Senate Standing Committee on Health and Human Services

Calling the Committee on Health and Human Services, 11:30am Calendar. On the informational briefing regarding Kupuna care funding. Present is myself as Chair of Health and Human Services of the Senate. And. And I also have with me the Chair of House Human Services, Representative Lisa Martin. Thank you very much.

So first up, we have, and I apologize, I have a brand new staff, as you can tell. That's why I don't have a gavel. So first up, we have Office of Aging Carolyn Caribou.

Good morning, Senator. Good morning, Representative. Happy New Year. And thank you so much for having us today to share about the state Copenhagen program. So I'll just go ahead and get started.

Okay, thank you very much. Please proceed.

Okay. We're going to be talking today about the funding and the distribution of funds and the effectiveness of those. The distribution.

I will be sharing with you the status of the current overdue rules, and then I'm going to hand it over to my colleagues that are going to be sharing about their component care program in each of the respective counties. Okay, thank you very much. Okay, thanks. Okay.

To understand and to really appreciate how we distribute the funds, it's important. And to know the effectiveness, it's important to understand how the funds are distributed. So our kupuna care funds are distributed using the factors that we have in our approved federal interstate funding formula.

And it's been our policy since 2010 to use that funding formula to also distribute our state kupuna care funds. Thank you. Thank you. Thank you. And so you're going to ask, well, what is an interest state funding formula? That's the formula that we are responsible for developing in order to distribute our older American act funds.

And as I said, we use the same factors to distribute our state funds. It needs to be distributed in a fair and equitable manner. And there's three minimum data sets that the Federal Government requires us to look at.

The proportion of older adults in each of the planning and service areas, which in Hawaii is our state, our county jurisdictions. We need to look at greatest economic need and greatest social need, with particular attention to Low income minority. And I'll explain what that all means. Okay. Please. Okay.

So in Hawaii, we, because of our diverse population and cultures, we actually have eight factors that we consider in our funding formula. So the first three that I just mentioned, older adults, greatest economic need. We know those people have difficulty meeting their cost of living.

We also look at Low income minority because we know that those individuals proportionately export social and economic hardships. We also include in our funding formula those older adults with disabilities, physical and mental, because they will need additional supports to remain independent in their own homes and communities. Language barrier, another.

In Hawaii, a very large issue, because those that are unable to speak English at all or not well have very limited or no access to services and supports.

We look at geographic isolation because we know those living in very rural areas, such as those in Hawaii County, Kauai and Maui, are really isolated from the service infrastructure that we have through our services and supports.

We also look at what we call inverse population density, where we take the land mass and divide that by the number of older adults in each community. So this benefits very large counties, such as the County of Hawaii.

And then we also look at those that live alone in poverty, and we know that those living alone don't have natural supports in their home to provide that ongoing support and infrastructure. So before I move from the factors, I wanted to see if there were any questions.

No. Looks like you are reading off of your PowerPoint, so please proceed.

Okay, but before I get to that, and this is the funding distribution, what I wanted to say is those factors, those eight factors that the State of Hawaii has included in its funding formula, really supports those socioeconomic barriers that we see in our community from not having enough funds, not having access to services and supports, having various things that are really those detrimental things that support, that are part of the things that affect our community.

So what we do, and I'm going to back up, is those. I'll go back to this. These data factors are. Then we look at. We use census data and American Community Survey data to look at the distribution in each of the four counties. So we get a calculation from that.

We then weigh all eight factors to come up with a percentage, percentage by county, of how those funds will be distributed. So this is utilizing census data to support and address these needs for the distribution of funds?

Yes, but did you give us a PowerPoint of this earlier today? I mean, prior to this hearing?

No.

Okay. That's the reason we couldn't distribute it to our people.

Right.

Okay.

And I'll make sure that they have it. Thank you, Louis.

Okay. Next time we would like to have it beforehand. That way we know what kind of questions to ask you, but please proceed.

Okay. Okay. So this is the current distribution percentages that we use for each county. If you look at the middle column, the County of Kauai receives 7.458% of the overall funding for the State of Hawaii. The city and County of Honolulu Planning and Service Area 2 received 62.961% County of Maui receives 11.7%.

The County of Hawaii received 17.881% for a total of 100%. And then the corresponding current state fiscal year allocations are in the right hand column.

Okay, so how did you come up with those formulas? Is it based upon population or is it really based only upon what you talked about earlier?

Right, so those eight factors will take say for the County of Hawaii or even on Oahu, we'll take population divided by the total population and we come up with a calculation. That calculation is then times by a weight to come up with a percentage.

And the weight is based upon those factors you talked about?

Right. And then we add up those eight percentages to come up with like in Hawaii County, the 17.881%. So yes, this is all based on census data. And also whatever's the most current or the American Community survey.

So in theory, like Hawaii island would be weighted so they would get a higher percentage than their just their straight population might otherwise indicate because it's rural and we know it tends to be. A poorer county and things like that.

So every county though does have those eight factors weighed. And so. Yeah, and that was like you said, those are all weighed. And the inverse population density really supports large land masses like County of Hawaii, the island of Maui. So that helps to factor in to support their needs that they have in each of those counties.

Whereas what helps city and county Honolulu is just sheer older number of older adults. And so that. And then when you add that all up, you come up with these percentages. Yes, and I do. I have the math for you so I can share that with you.

Who does the math?

Well, that was done. We actually had worked with the University of Hawaii about a decade ago for this information. We're currently actually reviewing these weights and factors to make sure that we're using our most current data. And then we've applied this in the distribution of our funds over the last decade.

Okay, so do you have a University of Hawaii report that shows how they came up with these formulas?

I do. I don't have it with me, but I do have it back at the office and I'd be happy to share that with you.

Okay. Okay. Please receive.

And then it has to be reviewed by the feds and approved. And so that's our next step in looking at the most current data is to to get that approved by the Federal Government. And once we have that, we'll have to take it out to public hearing.

How often do you make this determination?

Every time there's new data. We take a look at that. So right now we're applying the 2020 census data to the factors that we have inside our funding formula.

So every time there's a new census. Okay.

