POLICY ADVISORY BOARD FOR ELDER AFFAIRS (PABEA) Friday, January 6, 2017

MEETING MINUTES

Members Present: Colette Brown, James Cisler, Patrick Duarte, Tony Lenzer, Joy Miyasaki, Adele

Rugg, Marilyn Seely, Gary Simon, Scott Spallina, Beverly Jean Withington, Sarah Yuan, Tom Duran, Kanoe Margol, David Rodriguez

Members Absent: Suzie Schulberg, John Tomoso, Kathy Ishihara, Keith Ridley, Margaret Perkinson,

Melina Sanchez Others present: EOA Staff: Aaron Arakaki, Terri Byers, Caroline Cadirao, Jen Ching, Loren

Okamura, Debbie Shimizu TJ Davies, Nathan Hokama, Charlene Iboshi, Neva Keres, Barbara Kim-Stanton, Larry Nitz, Sharon Nobriga, June Renaud, Barbara Service, Lori Tsuhako, Lori Wada, Tessy Yokota

The meeting called to order by Joy Miyasaki at 12:10 p.m. ROLL CALL Fourteen (14) members present. MINUTES October and November minutes were approved. December minutes are still pending. INTRODUCTIONS Everyone introduced themselves. DISCUSSION ISSUES Chair’s Report Joy mentioned two items: 1) Letters were sent out to ex-officio department heads to confirm their designees appointed to

PABEA. a. No letters were sent out to DOE and DHHS as CMS is under DHHS, but SSA is not.

2) Joy and Gary met with Speaker Souki and confirmed PABEA’s methods is good for Legislative advocacy. Also, met with Senate President Kouchi and he would write a general letter to invite PABEA to contact them.

3) Caroline will look at the OAA to see if there are any stricter requirements about PABEA’s advocacy efforts.

PABEA Committees Legislative

Gary shared the committee’s nine legislative priorities. (See attached Legislative priority dated 12/29/17) All priorities were motioned and approved by PABEA board.

Plans and Projects Review Marilyn mentioned that the committee is working on the By-laws. Recognition and Awards Jim reported the committee still lacks quorum. The OAM event will be on June 2 Friday. The place, time, and logistics are pending. Aging Network Executive Office on Aging Terri reported that Senator Baker will present her Kupuna Care bill at Kupuna Caucus. EOA’s Planner starts 1/11/17. Kauai County on Aging June reported: - Conducting pilot program for NWD system and start training at the end of the month - This past December, I&R Assistance staff did a site visit with MCOA staff. Maui County on Aging Lori reported: - Staff enjoyed visiting Kauai staff. - Trying to partner in the community to develop Healthy Aging program and have sufficient capacity - Participating with Caroline and staff on advocacy efforts for Healthy Aging Hawaii County on Aging Kimo emailed HCOA report. (See attached HCOA report). Members Report David from DOT mentioned that DOT will be supporting bills that address drunk driving, speeding, and distracted driving (ie. increase fines) for pedestrian safety. Kanoe from ERS mentioned that ERS issued the quarterly newsletter last week for retirees and active members that contain important year-end tax information and Medicare information. Tom from CMS mentioned CMS implementing quality payment program established under MACRA so clinicians, hospitals, and anyone who receives Part B reimbursements have to comply with CMS’ quality payment program unless excluded. This changes how CMS pays for Medicare Part B claims. It shifts from payment-for-volume to payment-for-value so patients should have more quality care. The first payment adjustments based on performance go into effect on January 1, 2019.

STATEMENTS FROM THE PUBLIC Barbara from AARP commented about AARP started looking at the what’s happening at the federal level. Matters that happen at the federal level will impact the state level. Tony asked that AARP keep PABEA apprised of issues so PABEA can respond accordingly to some of the challenges.

OLD BUSINESS Debbie for No Wrong Door: - End of month trainings with KAEA staff and pilot with new referral forms - HCBS Summit (MedQuest, DDD, and older adult agencies) was held in December - Did overview on federal final rules, updates to No Wrong Door, and some agreements across the

department Nathan for PAC: - Official launch was in mid November - Ran tv and radio (KSSK) spots for about a month - Intent was to drive people to the takecaretakecharge website - Gave statistical information about the website (See attached Web Site Data report.) - Showed draft LTC Awareness booklet by Dr. Nitz - Looking to start doing digital ads NEW BUSINESS ANNOUNCEMENTS

None.

ADJOURNMENT The meeting was adjourned at 1:20p.m.

