Meeting Notes 2001

Waipahu Hongwanji Mission Adult Day Care Center

“Our priorities at the Center are to give our clients a feeling of family, with lots of love, attention, and activities,” described Ms. Vanassa Tanouye, Director of the Waipahu Hongwanji Mission Adult Day Care Center. The activity schedule attempts to put clients in the same rhythm as their families, wanting a slower pace at the end of the day, leading to a restful night.

Vanassa once served as an assistant at the Center. She returns, as Director, after managing several day programs at the Waianae Comprehensive Center. This work experience and her many years as a primary caregiver give Vanassa keen insight into the special needs of clients and their families.

The two-year-old facility, licensed by the State of Hawaii, is located less than a mile from the Waikele Shopping Center, on the grounds of the Waipahu Hongwanji Mission. Affiliation with the Mission is not required for program participation.

Applicants must meet the criteria for day programs. Eligibility requires that applicants be: (1) 55 years or older, with physical or mental disabilities; (2) living alone or in need of supervision and care while family members or caregivers are at work; or (3) in need of social and mental stimulation to prevent institutionalization.

Staff members often entertain by singing, playing instruments, dancing, conducting arts and crafts sessions, organizing bingo games, leading exercise periods, and providing other activities. Special guests often volunteer their time. Don Glover, “Mr. Sunshine,” a frequent Center volunteer, accompanied Vanassa to the meeting and made members laugh and smile with a sample of the light-hearted humor that he brings to the Center.

“I have a wonderful staff and dedicated volunteers,” Vanassa described. “I always look for people that have a special magic with our clients.” The staff includes certified nurses aides, activity assistants, and volunteers experienced in working with the elderly.

At present, the program’s cost is $35.00 per day or $600.00 a month, Monday through Friday, from 6:45 a.m. to 5:00 p.m. Fees include lunch and snacks. Program enrollment has almost reached peak attendance. Anyone interested in more information should call 678-1770.

Kupuna Care

Ms. Ann Hartnett has been working with Hawaii’s senior citizens for several decades, most recently as a consultant with the state’s Executive Office on Aging, Kupuna Care program. The statewide program has existed since July 1, 1999. According to Ann, “Kupuna Care administers a variety of services to assist frail, elderly adults live at home, with the help of others.”

State-funded in-home and community-based services include:

• Adult day care to support functionally impaired adults in a supervised daytime setting.
• Transportation assistance for those who cannot use regular transportation services.
• Companion and oversight assistance for those who are frail or have disabling conditions.
• Case management assistance to identify needs, explore options, and develop a care plan to assist individuals achieve greater independence.
• Chore services to assist with yard work and heavy housework.
• Home delivered meals.
• Personal care assistance for those unable to bathe, eat, dress, toilet, and/or transfer from bed to chair by themselves.

To qualify for program services, an individual must:

• Be a U.S. citizen or qualified alien.
• Be 60 years or older.
• Not be covered by any comparable government or private home and community-based services.
• Not be residing in an institution, such as intermediate care facility, skilled nursing facility, adult residential care home, hospital, or foster family.
• Be unable to perform one or more activities of daily living (eating, bathing, dressing, transferring from bed to chair, controlling bowels or bladder, and moving about the house safely on their own) or instrumental activities of daily living (preparing meals, shopping for food and personal items, taking medications, managing money, using phones, doing housework, and using public transportation).

Anyone interested in learning more about Kupuna Care should call the Executive Office on Aging at 586-0100.

Therapists On Call / HomeCare On Call

According to owner Sandra “Sandy” Pascal, Therapists On Call, Hawaii’s first mobile physical therapy unit, developed from her desire “to deliver care to the frail elderly, and patients in too much pain to travel by car to on-site clinics.” Indeed, that early goal has been realized as the company now services clients at adult day programs and homes, as well as their business office on Kawa Street in Kaneohe.

A physical therapist since 1973, Sandy has worked in California and Hawaii. In 1955, she decided to leave her state position as a pediatric physical therapist to pursue “new horizons” through self-employment. Within a few months, she hired her first employee, an occupational therapist, followed by speech and massage therapists and nurses.