Okay. Now, I know you asked us to share with you our current utilization over the last two state fiscal years. In the middle column is the 2023 state fiscal year allocation and expenditure. We expended about 93% of our overall allocation. We serve 5,4473 older adults at an average cost of $1,358 annually.

Our allocation in 2024, we had some budget restrictions, so that's a little less. And we expended about 97% of that in expenditures. We served about 1% more older adults than the year before. 5520. But as you can see, the average cost went down, went down by about $200.

And what that is showing us, what that's telling us is, though we're continuing to try to maintain those that we're serving, they're probably receiving less services and supports.

And that's something that we want to continue to look at and trend over, over time, because that could have an impact on whether they stay in the community or they need a higher level of care. Okay.

And I wanted to, before I actually share with you, our profile, all of our profile data for 2024 that I actually sent out in some packets a few weeks back to each Legislator, I wanted to share with you the kupuna care eligibility.

So to receive compuna care services, you need to be 60 years of age or older, a US citizen, or a qualified alien. You have to have a cognitive impairment or disability. You need to not be residing in an institution because care is provided in institutional settings.

So this has to be those in communities, in our communities, living in their own homes or with family and friends. And they need to have deficits and performing two or more activities of daily living, such as bathing, dressing, transferring, walking, or have deficits in instrumental activities of daily living.

That's like Bill paying, answering the phone, shopping, things like that. When we do our assessment of individuals, their determined eligibility is done through the Aging and Disability Resource Centers. And we look at all of these factors to see what services and supports may be available for them in the community. Okay.

So this is the overall statewide breakdown of those that we served. In 2024, we serve 5,520 older adults. Like I said earlier, we call them our participants because they're part of the process. 55.5% are over the age of 80. 1,829 are between the ages of 70 and 79.

And then just shy of 600 are between the ages of 60 and 69. Just this age demographic shows you that we are serving those that are probably of the most need just based on age, because we know that those deficits increase as we get older.

And then I also wanted to share with you our other factors that we look at that kind of you can make a tie in to those factors that we had in the interstate funding formula. We know that 31% of the 5520 are what we call homebound. 43% of those are living alone. That's very telling.

We know that means that we're directing the services to those that don't have any other support services within their own home and their living arrangements because they are living alone. So we really take that into consideration. 19% of those participants are living at or below the poverty line.

And then 30%, 1,682 are actually participants that we've assessed to have three or more deficits of activities of daily living. So they're higher in need than our overall minimum kupuna care eligibility. So we really are trying to target those most in need. And our participant demographic profile reflects that.

And then to the right of that is actually the services and supports that we provided. The various services that are provided by Kapoonicare, the person served and the service units that correspond to those that were served. As you can see, the greatest numbers are in transportation, case management and home delivered meals.

And then most of these services, we measure them by hours. A unit is an hour except for home delivered meals, which is a unit is a meal or transportation is a one way transportation, say from your home to the Doctor.

So if you were going to take transportation and go from home to the Doctor and back, that could be counted as 21 way trips.

Okay.

Okay.

Okay. Now, I wanted to pivot, but I wanted to see if there were any questions. I wanted to pivot to the rules. Okay.

Any questions? I'm going to save my questions in case you answer them along the way.

Okay. Okay. So I have a number of questions. Okay. So. And I'm sure they will ask they. If it's going to be answered later on, you can tell me. It'll be answered later on. So I know when you put in the eligibility portion, it appears that the Kupuna Care Monies are supposed to go to the individuals.

But I know kupuna care monies don't just go to the individuals, they also go to institutions like Meals and Wheels. Right. Our service providers. Service providers. Okay. So are you requiring those service providers to have those eligibility requirements before you give them money or what?

I see what you're saying. I'll take a step back. You're right. So we have the State Executive Office on Aging, we have our Area Agencies on Aging who procure out for those services and supports that you mentioned.

We require them to meet those service standards that are outlined in our service standard specifications and it's also included in the contract. But they don't just serve, we actually authorize them to provide the services.

That's why the Aging and Disability Resource center, which is provided through the Area Agencies on Aging, they'll do the eligibility determination, then make the referral over to the service provider to say, okay, Senator, you provide home delivered meals, can you pick up Mr. Smith as a new client? So that's how it's done.

Okay. Because when you said eligibility, you talked about they need to be of a certain age. So it sounds like the benefits go directly to the individual by. I know in practice that isn't.

No. Yeah.

So that's the reason why I keep from. Even back when in the house, when I was in the house, I really wanted you folks to come up with rules.

Right.

Because what is stated and what you folks are actually doing may be all well and good, but unless we have the rules, we don't know whether or not it is being the monies are being spent the way it needs to be spent. So I know you're going to go to that.

My other question is we put in money for kupuna Care as well as before Kupuna caregivers.

Right.

How much money went to kupuna Caregivers?

Well, what we do now, since we've combined the programs, we're just calling it Kupuna Care. We are tracking though those that have the caregivers. A lot of the services that are provided through what we used to call our traditional kupuna caregiver program is mostly adult daycare, because that's the biggest bang for our buck.

So we can safely put someone at adult daycare, provide the caregiver that breaks from caring for their loved ones. They can go to work, or if they're retired, they can have that break from having to care for their loved one throughout the day.

But the caregiver program was for those working caregivers, so it allows them to still maintain employment and know that their older adults are safe. So most of the funding that's combined now with those allocations are going towards mostly adult daycare and a few other services, too.

But I would say the bulk of it is adult daycare because that's. That way we can spread the money the farthest.

Okay, it looks like it's like $7,000, $7 million per year. I thought we allocated more than that.

We did. The last two years have had some budget restrictions at the departmental level, so we've had to adjust our budgets accordingly.

How much are you folks asking this year?

So this year we don't have an ask for funds, but we are tracking this very closely because I have a feeling in the following year or so, probably the next legislative session, we're going to have to come back to look. You know, we're going to have to look at our data. That's part of the reason.

We also want to make sure that the funding formula is using the most current data. We want to look at our service utilization to see where. And we've been tracking that and doing a better job at that so that we can really assess where and how much additional funding we may need in the upcoming years.

Because we know that this population is just going to continue to grow. And so it is something that we're going to.

