Notes 2003

For about five years, our guest speakers, Rachel and Elaine Sato, former primary caregivers, have served as trained volunteer counselors at SagePLUS, a federally-funded state health insurance and assistance program directed by the state’s Executive Office on Aging. Both respond to inquiries and give presentations on Medicare, Medicaid, Medigap, and related issues. Rachel and Elaine have retired from their full-time careers and now donate much of their time to organizations such as SagePLUS and the Alzheimer’s Association. Rachel has been facilitator of the Wahiawa/Mililani Alzheimer’s Support Group for almost nine years.

Medicare is a health insurance program for (1) individuals 65 years of age or older; (2) people under age 65 with disabilities; (3) people with end-stage renal disease (kidney failure, requiring dialysis or a kidney transplant). Medicare has two parts:

Part A: Hospital Insurance. According to Rachel, “the cost for each benefit period has increased slightly.” In 2003 you will pay:

In addition, various Medicare benefits exist for skilled nursing facility care, home health care, and hospice care.

Part B: Medical Insurance helps with doctors’ services, outpatient hospital care, and other services not covered by Part A. The individual pays a monthly premium of $58.70 a month for 2003. SagePLUS volunteers will be able to provide more details and information on other available Medicare plans.

Medicaid, according to Elaine, “provides medical assistance to families and individuals with limited financial resources. The program is funded by the federal and state governments and administered by the MedQuest Division of the Department of Human Services.” In response to an inquiry about Medicaid eligibility for long-term care assistance, Elaine explained that one of the questions on the application is “have you sold, traded, given away money, 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. In the past, properties held as Life Estates were considered exempt, but this may no longer pertain. The state is also in the process of tightening some “loopholes” pertaining to assets in Trusts, regarding some as countable assets.

Homes. The home is exempt if the individual can state his/her intentions to return once discharged from the nursing facility. Otherwise the state may seek to recover Medicaid payments by placing liens on the property of Medicaid recipients whose stay is likely to be permanent. Recovery will not be made while the following individuals lawfully reside:

Resources and Incomes. An individual is not eligible for Medicaid if his/her total countable resources exceed $2000. Countable resources include cash, bank accounts, stocks, bonds, annuities, CDs, property not used as the family home, jewelry, equity over $1500 in a funeral plan, equity in retirement plans, and other personal and business assets. If a spouse is present and is living in the community, $90,660 in assets (not including their home, cars, and special trusts for a disabled child) can be kept and the spouse can retain $2,266.50 in monthly income. The institutionalized spouse can keep an income of $30.00.

Because laws and policies frequently change, Elaine suggests that interested persons call MedQuest to inquire about qualification requirements and specific circumstances.

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

Hawaiian Islands Medical, located on Pohukaina Street, offers a wide variety of durable medical equipment to meet the needs of Hawaii’s health care community.

“Our company will be two years old in May,” described Laura Steelquist, President, Treasurer, and Director of Hawaiian Islands Medical. “I like to say that we are a new company, with a lot of old people,” referring to the 70 years of accumulated working experience she and her staff have with other medical equipment companies. Ms. Steelquist worked as the manager of another local medical company prior to forming Hawaiian Islands Medical, “a company founded on the philosophy that clients’ needs come first. We’re not just about equipment, we’re about people and about making their lives easier.” As such, time is spent to ensure maximum product comfort and safety, adjusting equipment for proper fit and height, suggesting alternatives, and, depending on availability, providing free, same day delivery (on Oahu).

For anyone purchasing grab bars, installation by a certified installer is available on a prorated basis. “If it takes half an hour, we will charge you only for that time,” explained Alicia DuPree, Director of Marketing.

In response to a question about insurance coverage, Ms. Steelquist explained that Medicaid may cover some bathroom equipment, but generally other insurances do not. Hawaiian Islands Medical will give a 10% discount on all items, such as shower and toilet accessories, not covered by insurance. For those items covered by insurance, the staff will work with the doctors’ offices and the insurance companies to expedite product delivery.

The company has rehab, home care, and travel concierge equipment available for rent or purchase. Rehab equipment includes power, sport, and manual wheelchairs.

“If there is a need, then a product probably exists to meet it,” described Ms. DuPree about the very long list of home care supplies available. Convalescent gowns, walkers, and canes come in a variety of styles and bright colors, including Hawaiian prints, flowers, and patriotic flags. Wheelchairs, hospital beds, patient lifts, crutches, trapeze bars, incontinence supplies, ramps, bathroom accessories and aids, cushions, and devices to prevent pressure sores are just a few of the items that can be obtained.