Policy Advisory Board for EIder AffairsExecutive Office on Aging

2017 PRIORITY ISSUES

December 29,2016

The Policy Advisory Board for Elder Affairs (PABEA) is appointed by the Governor to advocatefor the elder citizens of Hawai'i. PABEA has developed a set of legislative priorities tor 2017. Webelieve these priorities will contribute to the well-being of Hawai'i's older adults.

1. Funding for Executive Office on Aging Programs

K0puna Care Budget: $9M

Kilpuna Care helps otder adults continue living at home at a small fraction of the costs ofnursing home care. KUpuna Care is funded by the State of Hawai'i to provide servicessuch as

o transportation,o attendant care,. case management,. home-deliveredmeals,. homemaker, ando p€rsoool care services.

ln the two most recent legislative sessions (FY16 and FY17), K0puna Care was fundedfor $7.8 million/year.However, the program was allocated $9 million/year for severalyears prior to FY 2016. Furthermore, $3 million of the funding for FY17 is non-recurring:The base budget reverts to $4.85 million for FYl S.These losses in program fundingoccurred at the same time that the older population, and need for services, was and is

growing.

The Executive Office on Aging (EOA) is requesting that $4.15M be added to the EOAFYlSbase budget. The base budget for KUpuna Care ($4.85M) has not increased since2001 while the demand for home- and community-based supportive services hascontinued to rise in the past decades. With the appropriation of $4.15M, K0puna Carecan serve up to an additional 3,600 frail and vulnerable KUpuna for a year (compared to34 people in the nursing home setting).

ADRC (Aging and DisabilityResourcecenters) Budget: $3.1 1M

The ADRC is a statewide single-access point for information on long-term supportoptions and benefits. lt helps individuals and their families to identify their long-termsupport and service needs, understand their support options (including public andprivately funded programs), and develop and activate long-term support and serviceplans.The EOA has delegated the Area Agencies on Aging to develop and operate theADRC in their respective counties, using specific standardized tools and processes.

Recent datal show that the ADRCs received an average of 159 contacts per day throughwalk-ins, and inquiries by telephone and website. Of thesecontacts, about 5% (or 9 older

b.

IEOA', Report to the 29th Legislature, Pursuant to HB 1878, ACT 138. (November 2016).

Policy Advisory Board for Elder Affairs . Executive office on Aging2017 PRIORITY ISSUES

adults per day) were assessed to need a KrJpuna Care service(s) for the first time.Almost half (47%)of them were assessed to be at high nutritional risk, about one third(31o/") were llving alone, and half had 2 or more limitations in performing daily livingactivities. Over ninety percent of ADRC consumers were satisfiedwith tlieir RbnC

-

experience.

Based on a recently completed independent assessment,2 two ADRCs - Maui andKauai - were fully functioning, meeting all 10 criteriaset forth by federal guidelines.Honolulu met nine or ten criteria, since it began phasing in the AOnC sysiem in July2015, and Hawai'i County met six criteria and is on track to incorporate new operations.When an ADRC becomes fully functional, it will qualify for additional financial supportfrom various federal programs such as Medicare, the Affordable Care Act, and Medicaid.

EOA is requesting $1 .71M for Fy18 in addition to the ADRC base budget of $1.4M. Thefunding will support the Area Agencies on Aging to further develop and-run the resourcecenters.

Healthy Aging Partnership Budget: $550K

The Healthy Aging Partnership (HAP), established in 2003, aims to implement evidence-based prevention and disease self-management strategies to empower older adults tostay healthy, active, and socially engaged. lt is a joint effort by the EOA, County Officeson Aging, non-profit senior services providers, and the University of Hawai,i.

The HAP offers two programs:o EnhanceFitness, a low-cost, highly adaptable exercise program that has proven

to be effective for older adults who are activeas well as unfit or near frail. Theseone-hour group classes are designed to work the cardiovascular system andimprove participants' balance, flexibility, and muscle strength.o Chronic Disease Self-Management (CDSMP),a six-week workshop series inwhich a small group of participants meet once a week for 2.5 hours to learn howto better manage their chronic conditions, improve their quality of life, and lowerhealth care costs.

o General Chronic Disease Management-The Ke Ola Pono:HealthyLiving focuses on all types or combinations of chronic conditions,including high blood pressure, cancer, being ovenrveight, diabetes, stroke,asthma, heart disease, and arthritis.

o Arthritis Self-Management-Livrng Well with Arthritistailors towardsindividuals affected by arthritis and fibromyalgia.

o Diabetes Self-Management-Living Wellwith Diabetes is designed forindividuals with Type 2 Diabetes or Pre-diabetes and their caregivers.