I know we used to have actual bills that would allocate like between. My last memory was back when I was in the house, like 25 million. And I know it came down.

Do you think that was possibly dhs?

No, it was Kupuna Care. And then there was a separate Bill for Kupuna Caregivers. And then you folks wanted it combined. And I was. That's why I'm really super insistent upon the rules, because there wasn't at the time when we gave you folks the money back in 2020 or 2018, trying to figure out back when.

I think it was 2018. It was 2018. 2018, back when I was in a house chair, the requirement of you guys getting the money was you folks needed to come up with the rules.

Correct.

And here it is seven years later and we don't have rules. And at the time in 2018, you folks promised me rules within two years. And then since then, the rules have to change because now we have, at the time we had two funds and now it's combined to one. So we're gonna.

Okay, you're gonna be discussing rules and the budget though.

I, I would like to just. I know the highest I've ever had for Kupuna care was 9 million. Yeah. And then you're right. I think there was about one. Was it about 1.0 million? I believe for the kupuna caregiver program?

For some reason I thought it was in the, was a two digit budget.

But okay, maybe that was my overall state funds for all my state funds.

Maybe, maybe that's what it was like 10. I was, I was thinking about 10 to 15 million, but I think that.

Includes our overall, our whole state allocation for the Executive office. And then we have those line items. Yeah, I think so.

Okay. So it has never been more than nine and generally around eight. And that includes the component caregiving.

Right, right. Okay. So we are, before I go to the rules, we are really trying to keep. You know, I'm getting positions filled at Executive office on aging. We now we were two years without a statistician, two years without a planner. So we're making progress now.

And so we're really looking at the data, helping the data to inform decisions that we make and also to see where those gaps are going to be and where we may need additional funds in the future.

Okay. Yeah. Yeah. Okay. Tell me about your progress on your. That way. Hopefully we don't keep having informational reasons.

Okay. So we are probably about a few steps away from the finish line. We did finalize the written part of our draft rules in 2023. We knew we were behind, I take ownership for that. We did say we would have them by 2021 and we didn't.

We were heavily involved with helping our kapuna with the vaccination efforts through the COVID pandemic and things of that sort. And we also were impressed upon to expend all of our funding that came down from, from like the CARES act and the Families first monies. And there was another one too, the ARPA money.

So we were really focused on getting those done, getting the monies expended so that we could make the Federal Government look Good. But at the same time, unfortunately, we were behind with our rulemaking. So we did.

After we had them written, we actually did put a pause because the Federal Government was also looking at their rules and regulations for the Older Americans Act. And because the services that are provided by Kupuna Care, we use the Older American Act definitions. Those are all of our guiding documents that dictate our Kupuna Care Services.

So we didn't want two competing or to rules that were in conflict. So we wanted to make sure that whatever was in the ACL rules that there was no conflict if we were going to go forward.

So we had to review those rules when they came out this past April and then make sure that there were no conflicts. And now we're in the final stretch where we're going to be sending this to our deputy Attorney General and then we're going to have to go out for public hearing and then get this executed.

So 2025, that.

That's my goal, Senator. And I, I do take ownership for that. I really do want to get this done. Rules do provide that guidance. Rules really help to they answer the questions of how these services and supports are going to be provided.

I love rules myself, so I was really excited when the feds came out with their rules. So, yes. Something I do want to get finalized and done this year.

Okay. And it helps us because when people want to know whether or not they can apply directly for Kupuna Care, it doesn't sound like it. They have to go through their ADRCs. And it's also that the nonprofits. Right. They want to make sure that they're getting their fair share.

Right. Right. So get it done. We will. I just want to say, though, that, you know, it really is the part where we keep it from having a conflict of interest is by having the Aging and Disability Resource center do the eligibility and then authorizing the providers to provide the services in the community.

So that's a really good model for us. Okay. But we will work on the rules, I promise. Okay. Thank you. Thank you. I'm actually joined today by our four county counterparts. I have Derek Aroshi here from the city and County of Honolulu, Rowena Dagdagandaya from Maui County Office on Aging on Zoom, we have Emily Ishida.

She's the newly appointed county Executive for the County of Kauai Agency on Elderly Affairs. And then we have. Joining us from Hawaii County, we have Keola Kanoe with the planner at hcoa. And Erin Samura, who is Executive assistant to newly elected MAYOR kimo, Alameda.

So I know they're on with us and we were going to actually start with Keola and Erin and I will just go ahead and turn it over to them. I think they are on by zoom.

Keola or Karen or Aaron, are you available?

Senator, can you hear us?

Yes.

Ah, well, aloha.

First of all, Senator, hold on. Can you make, can you give them the full screen instead of a small screen? Senate it. Okay, maybe not.

What if I stop my. Or just minimize mine? That may help here. Hold on. Oops, sorry. That's quiet.

I think it must be on there. So. Yeah. Okay. Do you folks have a PowerPoint that Carolyn can proceed with?

We actually do not, Senator. Okay, we are here. First of all, we wanted to share from Hawaii county in terms of our three successes that we have been fortunate to share with you today and then three of our challenges. And we're happy to get that information to Caroline so that she can in turn share it with you.

Senator. Okay, okay, so I'm going to turn it over to our Erin and she's going to give a couple of points to support what Caroline shared. There it is. Okay, thank you.

You're now on full screen.

Hi there. Thank you so much for having us today. Just a little bit of background for everyone else. Point county encompasses a total area of about 5,000 square miles. And within Wake county we have about 208 residents. And all those residents, about 30% are over the age of 60 years old.

We did a little bit of, we went to look for a little bit of other data and we found that about 60 within our county, about 24% in our county are the age of 65 and over.

Just to share a little bit of demographics with you all, as far as Hawaii county goes, as far as our population, our people, our community that we serve. And so from that, you know, we do see our challenges, we do see our success.

So just to start us off, some of the challenges that we see here, number one, is capacity, not enough staff in our program, within our program providers, you know, and it, you know, it, it affects our community not having the providers be able to give provide services. Right.

And also the retention that goes along with those providers as well. It's a challenge that we consistently see. It's hard for providers to keep people on board, you know, within the career path, just, you know, when they have other options and they can do something else for the exact same or even more, you know, wage wise.

