Scores of residential “aging in place” facilities are opening in neighborhoods across Hawaii. But they’re not following the traditional care home model, which requires state licenses. Rather, they function as a sort of boarding home for elders in which renters sign a separate contract for individual health care services.
Reaction to the trend echoes that tied to the emergence of Uber and Lyft ride-hailing services, which compete with conventional taxis. While supporters laud an innovative business model because it creates more consumer choices, opponents fume at what they see as a sidestepping of government regulation that’s critical to health and safety concerns.
Chief among the critics of the fledgling facilities is the state Department of Health’s Office of Health Care Assurance, which oversees state-licensed elder care options. Asserting a failure to comply with intent and spirit of Hawaii law, the agency is working with a state lawmaker on a bill that would make it easier for the DOH to shut down unlicensed operations.
Such a move seems to confirm the old saying that if all you have is a hammer, everything looks like a nail.
The DOH should reach for other tools in its efforts to address the state’s growing elder care issues. Frustration with current regulation — such as waiting months or even years to get licenses approved by the DOH, or being adversely affected by inconsistent, subjective inspections — prompted the forming of a new nonprofit called Aging in Place Association.
In a recent Honolulu Star-Advertiser story by reporter Rob Perez, the association’s founder estimated that more than 100 operations embracing the aging-in-place (AIP) model have opened within the past several years. Meanwhile, there are 1,700-plus licensed elder care facilities. The proliferation of the AIP homes serves as evidence that the state is failing to keep pace with demand.
At an AIP operation, residents sign a boarding agreement with a homeowner, setting monthly rent. They also sign a separate agreement with a home health care company, specifying a set rate for care that can be as basic as getting help with daily activities or as complex as nursing-home-level services. The care is overseen by independent nurses, referred to as case managers.
Because the state cannot dictate where someone rents or whether the person is able to get care in that rental, the AIP model has so far avoided regulation’s hammer. Shady operations should be shut down, of course. But the state must also take a hard look at how to address its bureaucratic shortcomings and find ways to fold in innovation to better serve our elders and their families.
Also, because the AIP homes aren’t licensed or certified by the state, they cannot accept patients covered by government-funded Medicaid. That limits their market to private-pay clients only. But that’s also where the demand for a range of affordable elder care-related services is rapidly growing.
There are nearly four dozen nursing home in Hawaii, but the price tag attached to that level of care is out of reach for just about anyone other than the most wealthy and the impoverished (Medicaid-dependent) among us.
According to the 2017 Cost of Care Survey conducted by Genworth Financial, a Fortune 500 insurance company that tracks long-term health care price tags, the median annual cost for a nursing home semi-private room and private room in the islands: $137,240 and $158,593, respectively. Those rates exceed national median figures by $51,000 and $61,000, respectively.
The latest U.S. Census data finds that 17 percent of Hawaii’s 1.4 million residents are age 65 or older, with the oldest baby boomers now in their early 70s. By 2030, our senior count is projected to nearly double.
Clearly, there’s a need for more consumer choices as well as more beds reserved for seniors in need of long-term care outside of their own homes. The DOE, state lawmakers and others must work in tandem with innovators such as the Aging in Place Association to forge a senior-friendly future for Hawaii that’s both proactive and pragmatic.