Evaluation research conducted by the University of Hawai'i Center on Aging shows thatthese programs reduced hospital stays, emergency room use, and falls among the frailelderly and increased physical functioning, thus resulting in substantial reductions in

c.

'EOA', Report to the 29th Legislature, Pursuant to HB 1878, ACT 138. (November 2016).

Policy Advisory Board for Elder Affairs . Executive Office on Aging2017 PRIORITY ISSUES

health care costs. Furthermore, national studies conclude that the annual total healthcost of these participants was $642 compared to non-participants at $1 ,175. Those whoattend the EnhanceFitness class once a week show a health care costs savings of 6%.Those who attend more than once a week show a cost savings of 21o/o.

However, the state didn't fund this program in either FY16 or FY17.ln FY16, theprogram was supported by carry over funds, which are depleting rapidly. Unless thecounties find other funding, these programs simply will vanish.

A bill requesting $550Kfor FY18 to fund the Health Aging Partnership will be introducedat the 2017 legislative session. The requested budget will allow the state to serve 220participants statewide through 22 Chronic Disease Self-Management Program (CDSMP)workshops ($92,400) and 575 participants through classes for EnhanceFitness($344,600).

d. Additional Staffing for Long-Term Care Ombudsman Program: $150K

Assuring quality of care for residents in long{erm care facilities and other settings hasbeen a serious and continuing concern of policymakers for decades. The OlderAmericans Act's Long-Term Care Ombudsman (LTCO) program is a consumeradvocacy model intended to improve the quality of care by helping 2.5 million residentsof almost 67,000 nursing and other residential care facilities resolve complaints abouttheir care and protect their rights. Despite broad recognition of its value in assistingresidents and its efforts to complement federal and state oversight of long-term carefacilities, some are concerned about the program's ability to meet its legislativemandates. Limited funding affects the ability of many states to meet minimum staffinggoals recommended by the lnstitute of Medicine (lOM).

Currently Hawai'i's LTCO office, with a staff of one, is tasked with serving 12,000 long-term care residents statewide, resulting in a staff to resident ratio that is six times therecommended ratio of 1 to 2,000 by the lOM. Back in 2014 when the LTCO office had astaff of three, its staff to resident ratio ranked the 1Oth worst state in the nation, and theoffice handled a case load of 79 (or 130 complaints). ln Hawai'i, about 460/o of the long-term care beds are in small community residential care homes (1 ,630) and 54o/o of thebeds are in larger nursing facilities (49) and assisted living facilities (13). The highpercentage of small care homes adds a challenge to an already difficult situation withgeographic barriers, where 17% of the total 1,692 facilities are located on the neighborislands.

Hawai'i does have a LTCO Volunteer Program. However, many inquiries on volunteeringopportunities would go unanswered for months, due to understaffing and issues withcontacting the potential volunteers. Additional staffing is necessary for the LTCO officeto conduct quarterly visits with each facility, facilitate resident and family councils, andprovide more community education.

A bill will be introduced to request $1SOKfor FY18 to provide additional staffing for thelong-term care ombudsman (LTCO) program, including $75,000 for an ombudsmanspecialist position for the City and County of Honolulu, and $25,000 each for Hawai'i,Kauai, and Maui Counties for part-time positions.

2.

Policy Advisory Board for Elder Affairs . Executive Office on Aging2017 PRIORITY ISSUES

Alzheimer's Disease Coordinator Position: $80K

A bill will be introduced to request $80K for FY18 to fund one fulltime coordinator toimplement the State Plan on Alzheimer's Disease and Related Dementias. lt has beenestimated that dementia is the most costly chronic disease in the nation. The likelihoodof developing the disease doubles about every 5 years after age 65, and almost half ofpeople over 85 will have some form of memory loss. The Alzheimer's Associationprojects that in 2025,34,000 people or 10o/o of Hawai'i's residents age 65 and over willhave been diagnosed with Alzheimer's disease, together with an unknown number ofundiagnosed cases. The State Plan is a blueprint created to improve the way Hawai'ideals with this serious health problem. A key element in the state plan is the need for acoordinator to ensure that it continuous to move forward.

