Caregiving

Medicare is federal health insurance for people 65 years older, and some people under 65 with certain disabilities or conditions. Medicare does not pay for home care or long-term care services. Medicaid is a joint federal and state program that provides health coverage or nursing home coverage for people with limited income and resources. The Medicaid program in Hawaiʻi is called Med-QUEST.

Learn more:

• Med-QUEST: What is Medicaid?
• Hawaii SHIP – Free, Local, One-on-One Medicare Counseling
• U.S. Department of Health and Human Services

Home care is personal care services provided in the home or community. It may include assistance with activities of daily living (e.g. bathing, toileting, meal preparations, etc.), chore services or light housekeeping, escort to appointments or grocery shopping, companionship and supervision. Home health care includes a range of intermittent skilled services provided in the home for an illness or injury. It may include physical therapy, occupational therapy, speech-language pathology services, and intermittent skilled nursing care like wound care, monitoring serious illness, or patient education.

Home care is often paid for privately, with long-term care insurance, or Med-QUEST. Home health care may be covered by Medicare, private health insurance plans, or Med-QUEST.

Learn more:

• Medicare.gov
• Hawaiʻi Department of Health – Home Health care
• Hawaiʻi Department of Health – Home Care Info

Both are services that provide supervision and assistance for adults during the daytime. Adult Day Care help seniors remain engaged while promoting physical and mental health through socialization, activities, meals, minimal assistance and gentle exercise. Adult Day Health includes the same services as Adult Day Care but may also provide medication administration, more assistance with personal care, skilled nursing care, physical therapy, health monitoring (e.g. blood glucose levels), and support for ongoing health conditions. Both Adult day care and adult day health are often paid for privately, with long-term care insurance, Med-QUEST, or the State Kupuna Care Program.

Learn more:

• Adult Day Centers Hawaii
• Hawaiʻi Department of Health
  • Licensed Adult Day Health Centers
  • Licensed Adult Day Care Centers

Both care homes and foster homes are non-institutional settings where adults can go to live and receive care in a residential home-like setting. In Hawaiʻi, we often use the term “Care Home” for Adult Residential Care Homes (ARCH) and the term “Foster Home” for Community Care Foster Family Homes (CCFFH).

An ARCH is a type of residential care home for adults who require at least minimal assistance with activities of daily living (ADL), such as bathing, walking, dressing, eating, and toileting. There are different levels of care for ARCHs. An Expanded ARCH cares for adults who require 24/7 assistance with ADLs and/or may require skilled nursing  services. An ARCH usually has one to five residents, but level II ARCH and level II Expanded ARCH can have six or more residents. ARCH costs are usually around $6,000-12,000+ per month for private pay and some residents may use long-term care insurance.

A CCFFH is a type of residential care home where residents live with the home-owner family and receive assistance with ADLs. They provide a higher level of care called intermediate care facility (ICF) level that is often provided in large institutional facility settings except CCFFHs provide this care in a home like setting. CCFFHs usually have three residents. CCFFHs are often more affordable than ARCH. CCFFH usually costs start around $4,000-$6,000+ per month for private pay and they are required to accept at least one resident on Med-QUEST or Medicaid. CCFFH residents are required to have a case management agency to monitor their care and this may cost private pay residents $500+ per month.

Learn more:

• CareSift Info about Adult Residential Care Home & Community Care Foster Family Homes
• Kupuna Care Pair has a map and searchable listing of care homes, foster homes, and facilities in Hawaiʻi.
• Hawaiʻi Department of Health, State Licensing Section – Click the lists of ARCH and CCFFH

A Geriatrician is a doctor who is specially training in treating older patients, especially those with multiple health problems or complex conditions. Geriatricians promote quality of life, preventative care, and healthy aging. Geriatricians may be more familiar with managing illnesses and addressing issues that are more common among older adults, such as dementia, arthritis, fall risk, advance care planning, end of life care, etc. Geriatricians have a specialized approach to medication management for older adults, considering multiple comorbidities, longer half-life, potential interactions and side effects. Primary Care Physician make refer older patients to see a Geriatrician and patients may continue to receive medical services from both disciplines.

Here’s few links to specialty Geriatric clinics:

• Kokua Kalihi Valley
• Queen’s Geriatric Services Website
• Hawaii Pacific Health Geriatric Medicine
• Kaiser Geriatric Medicine
• JABSOM Department of Geriatric Medicine
• Click here for more guidance finding a provider near you.

