Joint Legislative Committee on Family Caregiving; Kupuna Care; Appropriations
Extends the joint legislative committee on family caregiving; changes the committee's name to the joint legislative committee on aging in place; expands the committee's mandate to include aging in place issues related to family caregiving; requires the Hawaii aging and disability resource center to report to the committee; requires the joint legislative committee to design a cash and counseling project; appropriates funds to the joint legislative committee; allows kupuna care to include overnight, weekend, and emergency respite, as well as provide grants to caregivers and for home modification; appropriates funds to the kupuna care program. (HB2196 HD2)
HOUSE OF REPRESENTATIVES
TWENTY-FOURTH LEGISLATURE, 2008
STATE OF HAWAII
A BILL FOR AN ACT
RELATING TO CAREGIVING.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
PART I. JOINT LEGISLATIVE COMMITTEE ON FAMILY CAREGIVING
SECTION 1. (a) The legislature finds that during the 2007 interim, the joint legislative committee on family caregiving continued its work on creating a comprehensive and sustainable, community-based family caregiver support system that includes:
(1) A coordinated referral and case management service;
(2) Centralization of available services;
(4) Education and training; and
(5) Financial assistance.
During the 2007 interim, the joint legislative committee had the benefit of examining localized studies and surveys, some of which contained preliminary results, which provided concrete evidence of the needs of family caregivers. The joint legislative committee also had the benefit of looking at what other states have done and are doing in response to the growing concern of eldercare issues.
(b) The purpose of this part is to:
(1) Extend the work of the joint legislative committee for one year;
(2) Change the name of the joint legislative committee on family caregiving to the "joint legislative committee on aging in place"; and
(3) Require the Hawaii aging and disability resource center to provide the joint legislative committee with an update on its physical site in Hawaii county, and the "virtual" site in the city and county of Honolulu.
SECTION 2. Act 285, Session Laws of Hawaii 2006, as amended by Act 204, Session Laws of Hawaii 2007, is amended by amending section 2 to read as follows:
"SECTION 2. (a) There is established a
joint legislative committee on [
family caregiving.] aging in place.
The committee shall be composed of eight members as follows:
(1) Four members of the house of representatives, consisting of three members from the majority party and one member from the minority party, who shall be appointed by the speaker of the house of representatives; and
(2) Four members of the senate, consisting of three members from the majority party and one member from the minority party, who shall be appointed by the president of the senate.
The committee shall select a chairperson from its membership.
(b) The joint legislative committee shall develop comprehensive public policy to strengthen support for family caregivers. For purposes of this Act, "family caregiver" means:
(1) A person, including a [
such as a friend or neighbor, who provides unpaid, informal assistance to a
person age sixty and older with physical or cognitive disabilities; and
(2) A grandparent who is a caregiver for a grandchild who is age eighteen years or younger, or who is nineteen years of age or older with physical or cognitive limitations.
(c) The joint legislative committee shall:
(1) Consider providing support in categories, including:
(A) Coordinated services and policies;
(B) Training and education;
(C) Respite services;
(D) Financial incentives; and
(E) Balancing work and caregiving; [
(2) Explore establishing a paid family leave program under the state temporary disability insurance law, similar to the California Paid Family Leave Program, to provide wage replacement benefits to employees who take time off from work to care for a seriously ill family member.
(d) The joint legislative committee may explore issues of "aging in place" as they relate to family caregiving.
(e) The Hawaii aging and disability resource center shall provide an update to the joint legislative committee of its development and implementation of the physical site for the center in the county of Hawaii, and the "virtual" site planned for the city and county of Honolulu.
(d)] (f) The joint legislative
committee shall seek input from the department of health, the department of
human services, the department of taxation, the University of Hawaii, the executive office on aging, and the elderly, disability, business, and faith-based
(e)] (g) The joint legislative
committee shall submit its findings and recommendations to the legislature no
later than twenty days prior to the convening of the regular sessions of 2007 [ and],
2008[ .], and 2009.
