AARP Public Policy Institute
Long-Term Care in Hawaii: A Long Way to Go for People Who Need Services and Supports Susan C. Reinhard and Ari Houser, AARP Public Policy Institute
Hawaii’s 85+ population—the age group that is most likely to need long-term care services—will grow 65% from 2007 to 2030, and the first of the boomers turns 65 this year. However, Hawaii is far from providing a high-performing system of long-term services and supports (LTSS) for its older adults and those with disabilities. Hawaii’s biggest challenges are helping people of all income find affordable choices for long-term services and supports and investing its public resources more on home and community-based options. Affordability and Access The average nursing home cost is 236% of the average annual household income of older adults, making it unaffordable for the vast majority. o Hawaii has one of the most expensive nursing home costs in the country, with an average private pay daily rate of $336 (about $123,000 per year or $368,000 for three years) according to the 2011 Genworth Cost of Care Survey. Hawaii’s rates for private pay home health aides averaged $25 per hour ($39,390 per year for 30 hours of care per week, or about $118,000 for three years). o There are only 121 private long-term care insurance policies in effect per 1,000 people who are 40 years or older. Thus, less than 1 in 8 older Hawaii residents have private insurance to help pay for care. Although this rank is among the highest in the country, it is still too low to make private pay affordable for most people. o The state ranks 41st in the nation in developing a fully functioning Aging and Disability Resource Center (ADRC) that can help people on every island find information about LTSS options for both caregivers and care recipients.
Choice of Setting Hawaii is one of the least “balanced” states in the country, investing 8 out of 10 public dollars on institutional care, rather than on home and community-based choices that people prefer. o The state ranks 42nd in the nation for the percent of Medicaid and state-funded spending going to home and community-based options (19%) compared to institutional care (81%) for older people and adults with physical disabilities. o Only 37% of “new users” of Medicaid LTSS start receiving services in home and community settings (33rd rank), which means more than 6 out of 10 must enter nursing homes to receive LTSS instead of being able to access services that enable them to remain in their own home. o On average, states are able to provide care for 3 people in HCBS for the cost of caring for 1 person in a nursing home. The need for building stronger home and community-based options for people of all incomes is evident in the state’s low rankings on alternatives to nursing homes and the low ranking of caregiving support.
o The state ranks 38th in the supply of home health and personal care aides. Attracting more people into becoming home and community based front line workers is a jobs-related challenge and opportunity for the state. o Hawaii ranks 32nd in the nation for the percent of family caregivers who say they get the support they need.
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o The state ranks 30th in the availability of assisted living and other more affordable residential options.
Hawaii has a long way to go to provide its growing elderly population with adequate services.