Wellbeing Survey, Caregiving Costs U.S. Economy $25.2 Bil-lion in Lost Productivity, July, 2011.

18. Joan C. Williams, Robin Devaux, and Pa-tricia Petrac, Center for Work Life Law, Uni-versity of California, Hastings College of the Law, Lynn Feinberg, AARP Public Policy Institute. Protecting Family Caregivers from Employment Discrimination AARP Caregiv-ing (August, 2012).

19. National Alliance for Caregiving and AARP (2209), Caregiving in the U.S., Bethesda, MD, National Alliance for Care-giving, Washington, DC.

20. Hawai‘i Executive O� ce on Aging, SFY 2013 Kupuna Care Program utilization data.

� is section will brie� y cover several oth-er bills related to aging, disability, and long-term care that have been introduced at the 2015 legislative session. � ey il-lustrate the range of decisions that legis-lators will be called upon to decide. � e number and complexity of such decisions can only grow as the older and disabled populations increase in numbers.

� e Role of the University & Community Colleges in an Aging SocietyA few years ago, the United Nations point-ed out that the 21st century will be facing three major challenges: 1.) terrorism and security; 2.) sustainability and resources; and 3.) population aging. � e fact that the entire world’s population is rapidly ag-ing is well acknowledged and recognized to have far reaching economic and social consequences. � e impact on Hawai‘i may be magni� ed given the fact that our archi-pelago state requires each island to create entire long-term support and services systems even with sparse populations. Is Hawai‘i ready? When will the bulk of this pressure for eldercare crest?

We will need to develop an array of support services for each island. We will need the means to assure that our ku-puna and their families can � nancially a� ord services. We will also need the means to train a competent paraprofes-sional and professional eldercare work-force and unpaid family caregivers. We have hardly begun. Over a year ago, the Kupuna Caucus requested that the Uni-versity of Hawai‘i’s administration ad-dress the question regarding the creation of a competent workforce for Hawai‘i’s aging population. Unfortunately, UH could not provide an administratively sanctioned vision and strategic plan.

� e challenge for UH is daunting, since it involves all of the community colleges and its four-year professional and lib-eral arts programs on all campuses. Will UH be ready? � is year, one legislation – House Bill 493 HD1 and its compan-

ion, Senate Bill 967, are attempting to reestablish support for the University of Hawai‘i’s Center on Aging program with two positions. Currently, there is an inter-im director and two researchers sta� ng the Center on Aging. � ese positions are funded by grants and contracts, limiting the Center on Aging to projects that have funding. With permanent funding and support, the Center on Aging can respond to the needs of the community by provid-ing education and training opportunities to professionals in aging, including rein-stating the undergraduate and graduate certi� cate program in Gerontology. With this certi� cate program, students from any discipline (social work, public health, business, architecture, urban planning) can tailor their skills and build expertise in working with the aging population. In addition, the Center on Aging’s capac-ity would be enhanced by, for example, enabling workforce development in the community and systems development throughout the state to support the grow-ing needs of Hawai‘i’s aging population.

Motor Vehicle LicensingFrom time to time, bills are introduced at the legislature that raise the issue of age discrimination, often directed at older persons. In 2014, for example, there was a bill to require mandatory retirement of judges at age 70. � is year, the issue is driver’s licensing and whether relicensing requirements for older drivers should be di� erent from those of other adults. Under current Hawai‘i law, most adults need only renew their driver’s licenses every eight years, while drivers age 72 and older must renew every two years. In the absence of clear evidence to support these di� eren-tial requirements, it could be argued that the current law is in itself discriminatory. However, Senate Bill 935 imposes addi-tional requirements on older drivers. Un-der this bill, all older licensees must: 1.) obtain a medical form from a drivers ex-aminers o� ce; 2.) � nd a doctor willing to examine them to determine whether they meet (unspeci� ed) medical conditions for driving; 3.) successfully pass the exam and

have the doctor complete the form; and 4.) return the form and license application to an examiners o� ce within 30 days. � e ease or di� culty in obtaining a drivers license is a critical issue for many older people. � e ability to drive is not only a sign of independence, but often an essen-tial activity, especially in rural areas where other means of transportation are scarce.