Ms. DuPree demonstrated the variety of incontinence supplies available in all sizes, brands, and styles, including vanity and pull-up briefs with adjustable waist bands.

“Don’t ever be afraid to inquire about products,” she expressed. “We’re here to help you. If you need it, we’ll do all we can to get it for you.”

Anyone interested in product availability, pricing, equipment catalogs, or inquiring about Hawaiian Islands Medical, should call 597-8087 or log on to www.himed.cc for details.

Dr. Arthur Harvey entertained and enlightened members and guests with his humor, musical exercises, and information on music’s influence on health, wellness, and relieving stress. “It made so much sense,” one individual remarked. “I never realized the impact music could have on my mind and body.”

Throughout his 43 years as a music educator, Dr. Harvey has directed his energy and interests in three areas of music: (1) school music education, with an emphasis on special needs students and the effects of music on the brain, (2) church music education, and (3) health care music education.

He currently serves as Coordinator of Music Education and Assistant Professor in the Department of Music at the University of Hawaii, teaching music education courses, music in special education, psychology of music, music and the brain courses, and advising graduate research. He has had an extensive national and international career in these fields and has, to date, authored or contributed to some 70 publications.

Dr. Harvey explained that “music can be used as an adjunct to our health care, but careful selections must be made to achieve certain results.” He briefly described the body and brain process and response to sounds and music. “Some music can be toxic,” he cautioned. “Listening to prolonged loud, booming music can damage hearing, cause nervousness and anxiety, and create nonrepairable damage to certain audiologic parts of the brain.”

“Let’s sing,” he said, to illustrate the activity’s “beneficial psychologic and physiologic effects.” The group began with the simple beat of “When You’re Smiling” and ended by “multitasking” with sections of the audience simultaneously singing three different songs while keeping the beat with chopsticks and tapping feet. The singing session ended with smiling faces, laughter, and clapping hands.

Dr. Harvey explained the importance of predictable music, with structured cadences and orderly patterns, for the ill-health aging or those with Alzheimer’s, Parkinson’s, or other types of dementia.

Through his years of research and personal experience, which includes caregiving, Dr. Harvey has discovered the power of music for health, for motivation, for motor rhythmicity, for sleeping and waking, for energy and learning. “Music is not just for entertainment, worship time, or education. The brain needs the sounds of music. Music bridges all age gaps.”

Dr. Harvey is founder and Executive Director of Music for Health Services and Vice President of Sounding Joy Music Therapy, Inc., a new nonprofit organization promoting music therapy. For more information on the services available, please call 945-7878.

To inquire about music selections or to purchase CDs, books, and tapes, call Ms. Miki May (Dr. Harvey’s assistant) at 754-1456.

Caregivers understand, more than most, how fragile and fleeting memories can be. There can be no better gift than to start recording your memories now. Make it part of your “me” time.

“Every person has a story,” described Gary Powell. “Too often we look back and wish that we had spent more time with Grandpa and Grandma, our own parents, other family members. For our children and grandchildren, we will be the ones they look back to. Recording our memories helps to keep the family connections alive. It’s one of the best gifts that you can give your children.”

Mr. Powell’s own story began on the North Shore of Oahu, where he was born and raised. He discovered an early interest in the tales of old-timers and even as a child would sit, listen, and question for hours. He eventually crafted these personal chronicles into published articles and a play performed at Waimea Falls Park.

Circumstances led Mr. Powell to become an insurance agent for various companies, currently with New England Life. Concern for his clients, some older, some caregivers, brought him to our group, to learn more, to provide more assistance. He combines his career and various interests by presenting numerous community seminars throughout the year on a wide variety of subjects.

Getting Started. “To get started on your story, you can use a video recorder, a tape recorder, a typewriter, a computer, or write it out by hand. Whatever means you choose, be yourself. Don’t speak like someone else. Let yourself shine through, by using your favorite phrases and expressions.”

Seven Sections. The self-interviewing guide contains seven sections, each with a list of questions, structured to spur our memories and prompt stories.

“Okay,” said Mr. Powell, smiling at the members, “the first section deals with Where you came from. What do you know about your grandparents?” The list of nine questions includes names, nicknames, professions, also memories about great-grandparents. “It's too late to get most of the information,” explained one member. “I wish I had asked,” said another. “Let’s be the last generation to say that,” Mr. Powell expressed.