In 1998, a friend notified Sandy of a wheelchair-accessible van for sale in Hilo. The purchase and subsequent renovation transformed the secondhand tour bus into a well-equipped rehab van, with running water, therapy tables, weights, and electrical-stimulation equipment.

In addition, the business now includes HomeCare On Call, a comprehensive personal home care service, with staff available on a 24-hour basis.

Pauline Nichols, R.N., accompanied Sandy and explained that as one of two case managers, she meets with families for the initial free case assessment. The staff of 21 full- and part-time employees includes chore workers, companions, certified nurses aides, licensed practical nurses, and registered nurses. Live-in caregivers are also available. Pauline described the trusting relationships that she has seen develop between their clients and employees. “We try our best to create arrangements that will work,” she explained, “to be there when the primary caregiver needs a small break and to help the patients reach their best potential.”

Sandy further described their philosophy as helping people with a “spirit of loving kindness, with love serving one another.” She hopes, eventually, to expand to four mobile units.

A member mentioned that she would need help only in the event of an unforeseen emergency. Sandy recommended that a patient assessment be conducted and records kept on hand to be available when immediate help is necessary.

Anyone with questions on any of the services should call 235-8805 or view the company’s web site: www.therapistsoncallhawaii.com.

Senior Solutions

Ms. Suzette Yamasaki has worked with Hawaii’s senior population for more than 25 years. She was director of the Honolulu Nutrition Program for Senior Citizens for more than a decade, followed by 11 years as manager of the Kuakini Aiea Adult Day Care Center at St. Timothy’s Episcopal Church Family Center. She is certified in CPR and first aid. In 1998, while in her latter position, Suzette spoke to members of our group, providing much information about the adult day care center. At our last meeting, members learned that although her career status has changed, her focus remains on caring for the aged.

Suzette’s long career working with elderly clients and their families has given her keen insight into senior requirements, knowledge of available resources, and understanding of the various situations associated with caring for loved ones.

About one and one-half years ago, Suzette described, she decided to leave her position at the Aiea center, to help elders and their families through a different venue, by forming her own company, Senior Solutions. The limited liability company has about 18 Certified Nurses Aides (CNAs) available for home visits, bathing, companionship, personal care, and respite services. In addition to the CNAs, others provide a variety of services including house cleaning, cooking, yard work, shopping, and minor repairs. Suzette explained that in addition to at-home care, families also hire Senior Solutions employees to provide several hours of individualized attention for loved ones residing in nursing homes. Prices per hour (with a two-hour minimum) range from $16 to $21 an hour, depending on tasks required.

“Many times people are just unaware of their options and the available resources,” Suzette explained. “I receive a wide range of calls from people who need help with a variety of problems. I welcome the calls and always try to assist.”

Anyone interested in learning more about Senior Solutions should call Suzette Yamasaki at 454-0541 or 843-4665 (pager). Inquiries can be sent via email (kyamasak@gte.net), fax (454-2231), or mail (Senior Solutions, 1777 Hoolaulea Street, Pearl City, HI 96782).

Project Dana — 2001 Update

Our guest speaker, Florence Maruyama, R.N., and her volunteer colleague, Karen Oda, both donate their personal time as Project Dana volunteers. Florence serves as coordinator/manager for Loving Care, the Wahiawa United Methodist Church-affiliated Project Dana site, which has been in existence since the end of 2000. Karen has been a Project Dana volunteer for about six years at the Mililani Hongwanji Mission site. In addition to these two Central Oahu groups, Wahiawa Hongwanji Mission also has a long-established group of volunteers.

The project, conceived almost 11 years ago by two civic-minded women and the efforts of members from the Moiliili Hongwanji, now includes an interfaith volunteer caregivers’ coalition of 25 churches and temples, with more than 600 volunteers on Oahu and several outer islands.

According to Florence, all who participate in the project receive training and education on various topics, including being a “caring presence.” A recent training session dealt with “transferring” a person from one position to another, such as the body movements associated with getting into an automobile. Volunteers offer support to the frail elderly, homebound, and disabled by providing friendly telephone, home, or hospital visits; respite services; transportation for medical appointments, shopping, and banking; light housekeeping; minor home repairs; and yard work. Volunteers do not handle money, dispense medications, provide personal care, or remain overnight.