UH Center on Aging

A bill requesting fundingtor 2 positions in the University of Hawai'i Center on Aging(COA) will be introduced at the 2017 legislative session. The COA is in the process ofrebuilding, and these two requested positions would significantly impact the capacity ofthe Center. The new positions will be used to address the educational mission of theCenter. The state faces a shortage of eldercare workers and currently many peopleentering these jobs have no formal training in gerontology. The University System is keyto addressing this shortage and to insuring these workers receive the training necessaryto deliver quality care. The Center on Aging plans to reintroduce Gerontology CertificatePrograms in order to encourage current students to enter this field. lt also plans todevelop courses which would be designed to upgrade the skills of the current eldercareworkforce.

Long-Term Care (Ktipuna Caregivers):$600K

Every eight seconds, someone in the country turns 65 years old. Our local population isaging even more rapidly, and living longer, than any other state . By 2020, nearly300,000 people will be age 65 or older in Hawai'i. Because the demographic makeup ofour state is changing, we need to change the way we provide care for our kUpuna.When given the choice, most kUpuna prefer aging at home. Our extended 'ohana areoften incredible care givers, but providing that care can often create financial andemotional stress. ln 2016, the cost of home health care in Hawai'iwas almost $10,000higher than the national average.

Our caregivers need assistance too.Many caregivers make the difficult decision to leavetheir job or reduce their work hours to care for an aging family member. ln 2017, ourlegislators can create a fund to help caregivers provide care for our k[puna.

Purpose:This fund will help working caregivers pay for home health care workers, forextra help preparing meals, for transportation when a family caretaker is not available, orother designated services. This program will help make long-term care for our kUpunamore affordable and provide the helping hand caregivers so desperately need.

3.

4.

Policy Advisory Board for Elder Affairs . Executive Office on Aging2017 PRIORITY ISSUES

Qualifications and Program Administration: Beneficiaries of this program must meetthe same qualifications as recipients of KUpuna Care. ln addition, they must beemployed full{ime in Hawai'i. The program will be administered by the Executive Officeon Aging, and delivered by the Aging and Disability Resource Centers (ADRCS) of thecounty Area Agencies on Aging (AAAs).

Estimated Need and Future Gosts: Data from the Hawai'i LTC actuarial model(Actuarial Research Corporation ,2016) indicates that there could be 2,000 new clients in201 8, 2,566 in 2019, 3,57 2 in 2020, and 4,01 6 in 2021 for the proposed program.lnformal estimates of the number of working individuals between age 50 and 70suggests that about 3o/o are also caregivers. This age bracket is about 30% of the totalpopulation, which suggests that there are potentially 12,000 working caregivers in thecommunity. The majority of these caregivers have not applied for existing KUpuna Careservices, which currently helps about 4,600 clients. The $600,000 cost figure givenabove for the period July 2017 to June 2018 is for development of the program,contracting with County AAAs, and qualifying beneficiaries for services beginning in July2018. During the next year, July 2018 to June 2019 service would begin, with aprojected 900 persons served. Total cost would be $6 million.

This fund will: Be available to those in need-There is a large gap in assistance forfamilies faced with mounting long{erm care costs. Greate high-quality home carejobs-We need to put compassionate, trained workers in positions that pay fair wagesand respect the work they do to care for others. Represent our values-Caring for ourkUpuna is part of our island culture. This program doesn't replace the way we've alwayscared for our elderly; it makes it easier for everyone to afford the care they need.

5. Paid Family Leave for Garegiving

The United States is the only developed country in the world that does not offer itsworkers paid family leave. Federal law provides up to 12 weeks of unpaid leave foremployees of large companies, while the Hawai'i Family Leave Act (HFLA) only providesunpaid leave and job protection for up to 4 weeks for businesses with 100 ormoreemployees.As a result, only Zoh of companies and 16% of the workforce areprotected by HFLA.Hawai'i's only partial paid leave is the Temporary Disability lnsurance(TDl) program. However, TDI is time-limited, quasi-privatized like no other program inthe nation, and has very weak enforcement.Further, state government, a majoremployer, is self-insured.By providing a minimum amount of sick leave, the state doesnot need to provide TDl.

Why Paid Family Leave? Demographic data helps identify the problem in Hawai'i. By2020, 40% of Hawai'i's workforce will be providing care for older parents, and familycaregivers provide 70% of all care for frail elderly persons. Further, just over 40% ofHawai'i's workforce does not have access to a single day of leave from work (paid orunpaid).3|n 2014, women comprised 47.60/o of the civilian laborforce, and Hawai'i leadsthe nation in percentage of multigenerational family households (11.3%), exceeding thenational average by 5.4 points.At the other end of the age spectrum, are mothers with

3National Partnership for Women and Families, Paid Sick Days Fact Sheet, July 2015.