� is bill o� ers no scienti� c or other evi-dence to support a medical examination requirement exclusively for older drivers. Further, many people, older and other-wise, with chronic illnesses and disabili-ties may be perfectly competent drivers. Only an actual driver evaluation, such as the one o� ered at the Rehabilitation Hos-pital of the Paci� c in Honolulu, provides that type of information.

Senate Bill 935 has been deferred, but the possibility of age discriminatory legislation should always be considered as a real possibility.

Community Care Foster Family HomesHouse Bill 600 authorizes the Depart-ment of Health to allow two private-pay individuals to be cared for in the same community care foster family home if certain requirements are met.

While this bill is not a priority, it is im-portant to pay close attention to it. Cur-rently, Community Care Foster Family Homes (CCFFHs) can allow one private pay individual to live in a (Medicaid-ap-proved) home. House Bill 600 is request-ing that the Department of Health allow two private-pay individuals to be cared for in the same CCFFH if certain require-ments are met. � e concern if this passes is that if the CCFFHs are able to take two private pay individuals and then decide to take no Medicaid individually 1.) they may not be regulated as strictly by the state; and 2.) the allure of taking in private pay individuals by CCFFH operators may have an adverse impact on being able to place Medicaid individuals in CCFFHs. For some, the lesser oversight given to private pay clients might be even more attractive

Section 3: Other Bills

16

than the increase in revenue. Why take in a third person with the lower Medicaid re-imbursement? � en where will those folks go? Nursing homes? If that is the case, will the original intent of placing the Medic-aid population in the community be lost

or poorly served? 2.) How will we recruit, educate, and retain the necessary profes-sional and paraprofessional workforce, as well as provide appropriate training for family caregivers? 3.) Given the limita-tions of government’s ability to � nance

Karen Laborte and her family recognized her father’s behavior had lately been di� erent. Normally sweet, gentle, and very reserved, Herman Cambra had become confused, agi-tated, and angry. He was declining rapidly and Karen knew the man she had called her daddy for 56 years was no longer the man she knew.

Karen began researching the distinct types of behavior pa� erns she noticed. She made an appointment with Herman’s pri-mary care physician, who diagnosed him with vascular dementia.

A� er several months of hallucinations, agita-tion, and ge� ing physically and verbally abu-sive, his doctor diagnosed Herman with rap-idly progressive vascular dementia. Home health nurses cared for him for two months. However, a� er a severe fall in July 2013 that bruised the whole right side of his body from head to toe, Herman was admi� ed to the hospital for several days. � e family saw an even darker side of Herman’s dementia. Again, he was physically and verbally abusive to the doctors, hospital sta� , and his family—punching, biting, and swearing at them.

Everyone noticed that Herman was reliving a period he spent in the Philippines during World War II. Many times, he would tell his daughter and granddaughter, “get the hell out of here.” At � rst they felt deep hurt, but came to realize he was trying to “protect them from the enemy.” � is behavior continued, but with medication, there would be times when he was lucid. He would tell Karen and her family that he knew something was wrong with him. � ese changes took a toll on the family mental-ly, physically, and � nancially, but their main pri-ority was to help Herman regain his strength.

Prior to his release from the hospital, arrange-ments were made to send Herman to a Ka-hului care home for more recovery. He was admi� ed on November 13, 2013. During his stay, Herman was very afraid, insisting daily that someone would come to kill him at night when no one was around. He continued to be angry at times, and when he didn’t get his way, he was verbally abusive. He became up-set when approached in certain ways. Karen seemed to be the only person he would trust and listen to. She visited him every evening af-ter work and on weekends.