Calls for assistance should be directed to the main coordinating office in Moiliili (945-3736), where the request will be referred to site coordinators or other agencies. Florence and Karen both explained that once a referral has been received, an assessment visit follows. If appropriate, assignment of a volunteer occurs, always attempting to match people with similar interests.

Project Dana places no age or income requirements on the people they help. Also, those receiving assistance do not need to be affiliated with the volunteer’s church or temple.

Anyone interested in becoming a volunteer or in receiving more information on Project Dana’s services should call the Moiliili office at 945-3736.

WGH Senior Behavioral Health Update

“Wahiawa General Hospital’s geriatric/psychiatric unit is the first of its kind in the State of Hawaii to offer a focused unit/team approach to elder care,” described our guest speaker, Stefanie Klein, R.N., Community Liaison Director for Wahiawa General Hospital’s Senior Behavioral Health Care Unit.

The 10-bed unit, open since May 2000, occupies a section of Wahiawa General Hospital’s renovated second floor. A team of psychologists, psychiatric nurses, masters-trained therapists, licensed clinical social workers, and others trained in geriatric health, psychiatric issues, and elder care focus on treating seniors suffering from non-chronic psychological and emotional problems. Dr. Dan Tanahashi, the unit’s medical director, and Dr. Michael Komeya, attending physician, both specialize in geriatric psychiatry.

The admissions process begins with a referral. Clinical staff members are available on a 24-hour basis to provide initial consultation and assessment. Ms. Klein explained that referral sources include family members, physicians, clergy, nursing homes, therapists, and others. Admission is voluntary. Once a referral has been received, an assessment visit determines whether the individual could benefit from the services offered.

Ms. Klein described that some of the patients display aggressive tendencies such as striking out, hitting, and scratching. Others may be abandoning their personal care, refusing food or medication, becoming self-destructive, or exhibiting other changes in their behavior.

The team develops individual treatment plans, with the overall goal to restore, as soon as possible, the patient to normal activities of daily life. The average hospital stay is about 10 days. Treatment could include certain medications, psychotherapy, etc. The patient’s day could also involve time for socialization, meals, exercise, arts and crafts, occupational therapy, and sessions with the doctor. Family and caregiver support meetings are also scheduled. Team members continue to monitor the patient after release on an outreach and aftercare basis.

“In the past, there was a social stigma attached to seeking psychological help,” according to Ms. Klein. “We now understand that a person’s mental and emotional state contribute to their overall health.” The program accepts Medicare, Medicaid, and other insurance plans. To refer a patient, or for more information, please contact the unit at 621-4310; Stefanie Klein, R.N. at 621-4254; or Judy Brasel, R.N., M.A., Program Director at 621-4471.

SagePLUS and Medicaid: Long-Term Care Eligibility

For more than three years, our guest speakers, Rachel Sato and Elaine Sato, have served as trained volunteers with the state’s SagePLUS program, making public presentations and answering individual questions on complex issues related to senior health insurance options, Medicaid, Medicare, and Medigap. In addition, both donate their time with other organizations such as the Alzheimer’s Association. Rachel, for almost seven years, has been the facilitator of the Wahiawa/Mililani Alzheimer’s Support Group.

According to Rachel, “SagePLUS is sponsored by the Executive Office on Aging, in partnership with various organizations, and funded by federal and state governments.”

Elaine described that in Hawaii, Medicaid provides medical assistance to families and individuals with limited financial resources. She explained that the program, like SagePLUS, is funded by the federal and state governments and administered by the MedQuest Division of the Department of Human Services.

To qualify for Medicaid, certain income guidelines apply. An individual must be at least 65 years old or certified as blind or disabled. Elaine recommends that anyone interested in details should call the MedQuest Division Eligibility Branch (phone numbers below).

At the request of our caregiver group, Elaine discussed the special eligibility provisions for long-term care assistance. “When you apply for Medicaid,” explained Elaine, “one of the questions on the application is ‘have you sold, traded, given away money, vehicles, property or other resources/assets in the past five years?’ The lookback period is five years for irrevocable trusts and three years for other assets.”