Another challenge that we have is shortages within our own, in our own Department over here. We currently are not up to full stopping. We're working on that. But it also does, it's challenging when we're trying to run our programs here as well. And another one, we have three of them for you.

We could go on and on, but we have our top three. And our third one is we are now down to one adult daycare center on the island of Hawaii. So Hawaii does not have any adult daycare. There is no provider there for them on the west side.

On the east side we have, you know, that we are so fortunate that we still have this one that is able to provide services for our community. So we hope that we can possibly change this to serve our 24% that we do see, that we should possibly be serving.

But you know, all of those challenges, we do see our successes, you know, and it's great that we are able to provide services for our community. We are that prevention before they move on to other stages in their life, you know. And so a big one is that we serve the home and community.

We service those that are in need, those that are in that gap per se. And you know, talking about our adult daycare center, we are the only ones that are able to provide respite counseling and training for our caregivers.

So essential for our caregivers to extend their longevity of caring for our kupuna, caring for those in our community. And you know, we appreciate, you know, the budgeting that is given to us. We could do to do what we do, you know, and we have been able to service 467 individuals.

It's not quite the full 24% but it's 467 individuals that may not have been serviced without kupuna care. So very thankful for that, you know, to service our community that way. And you know, another thing is our last, you know, lastly, top three, our resource center answers the phone.

It may seem like very minimal, but answering that call, when kupuna call, when caregivers call for them to assist our community is essential. I recently had a phone call that came through the mayor's office and it was an 84 year old woman in our sector and she just needed someone to talk to.

She needed transportation services, she needed a way to communicate with the world. And it was a quick call to our aging Department, office of aging and they were able to assist this 84 year old lady. And it was like she, the way she explained it to me was this office is just a godsend for her.

She has been out of communication with her loved Ones, you know, over the holidays. And to be able to have that again was phenomenal. So Kupuna Care really, really impacts our community in massive waste. Massive waste. So any. Any questions, anything else that we can provide? You know, mahalo again for this time.

So why is it we only have one adult daycare on the island?

Okay. Hi, Senator Keola. I'll answer that. Unfortunately, it's capacity again. We had one in Waimea and we had one in Kona. So the other thing that happens is there is no younger generation that's willing and wants to carry on the service.

And so the individual that had the Waimea program now works for one of our home based individual programs because she could no longer maintain and keep it open capacity wise with workers and the cost and the Kona daycare. She retired and she was wonderful. And again, we couldn't.

And they could not find someone who was interested in taking on that program. So again, capacity, Senator, is really affecting our ability to provide services, especially for such a large island. So that's a of concern to us.

Yeah, so I noticed that. You know, I live over in Pune, Right? Yeah. So I noticed that. You folks use the senior centers, though. Yes. To provide daycare type services. Are you folks able to do that on. On the entire island? Are there senior centers beyond. This?

There's one in Pahoa, right? No, we have senior centers throughout the island. And that's again. Here we go, Senator, with capacity.

You know, we have a couple that are closed down because we need to find workers who can manage the site, who can receive the foods that are coming for congregate meals, who can spend those few hours that they come so that they're not home alone and they can socialize.

We understand how important all of that is and the transportation to get them there. So. So again, all of this comes down to capacity and finding the employees, the workers that can manage and care for these individuals. And so that's the problem with both the daycares as well as the current facilities that we do have.

Yes, we have the one in Pahoa, so we're happy with that.

Okay, thank you. Thank you. One last question. You guys are the capacity. I mean, the formula that Carolyn came out with, do you folks had any objections or any input? And I'm gonna ask that for all the islands. Yeah. Do you. Regarding the formula on the monies you guys get.

Sure. Thank you for asking that question.

We do think that the formula needs to be updated most definitely, since it's like a decade old, as Caroline Mentioned earlier here on Hawaii island, we do service a large area and we would require a little bit more, you know, percentage based funding to really go further out into especially our very rural communities like Kau Ocean View, you know, Naalehu, Captain Cook, Kealakeua.

Those are areas that are in desperate need of assistance. So being able to have more funding to really address those outlying areas which really do not get addressed as much really at all would be very, very helpful. So if we could please revisit the percentages that get distributed to the counties would be greatly appreciated. Okay.

And the senior centers are run by the county? Yeah.

Yes, yes, it's, it's the county program that we contract with them to, to do.

Okay, well I'll be talking to the mayor soon. So we'll. And he used to be Office of Aging. Yeah. Yes. So he, he's fully well aware of the issues. Thank you.

Thank you. And now I wanted to turn it over to Emily Ishita and I wanted to go back. Can I go back to sharing the slide? She had a slide she wanted to share. I'm sorry, Emily Ishida. Did I say I'm sorry? Did I say Aaron? Emily, I've known Emily for years.

Yes, no, I know Big Island. Okay, so Emily is with Kauai County.

Okay. And yeah, I remember seeing the Kauai PowerPoint.

Yes.

Okay, let me go back to. Current Smart share. I'm not sure where it's going to come up at. Hold on, Emily, I'm going to get that up for you.

Can you sell Hawaii County?

Okay, here we go. Share this one and then I will go to the next slide. Okay. And I want to congratulate Emily on her appointment. She's just started in December, has been at the area Agency on Aging and other capacities. So I'll turn it over to you, Emily. Thank you.

Thank you, Caroline. Hi, Senator. Thank you for having me on here. Yeah, so as Caroline mentioned, I'm brand new to this position but I've been with the agency for about seven years prior. So just wanted to share some of our data that we've collected and you know, like I'm sure all the other islands.

We're very, very grateful for the Kupuna care services as it allows us to service our elderly in ways that we wouldn't be able to without it. If you look on this slideshow, I just kind of touched on just giving some data, some numbers on our home delivered meals. We have two providers currently.

Some of our successes is that we were able in this past fiscal year to add on brand new one very popular with all of our pupuna that received that qualify for home delivered meals. They're using everything fresh service is awesome. A big part is not just we're giving them nutrition but it's the, the daily interaction.