Herman continued to relive his war experi-ences, so Karen sought help at the VA’s Maui Community-Based Outpatient Clinic. A clini-cal psychiatrist determined that he was su� er-ing not only with dementia but with post-trau-matic stress disorder. Herman never spoke about the war to his family because he didn’t want to trouble them, but he was � nally able to talk about it and how he had held on to sur-vivor’s guilt for 70 years!

Karen continued to seek help. She asked Herman’s primary care physician if he could see a neurologist. She su� ered daily as Her-man was so sedated that he couldn’t even

hold his head up, and it hurt her to see him that way.

In August 2014, Her-man’s primary care physician re-diag-nosed him with Lewy body dementia with parkinsonism. Protein

deposits called Lewy bodies develop in nerve cells in the brain where thinking, mem-ory, and motor control take place. Accord-ing to the Mayo Clinic, Lewy body dementia is the second most common type of pro-gressive dementia a� er Alzheimer’s disease.

With the right diagnosis � nally made, Karen fought hard to have the sedatives, which are harmful for Lewy body dementia patients, dis-continued. She also struggled to educate the care home sta� about the disease, which they didn’t seem to know much about, nor under-stand what her dad was going through. How-ever, Karen made sure her dad’s needs were being met. Herman was able to receive as-sistance medically and � nancially through the VA, as well as through Medicaid.

Herman’s care was long and arduous. Karen recommends the o� ces established in each county where seniors and caregivers can get information on resources. � ey helped her lo-cate the resources she needed. Karen points to a common thread: “Each human life is spe-cial and everyone deserves to die with dignity and receive the best possible care there is.”

On January 10, 2015, Herman passed away with Karen and his granddaughter Ailina at his bedside. “It was a beautiful passing without pain, without regrets,” said Karen. His family will continue to remember him for the won-derful father he truly was.

programs and services, how can govern-ment develop more extensive and e� ective partnerships with the private for-pro� t sector to meet massive future needs? It re-mains to be seen how well Hawai‘i will be able to meet these challenges.

Daughter’s Perseverance

Herman Cambra. Right: With Karen.

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Section 4: Conclusion

Sections 2 and 3 above illustrate the kinds of issues that legislators face each year with regard to aging and dis-ability. At the beginning of each ses-sion, there may be 20, 30, or more bills o� ered in these subject areas. Within a short time, however, the number rap-idly decreases as bills are either not heard by committees or are deferred inde� nitely. � us, advocates must be prepared at the very beginning of a legislative session to respond rapidly to identify and support favorable leg-islation and speak against legislation deemed harmful to the kupuna or per-sons with disabilities. Successful advo-cacy involves several key elements: 1.) personal contact with key legislators

and legislative sta� to educate them about important issues; 2.) a substantial number of written testimonies and per-sonal appearances at committee hear-ing to show wide support for bills being heard; and 3.) increasingly solid scien-ti� c evidence demonstrating a need for services and program e� ectiveness.

Hawai‘i is just at the leading edge of the baby boom “Silver Tsunami,” with its many thousands of additional elders and unprecedented numbers of the very old. � e legislation described in this report, even if all enacted, would hardly meet all the needs of Hawai‘i’s next generation of elders and persons with disabilities. State leaders, policy makers, and advo-

cates must think 20 or more years ahead. Here are a few challenges to consider: 1.) How do we create e� cient service net-works that will meet the needs of all our island populations, especially in rural areas which are often poorly served? 2.) How will we recruit, educate, and retain the necessary professional and parapro-fessional workforce, as well as provide appropriate training for family caregiv-ers? 3.) Given the limitations of govern-ment’s ability to � nance programs and services, how can government develop more extensive and e� ective partner-ships with the private for-pro� t sector to meet massive future needs? It remains to be seen how well Hawai‘i will be able to meet these challenges.