Respite care is temporary care intended to provide short-term relief for primary caregivers. Respite gives the caregiver time to rest, do self-care, errands, travel, or spend time with other family and friends. Respite care can last anywhere from a few hours to weeks at a time. It’s usually provided at home by private home care agencies, at an adult day care center, in a nursing facility or assisted living facility. It’s most often private pay, but it may be covered through long term care insurance or the state kupuna care program.

Click here to visit the Hawaiʻi Department of Health State Licensing Section website to view listings of Hawaii Licensed Home Care Agencies, Adult Day Care Centers, Skilled Nursing / Intermediate Care Facilities, and Assisted Living Facilities.

Hawaiʻi Caregiver Foundation – List of Oahu Respite Resources
https://thecaregiverfoundation.org/learn-more/mental-illnesses/respite-care

Call the statewide Aging and Disability Resource Center to find options for services and supports.
Phone: (808) 643-ADRC (808-643-2372)
TTY: (808) 643-0889

The Advance Health Care Directive is an important advance care planning document. This is a written statement about the type of care you want and the people you trust to help you with health care decisions, if you can no longer speak for yourself. It is a gift to family and friends so that they won’t have to guess what your wishes are. It empowers your choice.

Everyone age 18 years or older should have an Advance Health Care Directive. It is especially important for people with Mild Cognitive Impairment, early-stage dementia, or any illness to complete an Advance Health Care Directive as soon as possible. An Advance Health Care Directive can only be completed while the person has capacity to make decisions about their care. The Advance Health Care Directive can be made official by having a notary or two witnesses sign with you. Visit Kokua Mau – Advance Directives to download an Advance Directive with instructions and view frequently asked questions.

Video: Advance care planning with Kristin Lambert Bryant, Attorney at Law

Read: The Essential Elder Law Hawaiʻi Handbook

It is also important to consider working with professionals to complete a Providers Orders for Life Sustaining Treatment (POLST) form and a durable Power of Attorney.

A POLST form can be completed with a health care professional. “POLST is a form that contains medical orders that specify the type of care you would like in the event of a medical emergency. This form can be quickly understood by all healthcare professionals, including first responders and ambulance personnel,” (Kokua Mau). Click here to learn more.

One should seek competent legal advice to draft a Power of Attorney for financial decisions. This is a legal document that designates an agent, usually a trusted family member or friend, to assist you with managing property or business affairs if one day you do not have the capacity to do so. A caregiver will need this Power of Attorney in order to assist with paying bills and managing the funds.

Learn more:

• Legal Aid Society of Hawaiʻi
  • Call: 808-536-4302 (OʻAHU) or 1-800-499-4302 (NEIGHBOR ISLANDS)
  • Main website: https://www.legalaidhawaii.org/
• Hawai‘i State Bar Association
  • For attorney referrals and more information, contact the Lawyer Referral & Information Service office at (808) 537-9140 or by email at LRIS@hsba.org.
  • Website: https://hsba.org/
  • Free Legal line: Volunteer attorneys host a telephone hotlineevery Wednesday evening from the hours of 6:00 p.m. – 7:00 p.m. only to provide free legal information to the public. Call (808) 537-1868. This one-hour weekly program assists members of the public who may not have access to an attorney and need general advice or who just want to be pointed in the right direction to get information.

Caregiving is a hard job that most of us are not prepared for, and yet we end up filling this role at a moment’s notice. Kudos to you for answering the call! Here are a few resources with information on how to navigate day to day activities with a person living with dementia.

• Hale Kū‘ike Dementia Education Hub has multiple videos and articles about daily tasks like dining with dementia, activities, and dealing with behaviors.
  • Dining with Dementia — Techniques to Bring Joy to the Table – Hale Kū‘ike
  • Challenging Behaviors: Recognizing Unmet Needs
• Alzheimer’s Caregiving and The Caregivers have online resources about managing behaviors, meals, clothing, hygiene, and more.
  • Visit Website
• Teepa Snow Videos: Dementia Care Tips for Hygiene, Bathing Support, and Validation
  • Using Hand-under-Hand to Assist with Getting Dressed – Shirts and Coats
  • Care Partner Support Tips: Getting In and Out of the Car
  • Using Hand-under-Hand to Support Someone to Stand
• Catholic Charities Hawai‘i Circle of Care for Dementia has a range of videos from past webinars on all topics related to dementia care.
  • https://www.catholiccharitieshawaii.org/caring-for-persons-living-with-dementia-webinars-and-presentations/
  • Dementia and Dysphagia (Swallowing Difficulties)

It’s a big step to acknowledge the need for care and accept help for you or your person. It doesn’t mean you’re a failure. It means that you’re prioritizing safety and well-being by getting the care you need. As the care partner, you’re caring for your person by getting the respite you need to keep going.