Resources and income. An individual is not eligible for Medicaid if total countable resources exceed $2,000. Countable assets include, but are not limited to: cash, bank accounts, CDs, trusts, equity in retirement plans, property not used as the family home, jewelry, equity over $1,500 in a funeral plan, and other personal and business assets. If a spouse is present and continues to live in the community, $87,000 in assets (not including their home) can be kept and the spouse can retain $2,175 in monthly income. The institutionalized spouse can keep an income of $30 per month.

Homes. For a single person, the home is exempt if the individual can state his/her intentions to return to the home once discharged from the nursing facility. Otherwise the State may seek to recover Medicaid payments by placing liens on the home property of Medicaid recipients whose stay in a medical institution is likely to be permanent.

Revocable and irrevocable trusts. In August 1993, to close some loopholes that existed, Medicaid made changes to some eligibility rules regarding trusts and whether those assets would be considered disposable assets or income.

To learn more about SagePLUS call 586-7299. For more information on Medicaid/MedQuest call 587-3521 (Oahu Applications Section) or 587-3540 (Oahu Ongoing Section).

Status of Proposed Pacific Health Center

Although the scheduled speaker could not attend our August meeting, we more than filled the extra time by catching up with member news and enjoying good company. The following information is taken from the COCSG Newsletter for September 2001.

On September 4, several members of the Central Oahu Caregivers’ Support Group attended a special meeting of Wahiawa Neighborhood Board No. 26. The agenda listed as Unfinished Business: (1) presentation on the Wahiawa Hospital Association’s plans to develop the Pacific Health Center at Koa Ridge; (2) community input/feedback; and (3) resolution in support of Wahiawa General Hospital’s project.

The 210-acre site for the Center is located at the southern tip of Koa Ridge Makai. The parcel is directly across Ka Uka Boulevard from the new Costco.

Dr. Edmund Whang, Chair, Wahiawa General Hospital, provided an update on the Association’s proposals to develop the Pacific Health Center and responded to questions from the audience. Individuals inquired about the relocation of services and plans for the existing hospital.

Dr. Whang stated that circulating rumors about the abandonment of the Wahiawa facility are not true. Wahiawa General will continue to provide health care services for the community. At present, the hospital contains 50 acute care beds, 110 skilled nursing beds, and 10 gero-psych beds.

The skilled nursing beds and gero-psych beds will remain at the present structure. The 50 acute care beds will be relocated to the Pacific Health Center at Koa Ridge. Proposals for the vacated space include the possibility of expanding services for senior behavioral health, respite, and the skilled nursing facility.

A 24-hour urgent care component will be retained at the current facility, treating moderate to less severe health problems. Examples include:

• Asthma attacks
• Dehydration from diarrhea or vomiting
• Cuts or punctures
• Stomach and chest pains
• Severe cold or flu symptoms

At this time, x-ray, mammography, laboratory, specialty clinic, and respiratory services are also proposed to remain at the current hospital building.

On July 20, 2001, an acquisition agreement on the 210 acres was signed by Castle & Cooke Homes Hawaii and the Wahiawa Hospital Association. State Land Use Commission hearings on the proposal are scheduled for September 6 and 7.

Members of the Wahiawa Neighborhood Board ended the meeting by unanimously voting to support the project on behalf of the community.

“I Don’t Know — We Never Talked About It”

When a member suggested that a speaker be scheduled to discuss arrangements associated with death, we wondered how the presentation would be received, whether talk of funerals and required paperwork would deter attendance. On the contrary, attendees agreed that they gained much valuable information from the presentation given by Mr. Pat Souza, Vice President/Director of Sales, Mililani Memorial Estate Planning. Family services counselors Marcia Sumile and Sandy Yuasa also attended the September meeting. Both assist with pre-need arrangements.

Souza provided information on: (1) pre-needs, (2) funeral arrangements, and (3) after-service requirements. He explained that staff assisting family members often hear, “I don't know — we never talked about it.” Without prior discussion, family members are often left to guess and speculate about the vital statistics, assets, and preferences of loved ones. Was the individual a veteran? Do you know the location of discharge papers, the date and place of discharge, date enlisted? Do you know parents’ birthplace or mother’s maiden name? Did your loved one have strong feelings about cremation or burial? Do they have a funeral plan? Where are the insurance papers? For family members, lack of knowledge often results in higher expenses, heightens the sense of grief, and adds to the long checklist of things to do.