(f)] (h) The joint legislative
committee shall cease to exist on June 30, [ 2008.] 2009."
PART II. FINANCIAL ASSISTANCE FOR CAREGIVING
SECTION 3. The cash and counseling program is a national initiative sponsored by the Robert Wood Johnson Foundation; the United States Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation; and the Administration on Aging. Under the program, recipients of medicaid personal care services or home- and community-based services receive a flexible monthly allowance and decide who to hire and what services they want to receive.
The program's innovative approach enables participants to direct and manage their personal assistance services according to their own specific needs. Participants can choose a family member or friend, in lieu of an agency worker, to provide the services. They receive counseling and fiscal assistance to help them manage their allowance and responsibilities. The program was first implemented in Arkansas, New Jersey, and Florida, and has since expanded to include other states.
During the 2007 interim, the joint legislative committee on family caregiving received information and data related to the family caregivers needs assessment conducted by the executive office on aging, and cash and counseling research conducted by the executive office on aging and the University of Hawaii school of social work.
The family caregiver needs assessment indicated that caregivers need more affordable services and financial assistance. The cash and counseling research demonstrated that those states that had cash and counseling programs reported high satisfaction by both caregivers and care recipients and allowed informal caregivers to receive financial recognition for their services.
In Hawaii, there are out-of-pocket costs for families to pay for home- and community-based programs that are available for elders and persons with disabilities. The government pays for these services for those who have lower incomes and qualify for medicaid. However, a majority of Hawaii's families are ineligible for public assistance and are having to carry the financial burdens of caregiving. This leaves a gap in services for those elders of modest means. As a result, this group of individuals has the least coverage in terms of home- and community-based services. Hawaii should consider providing a cash and counseling program to non-medicaid eligible elders to allow this group of individuals to have control over their care, while benefiting their caregivers.
The work on cash and counseling being conducted by the executive office on aging and the University of Hawaii school of social work will continue until the end of the 2007-2008 fiscal year. The research conducted shows that a cash and counseling program is worth pursuing, and it is essential to continue the work in developing phase two of a cash and counseling project that can be completed by the end of 2008.
SECTION 4. The joint legislative committee on aging in place shall design a cash and counseling project for nonmedicaid participants to direct and manage their personal assistance services according to their own specific needs, while enabling family caregivers to receive a level of financial recognition and support. In designing a cash and counseling project, the joint legislative committee may consider including a respite care component, a case management component, a separate fiscal agent, a personal care component, and allowing the consumer to be the employer of any service provider, whether an agency or family member.
The joint legislative committee may contract with a qualified consultant to design a cash and counseling program.
A contract executed pursuant to this section and section 5 of this Act shall be exempt from chapter 103D, Hawaii Revised Statutes; provided that the joint legislative committee shall endeavor to ensure transparency in the letting of the contract.
The project shall include an advisory group to assist with the design of the cash and counseling program. To ensure that those who have the greatest need and the fewest resources are served by the program, the advisory group shall examine whether an asset limitation or restriction on consumers shall be implemented in the design of the cash and counseling program.
The joint legislative committee shall report on the results of its efforts to design a cash and counseling project as part of its report to the legislature pursuant to section 2 of this Act.
SECTION 5. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2008-2009 for the joint legislative committee on aging in place, which may contract with a qualified consultant to design a cash and counseling program, pursuant to section 4 of this Act. The sum appropriated shall be allocated as follows:
House of representatives $
The sum appropriated shall be expended by the senate and house of representatives to assist the joint legislative committee on aging in place for the purposes of this part.
PART III. KUPUNA CARE
SECTION 6. On July 1, 1999, the executive office on aging launched its statewide long-term care program called kupuna care. Kupuna care was developed in partnership with the county agencies-on-aging to address the growing numbers of elders with long-term care needs.