All about you includes questions on childhood memories about clothes, chores, pets, hobbies, school, games, organizations, events, gifts, and ends with “Describe your childhood in one sentence.”

All about your family includes questions on Father and Mother, entertainment, holidays, religious services, vacations, siblings, family cars, and shopping for food. “In my time, vendors traveled to homes,” explained one member. “The milkman delivered milk to our doorsteps.” “Do you remember the bus filled with produce that came once a week?” “There was also a tofu man that stopped by in his truck.” “We could get a big bag of candy for five cents.” “Candy was twenty-five cents a bag when I started buying.” “Movies were a quarter.” “For me, movies were always too expensive.”

Four other sections continue with All about your home, You as a teenager, You as an adult, Your thoughts and outlooks about life.

Members greatly appreciated receiving the guide. Some mentioned they would think about starting the project or working on it with the person they cared for. Anyone interested in a copy of the guide, inquiring about Mr. Powell’s schedule of presentations, or information on insurance, should call him at 722-1903.

Ms. Donna Whalen’s wide career includes private home care, family caregiving, and positions as a Skilled Nursing Facility Certified Activity Director, Volunteer and Special Events Coordinator, and Director of Community Relations for an assisted living facility. She schedules presentations (“Growing Older, Aging Akamai”) at various island libraries, where she speaks on a number of care option related topics.

Ms. Whalen currently works as the Community Relations Specialist for Health Care Solutions LLC, a family-owned business licensed in the State of Hawaii. The business provides a number of health care services, including 24-hour care, meal preparation, transportation, bathing, errands, and chores. The staff includes Registered Nurses, Licensed Practical Nurses, Certified Nurse’s Aides (CNAs), and CNA Technicians. The latter are trained to perform specialized services such as tube feedings.

Health Care Solutions also offers a six-week/120-hour Nurse’s Aide Training Program. Cost of the program is $650.00, which includes books, CPR, and first aid certification. Once students complete the course, they can go to the Red Cross to begin the CNA certification.

“The most important thing you can do,” Ms. Whalen explained to the members, “is to not lose track of yourself.” She described that caregivers often place their needs last. This accumulates a long list of want-to-do tasks that weighs down the mind, causes agitation, and contributes to a lack of focus. “With some help, caregivers can continue to attend to their own needs. Is it okay to ask for help? Yes. Is it the hardest thing to do? Yes.”

To aid our discovery of these “want-to-do” tasks, Ms. Whalen passed out brightly colored sheets of paper with six lines. “List six things you need to do for yourself in 2003. Pick one idea to complete each month, things in the back of your mind that you haven’t gotten done.” “I’ll read mine first,” volunteered a member. “I want to take walks, clean out the closets, plant two trees, throw out accumulated junk mail, and go to see the movie ‘Holes.’” “I want to organize 55 years of snapshots,” announced another member, “take a computer course, clean all the windows and shutters.” “I want to get my paperwork in order,” said a caregiver, “spend time with my grandkids, spend time with my friends, and work in the yard.” Other members wanted to do creative writing, take their family members out to dinner, spend time playing the guitar or ukulele, or have a massage.

Noncaregivers might wonder why completing such tasks would be difficult, but for the caregiver, finding time for the simplest chore amidst intense distraction often takes much effort.

“Getting things done gives you peace of mind. Mix and match services can help the caregiver find time during the day,” explained Ms. Whalen. “Home care is the number one choice. For some, an adult day care program is a big help.”

Another activity Ms. Whalen routinely does herself, just for fun, involves small personal rewards. Sheets of paper annotated with fun, simple “gifts to yourself” can be pulled out of a container. “Fun, relaxing activities,” she explained, “such as taking a leisure bath, reading a poem out loud, looking at the stars, forgetting an old grudge, practicing courage in one small way, giving yourself a present, humming, contacting someone you have been thinking about, organizing some small part of your life.”

Anyone interested in the services offered by Health Care Solutions LLC, learning about employment with the company, or Donna Whalen’s schedule of community presentations, should call 836-1085. Information can also be obtained by viewing the company’s Web site at www.hcshi.com or by emailing donna@hcshi.com.

By the end of the 1960s, Wahiawa General Hospital offered the first hospital-based Skilled Nursing Facility in the state. Following decades brought expanded services. Now the facility provides skilled nursing care, intermediate care, and rehab therapies.