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Public & Nonpro� t AgenciesHawai‘i Aging and Disability Resource CenterA one-stop source for information, assistance, and access to services and care for older adults, people with disabilities, and family caregivers.Website: www.hawaiiadrc.orgPhone: (808) 643-2372TTY Line: (808) 643-0889

Executive O� ce on AgingTerri Byers, DirectorPhone: (808) 586-0100Fax: (808) 586-0185 Email: Terri.Byers@doh.hawaii.govWebsite: http://hawaii.gov/health/eoa/

Kaua‘i Agency on Elderly A� airsKealoha Takahashi, County Executive on AgingPhone: (808) 241-4470Fax: (808) 241-5113Email: elderlya� airs@kauai.govWebsite: www.kauai.gov/OCA/Elderly

Maui County O� ce on AgingDeborah Stone-Walls, County Executive on AgingPhone numbersMain O� ce: (808) 270-7774Lahaina: (808) 661-2387Hana: (808) 248-8833Moloka‘i: (808) 553-5241Lana‘i: (808) 565-7114Fax: (808) 270-7935Email: aging@mauicounty.govWebsite: www.mauicounty.gov/departments/Housing/aging.htm

Hawai‘i County O� ce of AgingHorace Farr, Acting County Executive on AgingHilo: (808) 961-8600Kona: (808) 323-4390Fax: (808) 961-8603Email: hcoa@hawaiiantel.netWebsite: www.hcoahawaii.org

Elderly A� airs Division, City and County of HonoluluNalani Aki, County Executive on AgingPhone: (808) 768-7705Fax: (808) 768-7720Email: naki@honolulu.govWebsite: www.elderlya� airs.com

AARP Hawai‘iBarbara Kim Stanton, State DirectorPhone: (808) 545-6001Fax: (808) 536-2288Email: bstanton@aarp.orgWebsite: www.aarp.org/states/hi

Disability and Communication Access BoardFrancine Wai, Executive Director919 Ala Moana Blvd., Room 101, Honolulu, HI 96814Phone: (808) 586-8121Email: Francine.wai@doh.hawaii.govWebsite: http://www.state.hi.us/health/dcab/home/index.htm

Hawai‘i Family Caregiver CoalitionGary Simon, PresidentHawai‘i Family Caregiver CoalitionP.O. Box 3088, Honolulu, HI 96802Email: hawaiifamilycaregivercoalition@yahoo.comEmail: garysimon@hawaii.rr.com

Hawai‘i Paci� c Gerontological SocietyChristy Nishita, PresidentP.O. Box 3714, Honolulu, HI 96812 Email: hpgs.hawaii@gmail.comWebsite: www.hpgs.org

Educational & Research InstitutionsThe University of Hawai‘i at MĀnoa

Center on the FamilyDr. Maryanne Berry, DirectorPhone: (808) 956-4132Fax: (808) 956-4147Email: gfong@hawaii.eduWebsite: www.uhfamily.hawaii.edu

Center on AgingDr. Christy Nishita, Interim DirectorUniversity of Hawai‘i at Mānoa,Honolulu, HI 96822Phone: (808) 956-5001Fax: (808) 956-9582Email: uhcoa@hawaii.eduWebsite: www.hawaii.edu/aging

University of Hawai‘i Elder Law ProgramProfessor James H. Pietsch, DirectorPhone: (808) 956-6544Website: www.hawaii.edu/uhelp

Ha Kupuna: National Resource Center for Native Hawaiian EldersDrs. Kathryn Braun, Colette Browne, and Noreen Mokuau, Co-Principal InvestigatorsPhone: (808) 956-6243Fax: (808) 956-5964Email: hakupuna@hawaii.eduWebsite: http://manoa.hawaii.edu/hakupuna/index.html

Public Policy CenterDr. Susan Chandler, DirectorPhone: (808) 956-4237Fax: (808) 956-0950Email: chandler@hawaii.eduWebsite: http://www.publicpolicycenter.hawaii.edu/

Section 5: Information, Education & Research Resources

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& 2015& 2015&Aging Disability Issues&Aging Disability IssuesAging Disability Issues&Aging Disability Issues&Aging Disability IssuesA Guide for Hawai‘i’s Legislators, Organizations & Citizens