There are different types of care to consider, such as home care, adult day care, and residential settings like care homes. Click the other FAQ titles to learn more about the difference.

You can call senior care agencies directly to learn more about their services and arrange care for your person. If this seems daunting, it can be helpful to call for guidance. Here’s a few places to get started:

• CareSift offers a free service to patients and families by providing real, caring, local experts to assist with finding care that meets your needs. Contact them for a free consultation at (808) 400-9922, email info@caresift.com, or visit the website https://caresift.com/.
• The Aging and Disability Resource Center (ADRC) helps older adults, individuals with disabilities, and family caregivers find options for long term supports and services available to them in the State of Hawai‘i. There is a local ADRC in every county. This phone number will direct your call based on the county you are calling from. Call: (808) 643-ADRC (808-643-2372) or TTY (808) 643-0889
• If you or your person has Med-QUEST, they can assign a health coordinator or service coordinator to assist with navigating care. Call your QUEST integration health plan today and request a health coordinator to be assigned to your care.
  • AlohaCare Service Coordinator Info – Call (808) 973-0712 (Oahu) or toll-free at 1-877-973-0712. TTY users call 1-877-447-5990
  • HMSA Health Coordination Info – Call (808) 948-6997 or 1 (844) 223-9856.
  • Kaiser Health Coordinator Info
    • Call: 808-432-5330 or toll-free at 1-800-651-2237. TTY users call 1-877-447-5990 (for the hearing/speech impaired)
    • Email your Service Coordinator through kp.org.
  • Ohana Health Plan Service Coordination Program – Call toll-free at 1-888-846-4262 (TTY: 711)
  • UnitedHealthcare Community Plan QUEST Program Info – Call 1-888-980-8728 (TTY users 711)

Senior care can be quite expensive to pay for out-of-pocket, especially if someone does not have long-term care insurance or significant retirement savings. Here are a few resources to find assistance:

• The State Kupuna Care Program provides services intended to help older adults live independently in the community, safely and healthily, for as long as possible. These services may include Adult Day Care, Assisted Transportation, Attendant Care, Case Management, Chore services, Home Delivered Meals, Homemaker, Transportation, and Personal Care. This program is administered by the Area Agencies on Aging (AAA). Call: (808) 643-ADRC (808-643-2372) or TTY (808) 643-0889 and your call will be directed to your local AAA based on the county you are calling from.
• Medicaid is a joint federal and state program that provides health coverage and long term services and supports for some people with limited income and resources. The Medicaid program in Hawaiʻi is called Med-QUEST. These are the Long-Term Services and Supports that Med-QUEST may provide to members who qualify and meet appropriate level of care. Click here to get started on your application. This website has a quick Pre-Assessment to find out if you could qualify.
  • If interested in Medicaid Financial Consulting, this resource may be helpful: https://scottgardnerco.com/

Here are a few organizations with volunteers who provide support for older adults in Hawaiʻi at no cost:

• Our Kupuna connects kūpuna with volunteers who can shop and deliver groceries, medication and other necessary supplies. Call 808-215-0073 to see if you meet their eligibility requirements. Visit their website: https://www.ourkupuna.com/
• Project Dana has volunteers who offer non-medical services on Oʻahu to assist elderly in instrumental activities of daily living (IADLs) such as, transportation, grocery shopping, light housekeeping, and friendly visitation. Call (808) 945-3736 and visit their website: https://www.projectdana.org/
• Nā Hoaloha has volunteers on Maui who can provide friendly visitation, telephone reassurance program, escort transportation services, in-home respite, and falls prevention program. Call (808) 249-2545 and visit their website: https://nahoaloha.org/
• Catholic Charities Hawaiʻi has a wide array of Senior Services (e.g. Case management, housing assistance, transportation, Phone-A-Friend, workshops, caregiver support, etc.). They also have a Memory Mentor Programwhich offers free in-home services for seniors with memory loss who are living alone with little or no caregiving support. Volunteers may provide friendly in-home visits, safety checks, grocery shopping, help with reviewing mail, and providing reminders. Visit their website to learn more: https://www.catholiccharitieshawaii.org/senior-services/ Contact their Senior Intake Line at (808) 527-4777.

If you know of other programs who should be listed here, please email DOH.Dementia@doh.hawaii.gov