Pre-need arrangements. These include decision on a funeral home and memorial park, purchasing a funeral plan. Arrangements for veterans can also be made.

Funeral arrangements. Meet with selected funeral assistant to finalize interment or cremation details and pay for services requested. Order death certificates. Prepare short obituary. Bring clothing and personal items. Be ready to discuss religious preference, clergy, flowers (also disposal), pallbearers, music, food, program (speakers, organizations, brochure), people to handle reception (guest books), photographs, photography.

After the service. Obtain death certificates. Pay bills. Contact Social Security, Veterans Administration, Medicare, Medicaid. File life insurance and medical insurance claims. With expert advice prepare state inheritance tax forms, amend titles of jointly-held properties and bank accounts.

Souza provided the information with sensitivity, filled with anecdotes, stories of cultural customs, and changes that have occured during his 26 years with the business. He emphasized that lack of preparation always brings added stress to families during an already very difficult time.

The discussion included questions regarding the scattering of ashes, upgrading funeral plans, and coordination with veterans organizations. Anyone interested in receiving checklist booklets (Personal Emergency Portfolio and What To Do upon the Loss of a Loved One) should contact Marcia Sumile at 844-7776 (pager), 677-5631, or 538-6207. Formerly a Wahiawa financial institution manager and still very active with Central Oahu organizations, she will be able to provide information on funeral plans, veterans benefits, and group discount prices. We were notified that members of the Central Oahu Caregivers’ Support Group will receive a 10 percent funeral plan discount.

Long-Term Care Insurance: What You Should Consider

Ms. Laudra Eber has been involved with the health insurance industry since 1981 and with long-term care insurance for the past thirteen years. She is president of Long-Term Care Hawaii, Inc., a company that represents many companies offering long-term care insurance. She is a charter member of the Hawaii Association of Health Underwriters and has served several terms as the group’s president. Her own family experiences have provided personal insight into long-term care for the elderly.

According to Ms. Eber, there is no perfect policy. Individuals should become familiar with available features and make decisions based on their own personal and financial situations. When making selections, she recommended that the following be considered:

What to look for:

• A very large company with strong financial ratings. An international or national company is best.
• A company that has demonstrated a commitment to selling long-term care insurance, at least for a minimum of five years.

Plan features to consider:

• Provides for care in a skilled nursing facility, assisted living unit, Alzheimer’s facility, and home care.
• Has six activities of daily living (ADLs), including bathing, rather than only five. Bathing is often the first assistance recessary.
• Allows for “stand-by” assistance rather than only “hands-on” assistance. You may need “hands-on” care with only some activities.
• Waives the elimination period for home care under certain circumstances, or counts a week of the elimination period for any week that has at least one home care visit.
• Ensures continuing bed reservation when you are away from the facility for a short period regardless of the reason you are away from the facility.
• Offers a weekly or monthly maximum. This feature allows for more flexibility in arranging care.
• Allows for unlicensed help (companion, chore worker, or family member). Expect to pay more for the family member option.
• Has cost of living (COLA) adjustments. For example, the benefit would increase 5% simple or 5% compounded each year on the anniversary date of the policy.

Ms. Eber explained that an indemnity plan pays the full amount of your maximum daily benefit on the days you receive care regardless of your expenditures. A reimbursement plan reimburses for actual costs incurred up to your maximum daily benefit. The latter plan extends the maximum number of days your policy will last. You should consider the longest possible maximum that you can afford.

In addition, there are tax qualified and non-qualified policies. Non-qualified policies may be easier to trigger benefits, but could be more susceptible to rate increases.

Possible ways to reduce premiums:

• If you don't have a support network, consider nursing home and assisted living facility coverage only.
• Individuals in their seventies should consider simple rather than compounded COLA. Compounded COLA is more important at the younger ages.

Call Laudra Eber at 593-8111 to get additional details on long-term care insurance. You may also call for a proposal form to obtain quotes from several companies. Approval of coverage could be affected by age or existing medical conditions.