People who live in Hawaii are more likely to reach their golden years than residents of most other states — which might seem sweet, but many of those in retirement will be coping with poverty.
For many of those aged 65 or more, comprising 14.3 percent of Hawaii residents according to the 2010 census, reaching seniority was not something to celebrate. An analysis last month by the Kaiser Family Foundation estimated that 8 percent of them are living below the government’s official poverty measure of $13,230 a year and 19 percent below the "supplemental" poverty measure, or twice the income of the poverty level.
The difficulty is growing as baby boomers near the retirement age. Hawaii residents who have reached their 60th birthdays comprised 21 percent of all adults in 1990 but that grew to 26.3 percent in 2010 and their numbers are expected to reach one-third of the grown-up population by 2020 and 36.5 percent by 2030.
While some critics say the Census Bureau’s supplemental measure fails to count seniors’ income from savings, the stock market or other accumulated wealth, AARP Hawaii executive Bruce Bottorff points out that half of seniors "rely on Social Security for at least half their household income," with Social Security averaging $13,900 a year.
"We’re troubled by the prospect that there are that many people above the age of 65 in Hawaii who are living at or below even 200 percent of the poverty threshold," said Bottorff, AARP Hawaii’s associate state director/communications.
Gov. Neil Abercrombie promised that he would seek ways for constituents to cope with health care and plans to submit a proposal to the Legislature by 2015 at the earliest to provide a "social long-term care financing system" for residents to prepare, according to Dr. Wesley Lum, director of the state Executive Office on Aging. The system would consist of residents contributing $10 a month to a fund and ultimately draw down benefits of $78 a day for a maximum of 365 days.
"For the next two years, we will be working on determining the feasibilty of it and costing it out and designing the program," Lum said. "At that point, we’ll have a better sense of what it actually looks like."
People who are about 55 years old would be "the target group that will be benefitting from this program, if it actually gets implemented," he said.
AARP is disturbed that movements to shrink Medicare financing and adopt a "chained Consumer Price Index" could make matters worse. President Barack Obama’s proposed 2014 budget calls for the chained CPI, slowing cost-of-living Social Security adjustments by about 0.3 percentage points a year, to save $350 billion over a decade.
"Obviously, we would like President Obama to stay true to his promise during the last campaign that he would not affect Social Security in a negative way for existing seniors," Bottorff said. "But clearly the chain CPI, if that proposal were to go in effect, would have an impact on existing seniors as well as future generations."
Census data in 2010 indicate that fewer 65-and-older residents of Hawaii are disabled, overweight or obese or have been told by a doctor that they have diabetes, while faring worse in asthma rates, notes a report in January by the state Executive Office on Aging. It points out that a report last year by the Milken Institute that ranks Honolulu 20th out of the nation’s 100 largest cities for successful aging.
A report in May, "America’s Health Rankings Senior Report: A Call to Action," commissioned by the United Health Foundation, ranked Hawaii sixth in senior health, pointing out the low prevalence of obesity, prevalence of activity-limiting arthritis pain and geriatrician shortfall.
"It’s good to see that somebody thinks we’re healthy," Bottorff said, "but we see reports every day of just how large a number of Hawaii seniors are struggling with issues that are not easily dealt with."
For example, the United Health Foundation ranks Hawaii 49th in the percentage of older adults enrolled in hospice care during the last six months of life. Genworth Financial, an insurance provider, reported that homemaker care in Hawaii costs $53,768 a year, home health aid costs $57,200, adult day health care costs $18,200, assisted one-bedroom private living facility costs $50,400 and nursing home care is $127,568 in a semiprivate room and $145,270 in a private room, all far above the national averages.
"Obviously," Bottorff said, "people who are at the wealthier end of the spectrum are better prepared to cope with that high cost."
But increasingly, he said, unpaid family care-givers are called upon to handle feeding tubes and other "really quasi-medical services" for the elderly who are not so wealthy.
In a bright move, St. Francis Healthcare System of Hawaii is investing $10 million to convert three floors of its Liliha campus into a 100-day skilled-nursing facility for people who require constant nursing care and have significant dficiencies.
The mostly private rooms are to open next year, and St. Francis hopes to add independent living, assisted living, a memory care unit and other services for seniors. The plan is to turn what was an acute-care hospital into a health and wellness center catering to Hawaii’s older adult population.
The Abercrombie administration has begun a federally funded Aging and Disability Resource Centers program to help residents find medical care aimed at seniors or people with disabilities. Lum said the program is designed to direct people "who otherwise would make a dozen calls or by word of mouth" to find the heath care they need.
The program is now functioning on Maui, will fully operate on Kauai by the end of this year and subsequently on Hawaii island and Oahu.
"What we envision is that the ADRCs in each county will be able to be the ones who help navigate and to really be able to help identify (health care needs), given all the circumstances and variables that this person is facing," Lum said.
Most Hawaii residents who are more than 50 years old say they are likely to need long-term care sometime in the future and don’t want to rely on family or friends for long-term care, according to a AARP survey consisting of 800 telephone interviews last November.
"That’s an alarm bell, because right now we tend to rely in Hawaii and across the country on the unpaid care provided by family members — that is to say, family caregivers who in Hawaii have a cultural predisposition to want to take care of their aged loved ones," Bottorff said.
"But as times have changed and more women are now in the workforce working full-time, the stresses of those individuals is to continue to uphold their responsibilities while at the same time providing and ensuring that their own care, their own retirement security, is secure. These are troubling times."
