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