Following the money for Hawaii’s aging population

Hawaii’s kupuna, or elderly population, has faced serious risks during the COVID-19 pandemic, not only from infection of the virus, but also loss of community and access to care as the state locked down. As the state population continues to age, policymakers are reassessing where to allocate federal and state dollars to better serve kupuna.

Members of the Senate Committee on Human Services and House Committee on Health, Human Services, and Homelessness convened for a briefing from the Hawaii Executive Office on Aging (EOA) under the Hawaii Department of Health this month.

 

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With an FY 2020 budget of $27 million, EOA provided long term services and supports (LTSS) such as personal home care, home-delivered meals, and transportation to nearly 7,000 elderly adults in the program across the state. However, many of these services saw a 17%-40% decrease in the number of people served as facilities closed due to COVID, according to EOA Director Caroline Cadirao

The only service that saw a significant increase throughout the pandemic was home delivered meals, which jumped 27%, or over 1,000 additional people served. Derrick Arioyoshi, executive on aging at the Elderly Affairs Division of the City and County of Honolulu, says this feat was part of the office’s ability to pivot when resources, such as staffing, became scarce. 

“We don’t settle with the contraction [of services]. We expand on the areas that we have capacity.” 

With nearly one in five Hawaii residents over the age of 65, the state is working to ramp up its LTSS infrastructure. Cadirao says LTSS is a more affordable alternative than receiving institutionalized care in nursing homes or other facilities, which costs on average over $8,000 per person per day in the U.S.

Cadirao also said the office’s programs provide critical access to care for individuals who fall in the service gap—those who cannot privately pay for care but also don’t qualify for public assistance. 

Of EOA’s budget, $18.6 million was allotted for direct service programs. The office received approximately an even split between state dollars and federal funds from the Older American Act, as well as stimulus dollars from the Families First and Coronavirus Aid, Relief, and Economic Security (CARES) Act. 

Impacted in part by a drop in people served during the pandemic, the office spent about 80% of its allocated service dollars as of the end of FY 2021 on June 30.

 

Image: Hawaii Executive Office for Aging

 

The leftover funds drew concern from some legislators. Senator Joy San Buenaventura (D – Puna), chair of the Senate Committee on Human Services, asked why the office hasn’t expanded its services to more seniors across the state, especially those with Alzhiemer’s Disease. San Buenaventura also suggested using the extra funds to help address Hawaii’s health workforce shortage

“Perhaps the 20% savings you folks got in [fiscal years] 2020 and 2021 can go towards incentivizing more caregivers.” 

Representative Ryan Yamane (D – Wililani) also asked if federal funds, particularly the stimulus funds, were being fully maximized by the office. 

Cadirao outlined the office’s next steps, which include addressing the workforce shortage and preparing for the upcoming State Plan on Aging for 2023-2027. The current 2019-2023 plan outlined performance measures, strategies, and other information to provide support for Hawaii’s aging population and their caregivers. The new plan, Cadirao says, will include a comprehensive needs assessment to capture the impact of the pandemic on the community and care system.

Additionally, EOA is advocating for legislation to combine its Kupuna Care and Caregiver programs, so the office can address the needs of aging community members and their caregivers under a single, collaborative entity.