6.

Policy Advisory Board for Elder Affairs . Executive Office on Aging2017 PRIORITY ISSUES

newborns or young children. The evidence indicates the importance of maternal childbonding, as a prerequisite to successful growth of infants. ln addition, there are theneeds of families with disabled members of all ages, including disabled veterans of ourrecent wars. Thus, the evidence suggests that paid family leave supports overall familywell-being.Unfortunately, due to Hawai'i's high cost of living, few localfamilies are ableto meet their needs by taking unpaid leave for any length of time.

Current PFL Activity:Hawai'i and Elsewhere. Legislation was introduced in 2015 torectify this situation, but no paid leave bill moved forward at the last session .ln 2Q16, theHawai'i State Commission on the Status of Women and the UH Center on the Familyreceived grants from the US Department of Labor and the Annie E. Casey Foundationfor economic analysis, feasibility studies, public education, and other work which wouldform the basis for a new bill to be introduced in a later year. Experience in California andother states indicates that employers also benefit, in that such legislation reducesabsenteeism, improves worker morale and productivity, and helps employers retainexperienced workforce members.Furthermore, studies in New Jersey and Californiashow that employees do not abuse paid family leave programs and generally take lessthan the maximum time allowed.By helping to maintain a stable workforce, paid familyleave helps businesses thrive which keeps the economy strong.Finally, such a programcan be established at little or no cost to employers, and with a very modest cost toemployees.

Retirement Savings Work Group

There is a looming security retirement security crisis in Hawai'i as many individuals donot have access to an employer-sponsored retirement plan. lndividuals without aretirement plan are at significant risk of not having enough retirement income to meetbasic expenses during retirement.Retirement savings plans help employees achieveeconomic security, improve economic mobility, and reduce income disparity.lndividualsneed a lifelong savings system that provides them with the opportunity to build theirassets and attain future financial stability. Providing private sector employees withaccess to employer-sponsored retirement plans provides a reliable retirement income tosupplement Social Security income and helps workers to accumulate savings needed fora secure retirement.Approximately 50% of Hawai'i's private sector employees work foran employer that does not offer a retirement plan.The lack of opportunity to participate inan employer-provided retirement plan spans all levels of education andearnings.Employees of Hawai'i businesses with fewer than 100 employees are muchless likely to have access to a retirement plan than employees of largerbusinesses.Employees who are offered the opportunity to save through the employee'splace of employment are significantly more likely to participate and make steadycontributions to buildretirement savings.

Convening a legislative working group to study the feasibility and impact of establishinga retirement savings program for private sector employees who are without an employer-based retirement plan in the State is imperative.

1

From:Sent:

Subject:

Alameda, Kimo <Kimo.Alameda@hawaiicounty.gov>Thursday, January 05, 2017 3:57 PM

Re: Mahalo and Happy Holidays!

Aloha PABEA Members, Sorry I won't be able to make the meeting this Friday. Here are some random updates for Hawaii County. 

1. New Administration looking at the original intent of the ADRC. Mayor Kim wants services to focus onseniors and customer service is his primary area of focus. Wait times for options counseling haveincreased due to the number of caregivers looking for assistance.

2. Walk‐in and call‐ins have increased three‐fold. Data documentation in the consolidated data base isimproving because of volunteer help up front.

3. HMSA , etc.  and other public entities are referring to the ADRC as the “catch all”. This is concerning.4. HCOA is concerned that we are contractually bound to provide I&A to consumers from the other

“doors” and those under 60, but the other “doors” are not bound to provide I&A to seniors. The otherdoors are only “strongly encouraged.” County is feeling a little “dumped” on.  More ADRC money won’tsolve the problem (i.e., “just hire more employees”).  Mayor Kim has put a hiring freeze on all positionsand suspended the hiring of all contract hires when a comparable civil service position is available.Future Medicaid draw‐down possibilities has risen supplanting concerns in a recent EOA‐HCOA on‐site discussion.

5. County feels that the State might be pushing their areas of jurisdiction and responsibility (mentalhealth, developmental disabilities, Medicaid) to the county. All people are being sent to the ADRCwhen in fact they should first be directed to their area of service (i.e., people with mental illness shouldbe directed to children's or adult mental health division first, not the ADRC).

6. The Kupuna Care legislation on "respite for the employed caregiver" doesn’t make sense. HCOA isadvocating putting that money in the current kupuna care package for services, since that is alreadywhat we do.

Mahalo 

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