It's five days a week. We're able to touch base with them when the delivery is made. So it just helps sometimes for some of our home bond seniors it's the only interaction that they get all day long. So provides a sense of safety. So that's. You can see that data is on there almost 600.

Can we switch this one out where we blow up slideshow? Yeah, the PowerPoint. I haven't. Yeah. So next time if you provide us earlier we'd be able to look at it. Yeah.

So then we have. We also have one adult day health and that is in our main town. I'm not sure how familiar our with Hawaii but our adult day health.

So it. If you're still around. zero, there you go. We got it. Zero, but they gotta go back to Kauai. Zero this is Maui County. Can you put it on? I think yours is in Maui. Zero, it's mine. It's yours.

Okay, let's go back. Okay, go ahead. Okay.

There.

Thank you, Emily. Now we've got the.

We got the slide.

Okay, no problem. So no just to say we have one adult day health. We are a lot smaller, you know, land mass and but this seems to be very appreciated as well. And it gives respite to the caregivers. It.

You know I, I know of a couple people personally that have been utilizing adult day health center and they've been thriving. So they get not only providing respite for their caregivers at home but when they get there, they come home, they're in a better mood. Everyone's in a better mood. Right. So.

So just all around very grateful for that service. We have transportation. Something else to add. We also added assistant. It's called assisted transportation. So that's more house. I'd say location to location to Doctor's appointments and that really helps. We have one service provider that is able to assist with people that are fully contained to their wheelchair.

That's been. That's been a success bringing on more providers case management. So that's personal care, that's respite homemaker services. So yeah. Do you have any questions about our slide on the left Kupuna Care Services. The right just kind of shows the demographics just in General those that live alone.

So some also some statistics to share those that are 65 and older are a little bit under or over 15,000 people on the island, 50,500. And of that 19% live alone. As we found that the older people get the higher percentage of living alone. So basically Those that are 85 years or older, 25% are living alone. Yeah.

So we just are very grateful. We've had our shares of ups and downs. Some of our I share successes. Some of our challenges we've had are like the outer islands. We have had provider issues just keeping people employed, just seeing a lot of people that don't would rather work under other industries that pay a little bit higher.

So just kind of retaining that. And a lot of areas on Kauai are very rural.

So for example, the north shore of our island in Hanalei, although the need isn't as high, we the providers are mainly located in the towns like Papa or Lihue and they don't have the capacity or the manpower to go all the way out to the north shore. So that has been some of our challenges.

And then kind of started a wait list due to funding and to kind of touch on the question that you asked about the formula. We definitely would appreciate an increase in funding as that would be able to service more kupuna that need the service.

Okay, so you know the Kupuna Care Services Monies, are those all going to nonprofits or are some of them like the. I see the case management, is that being done in house?

No. So what our case management is is we, as Caroline kind of explained, we contract with different providers. Different providers on island will provide the service.

We kind of just, we do our initial assessment with our ADRC staff and they determine eligibility and then from there if they qualify, then we contract it out to a provider, we make that recommendation.

So I'm curious about this adult day health. Is that adult daycare or is that also including health care?

Well, it's a range. So it's an adult day health and care depends on. Just depends on what you need. But yes, it does offer like a minimal of some people that go there and need more like services and so yes.

Is that the provider that also provides health services?

Yep, just kind of depends on what they are. But it's just for the day, it's not overnight. So it is like a daycare center.

Okay, so for the health services though, don't to folks Bill like Medicare, Medicaid for that?

No. Well, I'm not sure what they. So it's kind of, we, we contract with them. Right. And so it, it's like for the kupuna care funds, it's kind of offers respite to the, the families that need it. Right.

So it's like if they, they can qualify if they work X amount of hours a week, I believe it's 20 now for qualifications. And then they would provide that service just depending on in what depth that consumer or that client that attends that, that program needs it.

I. I'm just curious about why health is in there.

I think that's just, that's just the. That's just the way. Or that's just what they called it. Their service just called the day health, but it's like a care.

Okay, okay, thank you.

Thank you. And Senator, just to clarify, in our Older Americans Act, they have adult day health slash care as one type of service. So when they're saying adult day health, it's. They combine it in the Older Americans Act and we use that definition. So, yeah, that's pretty much the adult day care that's being provided.

And Emily, who's the provider for that again? Was it Wilcox?

No, it is. I can't remember the main branch, but it's not through a hospital. It's a. Okay.

Sorry about that. I had my, my information mixed up in my head.

Okay, thank you for the clarification.

Yeah, no problem. Okay. Okay. And Molly Mali, Everyone is here. zero, Ron, you want to.

Good morning, Senator, and good morning, Representative. My name is Rowena Dag. Dag on Daya. I'm from the Congress County of Maui where I'm the Executive on Aging. I've been with the agency, the Maui County Office on Aging since March of 2022. So I'm about to go into my third year there.

I just wanted to give you some updates on our participant numbers for 2024. We don't have the slide up, but I do have in total, using federal, state and County Monies, 1029 participants. That includes both participants who are over age 60 and above, as well as their caregivers.

We also have 403 participants who currently live alone, 138 participants living in poverty and approximately 390 participants that have three or more deficits in their activities of daily living. Also, I wanted to note that we have a staff currently of about 16. When we are fully staffed, we're at about 25.

11 of the staff are access and assistance branch staff who conduct the individual intakes over the phone or walk ins. They also conduct assessments and they also work on the service authorizations for our participants. They answer phones, they do options Counseling. They range.

Total number of calls that we receive per month is about 1400, with about 550 unduplicated callers. Each call could last about five minutes to up to 50 minutes, so we keep pretty busy. Our office is located centrally in Wailuku, but we do have staff located in in Hana, Molokai and Lanai as well.

I also wanted to note that our staff also conducts around 80 to 90 assessments and reassessments monthly. Each assessment can last from about an hour and a half to roughly two to three hours, depending on the need and the type of discussions being had with the participants and sometimes their caregivers.

When I According to the screen there, that's our expenditures for fiscal year 2024 in the various areas of adult daycare, attendant care, check in care, and so on. As Caroline noted before, some of our big services include adult daycare services which include participant caregivers.