For the past two years, Ms. Jennifer Matsui, MSW, has served as Social Worker for Wahiawa General Hospital’s 103-bed Nursing and Rehab Center. The two-story building adjoins the main hospital on the southwest side. Each floor has a nursing station, staff offices, tub room, shower rooms, small kitchenette, and dining room. Along the hall on either side, private, semiprivate, and four-bed wards accommodate short-stay rehab patients and long-term residents requiring intermediate or skilled nursing care.

Ms. Matsui explained that currently (subject to change) room and board prices range from $230 a day for a ward room to $250 a day for a private room. “Methods of payment,” she described, “vary from private pay, cost-sharing, Medicare, private insurance, and Medicaid.” Social workers can give families general information on payment options and, when appropriate, contact a private contractor to evaluate the prospective resident’s Medicaid eligibility and assist with applications.

Rooms reflect a wide array of decoration. Stuffed animals fill shelves, photos hang on the walls, balloons, flowers, and plants adorn various spaces. Many rooms contain personal radios, televisions, and other items. Ms. Matsui explained that residents are encouraged to have their own clothing and familiar, “non-valuable” items to personalize their rooms. Laundry service is available and haircut appointments at the facility can be scheduled.

When bed space becomes available, admission follows the following priorities: (1) patients from Wahiawa General Hospital Acute Care; (2) patients from other hospitals; (3) residents from other nursing facilities; (4) individuals on the wait list from the community. Generally, within each category, preference goes to those who live in the hospital’s nearby areas.

“What type of activities do you have for the residents?” a member inquired. “Do you have church services?”

Ms. Matsui pointed to a large calendar posted low on the wall, which highlighted events, guest performances, and a number of other activities. “Some residents prefer to read or watch television in their rooms. We honor that preference. Several churches schedule services throughout the month,” Ms. Matsui described. “Some of the residents attend their own church with their families.”

“Do you have a method to monitor those who wander?” another member wanted to know. “Yes,” Ms. Matsui responded, “certain residents wear a small device that will trigger door alarms. Also, wheelchair alarms and bed alarms are available. Resident safety and security are top priorities for us, but always balanced with the need to create feelings of comfort and home, where individual wishes and privacy are respected.”

Anyone with questions about the facility may call the hospital at 621-8411 and ask for Ms. Jennifer Matsui.

With the word “divine” came human and spiritual love which led to compassion.

She brought to our meeting a new perspective, an ability to gaze beyond the day-to-day trials of caregiving to a place where creativity and compassion can take hold. An educator, writer, published poet, and former caregiver, Ms. Frances Kakugawa shares her talents to allow others to examine and creatively express their innermost thoughts.

Her recent work, Mosaic Moon: Caregiving through Poetry, Easing the Burden of Alzheimer’s Disease, includes the poems of several local caregivers, members of the poetry/journalizing support group workshop which she conducts monthly at the Alzheimer’s Association, Aloha Chapter. “The purpose of the support group,” she explains, “is to help caregivers seek the divine and rise above the burden of care. If we can do that, then our loved ones will receive the best possible care from us.”

Ms. Kakugawa admits that many considered her an unlikely caregiver. Since childhood, she had consciously avoided the unpleasant. But in 1997, after her mother’s diagnosis of Alzheimer’s Disease, Ms. Kakugawa accepted the daunting role of caregiver.

Most friends responded with sympathy; one, who was a caregiver, wrote, “There is something very divine in being a caregiver.” “The word ‘divine’ became the key to my journey. I told myself that I would seek this ‘divine’ in my caregiving experiences. It began with the first poem I wrote in which I made a proclamation that I would not stray from this journey. It didn’t come easily. But from the word ‘divine’ came human and spiritual love which led to compassion.” Ms. Kakugawa expressed that indescribable joy came from creating a poem “from its undefined beginning to its final form. From being able to create beauty from something as devastating as Alzheimer's Disease.”

Writing helped to identify and resolve many of the problems that beset her day. Like other caregivers, she suffered from lack of sleep and worry over decision-laden occurrences.

But through the experience, she gained strength and insight which allowed her to discriminate beyond the disease. ”People would say, ‘It’s the disease, not the person.’” But, in pursuing the divine, she discovered that often it was the person, the person trying very hard to retain their disappearing self. By looking beyond the behavior, she found human dignity, honor, and the realization that loved ones are doing everything in their power to preserve whatever human dignity still existed. “Just as each caregiver is unique, so are our loved ones. Everyone is an individual. General rules do not always work, except to preserve human dignity, love, understanding, and compassion.”