Services provided by kupuna care are intended to help meet the needs of older adults who cannot live at home without adequate help from family or formal services, and includes services such as adult day care, respite care, assisted transportation, attendant care, case management, chore, home delivered meals, homemaker, transportation, and personal care.
Kupuna care was designed to assist, not totally support, Hawaii's older adults to live independently, safely, and healthily for as long as possible. The care may cover United States citizens or legal aliens sixty years of age or older who are not receiving other comparable government assistance, who need help with activities of daily living (eating, dressing, bathing, toileting, transferring, and mobility) or because they have reduced mental capacity, and who are not residing in an institution.
State funds cover the cost of services for those who cannot afford to pay. Voluntary contributions to the service provider are welcomed for any service provided and are used to support the cost of care of additional clients.
In addition to the services provided to the elderly, kupuna care also offers services for the family caregivers of their elderly clients. As Hawaii's population ages, many more families will be providing higher levels of long-term care to frail and disabled older adults at home. For many family caregivers, their role as family caregiver arises as suddenly as the care recipient's health declines, leaving the family caregivers with an immediate need for services, but little preparation or education regarding who to contact for assistance or what services are available to them. In addition, the family caregivers may not know who is capable or qualified to provide them with the services that they or the care recipients need. Family caregivers themselves need support services, including training, education, and counseling in areas such as caregiving and dealing with end-of-life issues.
In addition, there are emotional, physical, and financial costs of being a family caregiver. Younger family caregivers are often in critical need of finding ways to reduce the stress caused by caregiving.
Respite has been shown to be beneficial in lowering stress and other negative consequences of caregiving and the State of Hawaii Caregivers Need Assessment (2007) shows that respite is something family caregivers need.
Besides the everyday stress that respite can relieve, there are times when a family caregiver may unexpectedly become unable to provide the needed caregiving services due to illness, an accident, or other reasons. At these times, emergency respite care becomes critical.
The needs assessment also shows that family caregivers need financial support as they carry the heavy financial burdens of caring for a loved one. In addition, both caregivers and care recipients need financial assistance in making necessary home modifications that will allow the care recipient to age in place.
The legislature finds that the kupuna care program can expand its services and incorporate progressive ways of helping meet the growing needs of Hawaii's older adults and allow these individuals to age in place.
The purpose of this part is to:
(1) Allow the kupuna care program to:
(A) Offer emergency, overnight, and weekend respite services;
(B) Provide grants for home modifications that facilitate aging in place pursuant to a care plan as part of a cash and counseling approach; and
(C) Provide grants to family caregivers pursuant to a care plan as part of a cash and counseling approach;
(2) Amend the 2008-2009 operating budget of the executive office on aging to increase program funding for kupuna care and ensure that kupuna care continues to maintain the quality of life of Hawaii's older adults and their family caregivers.
SECTION 7. The kupuna care program, as administered by the executive office on aging, may:
(1) Offer emergency, overnight, and weekend respite services;
(2) Provide grants for home modifications that facilitate aging in place pursuant to a care plan as part of a cash and counseling approach; and
(3) Provide grants to family caregivers pursuant to a care plan as part of a cash and counseling approach.
SECTION 8. Act 213, Session Laws of Hawaii 2007, is amended by adding a new section to part III to be appropriately designated and to read as follows:
"SECTION . Provided that of the general fund appropriation for the executive office on aging (HTH 904), the sum of $ or so much thereof as may be necessary for fiscal year 2008-2009 shall be expended by the executive office on aging for its kupuna care program."
SECTION 9. Act 213, Session Laws of Hawaii 2007, is amended by amending part II, section 3, item F.26 to read as follows:
OPERATING HTH 6,370,552A [
HTH 7,443,720N 7,443,720N
INVESTMENT CAPITAL HTH 250,000C C"
PART IV. MISCELLANEOUS PROVISIONS
SECTION 10. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 11. This Act shall take effect on January 1, 2050.