Through the Kupuna Care funding, we are able to provide adult daycare respite services for caregivers so that they can have their loved ones in a safe place while they go to work. I wanted to note that in central Maui we have two adult daycare sites, one in Kihei, one in Hana.

They're all operated by the Maui Adult Daycare center and the on Molokai. We also have a provider, NA Pu'uwvai and they also provide adult daycare as well as other services that include personal care and homemaker services.

On Lanai, the Lanai Kinaole is working towards establishing an adult daycare center there and the County of Maui has actually provided some assistance with capital improvement funding to help them with their planning efforts and hopefully at some point.

Construction the Lahaina West Maui senior or adult daycare site was destroyed by the fire and Since August of 2023, the adult daycare Maui Adult Daycare has been working towards identifying a new location. But of course with the limited capacity for facilities, especially appropriate facilities to establish a adult daycare center, they're experiencing challenges with finding a spot.

But we were very hopeful in the last month that they were able to identify a site with the County of Maui in a central location in Lahaina. So we're looking forward to seeing how that negotiation pans out and are hoping that we can support them with their operational efforts with adult daycare.

We currently have about 200 participants in fiscal year 2024. The Kupuna Caregiver adult daycare services that provides respite for caregivers. We had about 81 participants. The units delivered we delivered about 100, roughly 119 hours of adult daycare services to those participants needing that service. And then 48, about 49,000 hours for adult daycare services as well.

Well, Caroline in her previous slide had showed a number of our allocation totaling a little over 700,000. This number here also includes encumbrances from the prior the previous year that carried over. But we've been able to, you know, utilize all of the funding and direct it towards our service providers which include nonprofits.

They include Maui Adult Daycare Center, Ho'okele Caregivers, the Vivia program, which I'll talk a little bit about in a little while. Halemahaulu is also another nonprofit that provides not only housing but also in home care, personal care and Homemaker Inshore services. Assisted transportation was provided through Kaunoa Senior Services and agency with the County of Maui.

And then of course we had Napu Uwai, our Molokai provider. And Nahualoha is also another provider of ours as well for well friendly visiting and some volunteer services like transport, some small transportation and in home assistance. Some of our successes. The continuation of our partnership with Maui Adult Daycare has been very successful.

They've been able to provide caregivers with an option that allows them to continue working while having their loved one cared for in a safe environment. We also worked with Ho'okele Caregivers, their Vivia program to establish a check in care where it's a minimum of 15 minutes, 15 minute check in.

So what they do is they employ CNAs who will be assigned a community. And in that community there are about five to perhaps eight participants and they go and check in on those residents for about 15 minutes at a time, go to the next person, next person person, and then do that throughout the day.

So yeah, they keep rotating. So it's almost like having a, like a hospital scenario where you have the frequent check ins and it allows them to have, you know, it doesn't keep them in one home for an hour.

They can spend their time checking in and doing things like setting up for a meal or providing medication reminders, helping the participant with their grooming. And so we kind of see that as a talking with one of the program managers at Ho'okele.

They see that as a really beneficial service and one that can be very helpful in the community. We've also started a reimbursement program for homemaker and home respite services. This isn't with our Kupuna care funding. We utilize our county funds to do this reimbursement program.

But for those who those services that are on a wait list, we offer the participants the option of choosing a provider and then they can get up to $20 in a reimbursement so that they can pay a provider.

The provider has to be someone who is not related to them, but providing services in the homemaker and in home respite. So it's slowly catching on. I think one of the challenges is finding an appropriate provider or caregiver who we can reimburse.

Some of our challenges, I think the other counties have mentioned workforce capacity in the rural areas is limited. Funding sometimes or the pay is often a big issue. With employees also providing additional hours, a full 40 hour week is in those services sometimes becomes a challenge as well.

Inner Island travel for Molokai and Lanai participants is, you have heard it, that becomes a big issue. So for, especially for those who live on Molokai that need to attend the Doctor's appointment, reliability of transportation, airline transportation, transportation is a big hardship.

So those are, that's one area that, you know, we've been, you know, discussing with our, the public health nurses there and some of our stakeholders. That's something that we also want to continue working to address in the year ahead. And of course, transportation options for participants in areas outside of central Maui is sometimes, it's very, very limited.

With the recent wildfire that it became apparent in talking with other disaster case managers that transportation services for especially on demand seniors want that flexibility and be able to pick up a phone and call and be able to go to their Doctor's appointments or go and visit a friend or make a shopping trip without having to schedule something in advance about a week ahead.

So, you know, we're working with our counterpart on Oahu. They've started a pilot program, something that we've also liked to establish with our county as well so that we can provide those kinds of options to our seniors in the areas outside of central Maui.

But with that, if, if you have any questions, I hope I can answer them. But if not, I'm very willing to answer any questions through writing as well. Thank you.

Your model is so different than the other two counties we heard from in terms of their biggest service was meals, right? And you folks don't do meals. Instead you do a lot more care.

It seems we utilize Title 3 C1 and Title 3 C2 monies for our meal programs. So C1 is our congregate program and C2 monies are the home delivered meals program. And our major provider is our fellow county agency, Kaunoa Senior Services and we also contract with another agency called Mom's Meals.

It's a company on the mainland that does home deliveries. So they, they send the meals in a box refrigerated and those, those meals are ones that are like special diet type of meals pureed or like a special heart diet.

As long as there's a Doctor's note that accompanies the need, then we can initiate a service through Mom's Meals. Mom's Meals also provide services services to the outer, the outlying areas where Kaunoa Senior Services cannot reach because of the distance.

So for example, if a participant is all the way out in Honokohau in the valley or past Kaanapali, then at times you want to make sure that the meal is fresh and that the temperature is at a certain amount so that extra driving time, you know, is not gonna, it's not appropriate.

So that's where Mom's Meals comes into play.

So it's delivered through US Postal Service?

Yes, it is. zero I think USPS or UPS. No, no, no, I'm sorry, excuse me. FedEx.

And it's cold. So that they would have to heat it up.

They would need to heat it up. So when we conduct an assessment, we also assess the availability of a microwave and the ability for the participant to heat up their own meals.