“I saw every outward behavior as a heroic attempt on my mother’s part to retain the self that was disappearing. The ache that I felt, in a helpless way, was part of the divine that I sought and I found. I admired my mother for trying so hard to retain her own dignity through behavior that would be aggravating if we did not understand. I honored her to the very end.”

Copies of Mosaic Moon can be purchased at leading bookstores throughout the state. A portion of the proceeds will be donated to the Alzheimer’s Disease and Related Disorders Association, Inc., Aloha Chapter for medical research.

Ms. Kakugawa’s soon-to-be-published books are Teacher, You Look Like a Horse (Lessons from the Classroom) and a children’s story called Wordsworth, the Poet.

Anyone interested in attending the poetry/journaling workshops can call the Alzheimer’s Association at 591-2771.

Gary A. Powell, a member of the Central Oahu Caregivers’ Support Group, works as a financial representative with New England Financial. He has earned his LUTCF (Life Underwriters Training Council Fellow) and CLTC (Certified in Long Term Care). Both designations require lengthy study and continuing education.

Gary explained that his own caregiving experiences began as a teenager caring for his grandparents and continues today by assisting longtime friends. “When I got into insurance, I discovered a product that could minimize the tremendous hardship on personal finances associated with long-term care,” he explained, referring to long-term care insurance. But then, many people unfamiliar with the insurance considered premiums “frightfully expensive,” citing instead a preference to spend down assets, jeopardize homes, and become impoverished to allow Medicaid benefits to cover prolonged care.

“Now, people are becoming more aware of the need for long-term care insurance and realize that, in comparison to the cost of nursing homes, permiums are ‘dirt cheap.’ The reality,” Gary emphasized, “is that Medicaid may not be entirely available for the upcoming large group of ‘baby boomers.’ “Many of us just assume that, like our parents, we can apply for Medicaid to pay for nursing home stays,” a member remarked. Gary explained that the federal health insurance guidelines are under constant review to tighten requirements and eliminate loopholes that heretofore sheltered assets. Also, long reimbursement waiting periods and caps on payments cause detrimental cash flow problems for medical facilities, creating a reluctance, by many, to accept long-term Medicaid patients. With this understanding, more people are now opting for the added security offered by the insurance. Benefits finance care, ease the burden on familiies, and may allow policy holders to leave assets to their descendants.

Designing a Plan. “One person's plan may not be best for another.” Gary explained that policies should be individually designed by considering the policy holder’s personal finances, pensions, age, family medical history, and estimated length of need.

Choosing a Company. Gary cautioned that it is imperative to select a reputable, financially strong company, with a recognized history of administering long-term care insurance. Only a few companies meet the criteria.

Qualifying for Insurance. “Money pays the premiums, health buys the policy,” Gary explained. “Certain preexisting medical conditions disqualify persons from purchasing a policy. But don’t just assume you won't qualify; exceptions and waiting periods exist.”

What to Look For in a Policy.

1. Ensures bed reservation continuation during periods away from the facility, for any reason.
2. Offers payment for all levels of care (home care, day programs, nursing homes, alternative care, etc.).
3. Offers simple or compound inflation options.
4. Is a tax qualified policy.
5. When you receive benefits, you no longer have to pay premiums.
6. Covers respite care.
7. Includes six activities of daily living (including bathing).
8. Includes “standby,” not only “hands on” care.
9. Covers all mental conditions, including Alzheimer’s Disease.

Gary described a variety of other options, tax deductions, and alternatives to long-term care. Anyone interested in learning more should call your insurance agent or Gary Powell at 521-0818 or 722-1903.

Mr. Tom Oyasato has been a staunch supporter of the Central Oahu Caregivers’ Support Group from its beginning, offering ideas and a variety of assistance. His assistance led to the creation of our Caregivers’ Library, to which he donated literature and provided furniture to ensure patrons’ comfort.

A former postmaster, Mr. Oyasato has been a caregiver for almost 24 years. Quiet, unassuming, and intensely private, he spoke to group members with unusual frankness, describing his experiences with the hope of helping others, to make their way just a little easier by sharing what he had learned.

“In 1980,” he described, “I began to notice changes in my wife’s behavior.” Simple tasks previously done with ease seemed to confuse her. He wondered whether Evelyn, 55 at the time, was just “getting older.”

