Are we ready to really address aging in Hawaii?

AN OPEN LETTER TO DR. GOVERNOR GREEN, AND OTHER LEADERS OF HAWAII

Over 25 years ago, having served as Chair of the House Committee on Health, I earned a doctorate focusing on aging. 

The title of the dissertation was The Politics of Community Based Partnerships in The Development of Alternative Elder Wellness Networks and Service Delivery Systems.

Even more than 25 years ago it was obvious that our health and insurance systems could not or would not respond to or accommodate our growing senior population.  Among our challenges were:

1.  Our senior living facilities were expensive and unable to accommodate even the wealthier seniors.

2.  Even those with insurance or government pensions were unable to easily access urgent, nonbureaucratic affordable care. 

3.  So many older adults were living in isolation or 

alone in apartments and condos disconnected with even annual health exams or custodial care.

9. Options to “choose” one’s own specialists in fee for service insurance (HMSA) were beyond the average patients’ knowledge, and often with significant delays. Other systems like Kaiser also offered options. 

10. Shortages in some caregiver professions further delayed some treatments. 

11.  The open doors, friendly, community based health centers were challenged to accommodate specific community needs.

12.  University expertise in health policy were spotty, dependent on individual faculty,  and sometimes unwilling to dive into actual service delivery agreements.   

Today we, The Governor, SHPDA, and others are confronted with a proposal to essentially merge the already very popular and powerful HMSA with Hawaii Pacific Health, which intends to strike a lucrative administrative alliance with other fee for service entities based on the mainland: so theoretically less tied to and engaged with the needs of certain more vulnerable patient groups in our Islands. 

What we may be missing are the daily easy to access urgent needs of the poor, the frail, the disabled, and the suddenly ill, many of who are aging well above the age of 70.  

Major questions to The State Health Planning and Development Agency, which apparently has the power to approve or deny the merger is this:   Will the new arrangement accommodate these seniors at all, or better that we as a state have actually done in the past?

Will HMSA and whatever partners it will have, even under a nonprofit, make a concerted effort to open up urgent care affordable clinics?

The politically well connected to the large and influential HMSA seem to have major leverage without committing to a different aging friendly structure.

To be specific, for so many that are living in isolation this is a list identified by seniors surveyed for the dissertation:

1. Physical crisis;

2. Impaired eyesight;

3. Impaired hearing;

4. Confusion over papers and documents;

5. Impaired speech;

6.  Confusion over taking medications;

7. Buddy system for daily check-ins;

8. Controlling diet;

9. Remembering when to take medications;

10. Paying for medications;

11. Outside mobility, to Dr., shopping;

12. Household cleaning;

13. Inner household mobility;

14. Personal bathing;

15. Personal grooming;

16. Laundry;

17. Depression;

18. Need to talk about feelings;

19. Household crime prevention;

20. Household fire safety;

21. Companionships during holidays;

22. Outside mobility for recreation;

23. Skill in cooking;

24. Skill in shopping for food;

25. Household weather damage;

This proposed “merger” is an opportunity to reassess our aging friendly systems.  We need to rethink what may not have been ready for this tidal wave of boomer seniors who are living often disconnected from support system.

Whatever leverage our Governor or other leaders or policy influencers may have, we need to use it to craft a renewed and more innovative community based service delivery system.

Jim Shon, PhD

Honolulu, Oahu