So I want to thank you for explaining why your budget was more than what was the allocation and also because I was going to ask that and I forgot behind the other counties how much of a county match comes in. It seems it's kind of substantial for Maui. Yeah. So thank you for that.

And then I'm going to ask you Carolyn, how come the other counties aren't using the title three like Maui is doing?

Well, they actually are. They do a combination. So the other three counties use both their federal and state state funds to support and we allow the counties to decide how they want to utilize their funds as part of their area plan. So I think Maui's elected just use their federal funds for home delivered meals.

That's correct. And chair. Another thing I wanted to note is even in if this slide doesn't include all of the different services that we provide through our office, this is just a snapshot of all the kupuna k funded expenditures. But there are very, I mean there's, there's many more. So.

But we utilize the, the different sources of funding to create a very comprehensive program for our participants.

Okay, thank you very much. Thank you. Okay, welcome. zero, thank you, thank you. Thank you that helps.

Okay, Aloha Chair Bueneventura, Chair Martin, Derek Ariyoshi Administrator, Elderly Affairs Division with the City and County of Honolulu. We are Oahu's Area Agency on Aging. So similar to our colleagues in different counties, same, but different. Right.

So I wanted to kind of talk through that you could make the easy presumption that by us having the largest chunk of monies that we could cast the net wider. Yeah, but I think the connection has to be made and that's the struggle and challenge and opportunity for all of us. Right.

Are we going for the philosophy of casting the net wide and shallow or are we going to cast the net deep? Right. So it's relative of the money we have in relation to the amount of kupuna that we have. So I'll just point out a few of the demographic profiles of our participants.

60% of those folks receiving our in home services are 80 years and older, 37% have three ADL's or more and 43% live alone. So I think what this demonstrates is in a lot of ways that our services and monies that we do have, we go deep and the same and the different. Right.

So same with the counties, they have immense challenges with regard to the rural areas. That may not be by definition the case for Oahu. And maybe Chair Martin can connect and relate to this. Our challenges are different just by sheer numbers. But we have a high concentration of kupuna in multifamily kupuna housing properties.

Very concentrated, different areas, majority of them income constrained and limited English speaking. So that's where the challenge and opportunity intersects. I would say recently, you folks are probably aware of Hawaiian Electric's public safety power shut offs. Largely the concern was in our leeward area. And I'll make that connection, maybe Chair Martin, to your constituents as well.

So we took the opportunity to work with Hawaiian Electric, Department of Health, Public Health, Nurse, Board of Water Supply. So rather than the expectation of our kupuna come to us, we met them where they're at.

So we went and brought a team to all the kupuna multifamily Low income housing properties on the Leeward coast in partnership with all those organizations I mentioned and literally went door to door knocking, giving them information on how to be disaster resilient, disaster repaired, and to truly understand what public safety power shut off is.

And we brought all those folks with us. Yeah, we're proud of that. But again, that's the problem and the opportunity we have. Similar to Cherry, your area too, right, is Kaaba. I'm sorry, I don't know this. Waimanalo. Waimanalo, yep. But similar and different. Where your urban Honolulu is different than your area, your communities are different as well.

So same way we see ourselves where we have capacity to do outreach and make a difference there to do similar into different areas, your areas included, where we can meet Kupuna, where they're at, do the education and outreach as as best we can.

Are any of those Kupuna reliant on like medical devices, etc, that need power?

Yeah. Some of what do you do? So that is the education and outreach that we have. So Hawaiian Electric and I probably shouldn't speak for them, but they do have a medically fragile hotline number I think they call it.

So part of that was really Hiko in the door to door getting folks onto their listing so that they can get as much advance notice.

A lot of those individuals though, and this is not our space, but I'll offer the commentary on that regardless, is making sure that they have the battery backups, making sure they have the knowledge on their devices to make sure and working with their durable medical equipment providers.

I know our space and our impact is on the education and outreach.

Okay.

Yeah, okay. We're shaking the trees as best we can to build capacity. So if you take a look at the map right, you have some service deserts, if you will, for lack of a better word. Right. Particularly in the North Shore.

So I'm going to dovetail what my colleagues and the other counties and double down on what they said. It's not necessarily a provider capacity issue. It it's a workforce issue. And we are competing with workforce in many different sectors and it's not isolated to area agencies on aging.

We're talking about health and social services overall, whether it be home based services or even facility based services. And I know it's my understanding that LEG is having conversations and strategies to kind of look at different policy funding opportunities to incentivize more people to get into area that is truly really needed.

All that to say we try to influence where opportunities exist. Rowena mentioned similar to us when we did a community needs survey, what we came back was more service options in General, but in particular for transportation. So although we have robust transportation network, whether it be the bus, whether it be handy van, etc.

That does not work all the time in every cases, whether it be geographic limitations. For example, maybe some of our service providers don't operate 24 hours a day, weekends, evenings, etc. Maybe because of the individual's need with transportation, dialysis, for instance, or other medical appointments.

The scheduling pickup of Handy Van, et cetera, might not be a good fit. So that's where Rowena was mentioning that we have a test pilot right now where it's a on demand ride sharing program.

So we've contracted with a third party dispatch company where Kupuna, rather than going on their phone, can call this number and request pickup service, which will be coordinated by the third party dispatch company and get a ride when they want and where they want. Right now it's only 10 participants.

We've isolated that to those folks outside urban Honolulu and have a medical appointment or need. As far as we know, this model is the first of its kind built into a contract that no other government has maybe done yet, largely with the contracting provisions. So we think we have opportunity there.

If it goes well, like we hope to, maybe we can expand that and look at maybe, at least on our end, building greater capacity there. It's not going to be the be all, fix all, but we do think it'll address a niche area for the community.

Is it just regular cars driving them?

Good question. Good question. So that's why I said it's not the be all. It's regular. It's regular cars. What we do know though is that Uber and Lyft have drivers on the mainland that is specific for individual disabilities that can't accommodate wheelchairs, etc.

So I think if we can do it well and we can show the impact both on the community side but on the provider side, that there's a market there for them. Yeah. Hopefully that will incentivize them to increase their capacity to do something similar here. Yeah.

So using Kabuna care monies for that.