Visits to doctors brought no answers, except that they could find nothing wrong. Other symptoms developed, and Mr. Oyasato became more concerned. “Something is wrong,” he would repeatedly state to various physicians. But their examinations revealed nothing.

Work became difficult for Mrs. Oyasato and she retired at age 55. Mr. Oyasato retired shortly thereafter and decided that, while the opportunity still existed, he and Evelyn would travel together to Europe, China, Japan, the Aegean Sea, and to parts of the U.S. mainland. Fellow travelers assisted, but he found his responsibilities growing, while his wife's abilities declined.

In 1986, about six years after his initial concerns, he took her for specialized testing and learned that Evelyn had Alzheimer’s Disease, the progressive, degenerative brain disorder that robs the afflicted of memory, reason, and ability to function.

As the disease progressed, his wife began to get lost on her daily walks, sometimes falling as her limbs began to weaken.

“I read everything I could to understand the disease, to make it easier for everyone, especially my wife,” Mr. Oyasato explained. He found that it oftentimes took a great deal of effort, patience, trial, and error to discover the best way to provide care. Simple tasks such as teeth brushing, sitting in a chair, toileting, and bathing required developing new techniques and buying special equipment. A Toto toilet proved effective, certain laxatives worked, others did not. “You just have to try different things until you find something that solves the problem.”

He quickly accepted that the changes to his wife were “not her fault, that she couldn't help it.” He explained that this attitude, this understanding, for him, removed irritation, frustration, and negative feelings. Only once did anger occur, when brushing her teeth left him with a bleeding, bruised finger.

Much of Mr. Oyasato’s day now involves caring for his wife, pureeing her food, tending to her bathing, toileting, and grooming. Once a year he goes on a trip, occasionally he will meet friends for golf or other events. This “time away,” he has learned from his readings and experience, is crucial to his own well-being. During those times, family members “step in” as primary caregivers.

“You never know how long you will be a caregiver. It really helps to read and learn as much as you can,” he says. “Take advantage of services and resources, take care of yourself, and do the best you can.”

“As you all know, family caregiving has been going on in homes for ages. Recently, the situation has emerged as a public policy issue. Policy makers and government leaders recognize that our long-term care system could not exist without the services provided by family caregivers. In Hawaii and other states, legislation and government actions are being developed to provide assistance and support to caregivers.  —Wes Lum, Coordinator, Caregivers Resources Initiative Project, State Executive Office on Aging

At times, Mr. Wes Lum attends five different caregiver support group meetings a month, to hear the concerns and stories of Hawaii’s caregivers and to discover their needs. As Coordinator of the Caregivers Resources Initiative (CRI) Project, administered by the State Executive Office on Aging, his tasks include developing a statewide, comprehensive support system for caregivers. He explained that the project was established about two years ago, coincident with the creation of the National Family Caregivers Support Program and first-time federal legislation that directed states to develop support systems, products, and services for family caregivers.

Many of the initial goals of the young project have been accomplished. A quarterly newsletter highlights caregivers’ issues. A statewide caregiver study, completed in 2002, provides a “nice snapshot of Hawaii caregiver demographics, wants, and needs.” A caregiver web site has been designed and may be operational soon. In addition to the expected features, the web site will include a bulletin board, where caregivers can post and receive information; a chat room, where caregivers can communicate with each other; and an up-to-date legislative page of policies and bills related to caregivers. A Hawaii Family Caregiver Network of approximately 800 people has been formed, which offers caregivers and policy makers the ability to give and receive information.

With the creation of a database and network, efforts are now underway to create a coalition of organizations interested in supporting family caregivers. The Executive Office on Aging and four other organizations have agreed to serve as charter members. Other business, government, and private organizations will be invited to join the coalition and participate in education, public awareness, policy development, and system development planning.

In the near future, caregiver kits will be available for distribution, caregiver classes are being developed, and legislation is being drafted related to caregivers.

Mr. Lum described that direct services to caregivers are provided by various organizations that have received federal money passed from the state to the counties. The state drafts policies, introduces legislation, and — in the case of federal funds received from the National Family Caregiver Support Program — disburses monies to the counties, who in turn provide grants to various caregiver assistance organizations.

Anyone interested in learning about the CRI Project, caregiver assistance organizations, receiving the newsletters, or any of the developing programs, can call Mr. Wes Lum at 586-0100.