The odds that Hawaii residents will need long-term care as they age are far greater than the chances that their house will catch fire during their lifetime, but people don’t recognize the relative risks, says Stuart Ho, state president of AARP Hawaii.
"The odds that you’ll have a fire are 1 out of 300," Ho told a packed crowd of 400 at a free AARP session Monday to raise awareness about Hawaii’s need for long-term care. "Those are fairly long odds. The point is that you readily insure against those odds without even thinking about it."
But taking out long-term care insurance is still a rarity, even though the probability of needing such care is 1-in-2 over the course of a lifetime, according to AARP. Ho spoke at the first of a series of workshops the nonprofit AARP, a membership organization for people ages 50 and up, is holding on several islands this week to help the state and individuals prepare for the coming boom in the senior population.
"There is ample proof that we as a population do not take seriously enough the risks that we’re going to run into," Ho said. "Or maybe we think that Medicare is going to bail us out. But Medicare is not going to bail us out."
Ken and Ellie Yoshida of Pearl City came to the event at the Japanese Cultural Center of Hawaii because they are looking toward their own future needs after caring for elderly parents.
"We’re getting in that age group," said Ken Yoshida, 61. "I retired two years ago. My wife is still working. We know what we went through with our parents, and we don’t want that for our kids."
The Yoshidas are among the 12 percent of Hawaii’s population age 40 and older who have private long-term care insurance, but they are not sure whether it will be enough to cover their needs.
The AARP presentation highlighted some sobering statistics. Hawaii’s nursing homes have the highest occupancy rates in the country and charge the most for care, an average of $123,000 a year or $336 a day. The bulk of long-term care in the state is provided by family and friends. The typical caregiver is a 49-year-old woman who spends 20 hours a week caring for her mother, for an average of five years. About 247,000 caregivers provide unpaid care valued at nearly $2 billion in Hawaii annually.
"This is a critical point for Hawaii — access to services is limited," said Ilene Henshaw, AARP senior legislative representative. "There are relatively few assisted-living facilities, the supply of home health and personal care aides is relatively limited and even the supply of nursing home beds is very limited."
Premiums for long-term care insurance vary based on the age the policyholder begins coverage. The average annual cost in 2008 for a standard policy, offering a $150 daily benefit and five years of coverage, ranged from $2,050 for a 40-year-old to $3,100 for a 60-year-old, according to AARP.
Henshaw said there is a common misconception that Medicare will cover the cost of long-term care. In a survey of 1,000 AARP Hawaii residents the nonprofit conducted last month, the largest percentage, 29 percent, expected to count on Medicare to pay for such care for themselves or a family member. But Medicare pays only for certain types of services and for short periods of time, she said.
"Many people think Medicare covers long-term care, but really it was not designed to do that," she said. "It will cover up to 100 days in a Medicare-certified nursing home. It will not cover custodial care. Most long-term care is help with daily activities like bathing or eating. Medicare is not an option. Most people pay out of pocket."
Another alternative — long-term care through Medicaid — is available only to people who earn about $1,000 a month or less and have just $2,000 in assets, excluding their dwelling, she said.
"People are generally on their own," said Ho, who is chairman of the state Long Term Care Commission, which will deliver its recommendations to the Legislature in January. "We need to be better prepared to deal with the accidents and the incidence of long-term care, because we are headed for a train wreck, if we are not already in one."
Henshaw warned that women are especially vulnerable in their old age, because they live on average five years longer than men and are more likely to be alone later in life.
"Women are much more at risk of needing long-term care," she said. "The reason is because women generally live longer, lose their spouses and may not have the informal support they need to keep them comfortable."
Henshaw and other AARP officials will meet with legislators today to focus on the issue and alert them to new resources available on the federal level. The new health care law includes financial incentives for states to reform their long-term care systems, and more funding to move people out of nursing homes and into home-based care. It would also boost Aging and Disability Resource Centers, designed as one-stop shops, Henshaw said.
The survey of AARP Hawaii members found that nearly 8 in 10 would prefer to receive long-term care at home than in an institution.
"Medicaid dollars can support three older people in their homes and communities for the cost of one person in a nursing home," Henshaw said. "So when a state chops those services that allow people to remain in their home, they’re not seeing the big picture."