That's exactly right. Yeah, that's exactly right. I think those are the highlights for me. Again, grateful for the opportunity and I'll step back and offer myself for any questions.

So I guess the question is how much? Because unlike the other ones, well. zero, I can't provide a chart at all, but how much of the Kupuna care monies have you folks been able to use? All of it so far.

Yeah. I would say pretty similar to what Caroline almost shared. Almost all of it and most of.

It it looks like in case management and home delivery.

So I would offer this clarification. We have to point out that number of participants can look very different than expenditures. But I give this context. So for instance, on adult daycare, you take a look on ours, only 100.

But on the expenditure side it would look very different because that would be One of the highest or if not highest expenditures just because that type of service, like Caroline said, is so comprehensive and consequently expensive. But if the question is, can we do a expenditure breakdown, we can do that.

So are you also like Carolyn and Maui county using title three monies also for the meals?

Yeah, absolutely. And I think, Chair Martin, to your relevancy and constituency, one of them is a congregate meal program where you integrate meals and socialization requisition. A new one would be our partnership with the YMCA of Honolulu where they're using their YMCA sites, including your windward YMCA site, as a kupuna congregate site.

So now it's kind of that intergenerational piece. Right. It's not just the youth, but you're using the same facility and largely the same staff to provide services for kupuna as well.

Are you folks getting off county monies?

We're getting county monies too.

Okay, percentage wise, I mean, I didn't ask you guys for a breakdown because I want to make sure the kabuna tier monies was. Thank you. Of course. How much of your services percentage wise is feds state the Kupuna Care Monies and how much for county?

So don't quote me on this because I can provide the exact numbers. I'm just going to give you some rough percentages, if that's all right. Okay. So I would think for us would be, you know, two thirds largely would be state. Casey, you have Older Americans Act.

And then maybe the remaining percentage we have county largely for personnel cost. But if I could add one caveat to that is we did pursue federal earmarking funds, congressionally directed spending through Senator Hirono's office for us to relocate and have a community accessible, universally designed aging and disability resource center. And we did get awarded.

So as additional $2.5 million that we received, we are hopefully close the city that is in securing a physical site that 2.5 million will go into equipping up this potential site. So I would add that pot of monies too, as far as how we're trying to leverage our funds.

Thank you. Okay, so I see Emily here. I mean, basically for Maui County, basically around the same percentage wise. Okay.

Okay, Chair. Yes, we do get quite a bit of county funding. Yeah, we last year in fiscal year 24, it was. We had about 900,900,000 with Maui County.

You have the additional problem of Molokai and lanai transportation.

How do you guys handle that one? So our kupuna care funding, Title 3 funding we do not utilize it for airline transportation. It's on the ground transportation. But in recent years, in talking with stakeholders and community Members and also with our representatives, we, you know, we learned. Yes.

That the big issue right now is connecting Kupuna and our vulnerable populations with transportation options for them to attend Doctor visits outside of Molokai and. Or bringing in doctors. So that. That's an area that we're interested in addressing.

And I don't know how far it went, but there was a pilot program that was proposed last session. I remember that. Yeah. I don't think. And I didn't know whether or not you. I don't know. I. I'm really bad as far as figuring out whether or not it finally pass conference. No, I don't think it's my Committee.

Unfortunately, it didn't. And it's still a discussion item, I know, with our interdisciplinary team. So. But we're, you know, we're interested to see of any discussions to be had at the state Legislature this session regarding transportation for our rural population.

Okay. Thank you very much. Thank you. So I. I don't know when Emily's still there. Same. Same kind of percentage. Emily, basically around 2/3 state, 1/3 county. Yeah. And a smattering of feds. Yes. Correct. Okay. Okay. And my big question to Carolyn, because I don't see anybody else, is you folks used up all the monies because.

Or are there any monies for a statewide review like Alzheimer's or. I see disability people here for.

I'm sorry, Senator, you mean the service dollars for Kupuna care? So in this last state fiscal year, we spent about. Go back to the slide. I think it was about 97% of the allocation was spent. Spent on services and admin. So we receive our state funds by quarter now. And that's.

I think that's been a practice for a while now. So, you know, we're constantly, every three months, amending their contracts with our county so that they can amend their contracts with their providers and getting the funds out.

Okay. So I just want to make sure the model is basically, we give you the kapuna care monies, and you then distribute it out to the counties based upon the formula and whatever monies. There shouldn't be any monies left over.

Yeah. And so I know our state fiscal year 2024 figures. We're still. I think we're still awaiting some final billings for that. We're a little behind on that. I mean, as a network, we're behind. So those aren't our final figures.

Okay.

Yeah.

So there isn't any monies allocated for a statewide program, like I said, like for Alzheimer's or.

So we do use, and I don't want to speak for my counties and they can correct me if I'm wrong, we do use a lot of our Older American Act funds to, to provide things such as education and outreach to programs like Alzheimer's and things like that. Thank you. I'm correct. Right. Okay, thank you.

And so the core services that Kupuna Care provides are those services that have been identified back in 1996 as being those that most needed so individuals can stay at home for as long as possible.

All our other array of services and supports are provided through the use of both the federal Older American act funds and, and then the, and I, and I've got to thank all of our counties for providing county funds too because that allows them to innovate and do new things and test out new programs and services in the community.

So I, I have here my human health and human services. He was in Wham. Briefings that I was supposed to be part of also. So I thank him for being there for me. Yes, go ahead.

So on Oahu, I was surprised to see that there's really not many more participants than the other islands with much smaller budgets and much smaller populations. Is it that we have so many options?

So the big case management number is referring people out to other programs and the new folks are just filling the gap on the more expensive daycare or what.

Explain that part of that is correct. Yeah. Is for the folks that we do support, for example, adult daycare. Yes. It's an expensive service. So we go really deep with those folks because those folks have substantial, substantial needs.

I would say what's not reflected in here is how we complement our federal monies, which for us it does include home delivered meals, it does include congregate meal services, caregiver support services, etc. Yeah. So this is just one picture of what we do, correct? Yeah, correct.

Yeah, go ahead. So one thing that we're going to be looking at this session is Medicaid rates for. In home care, not for medical care, but for some of the things that are provided in a small amount here. Bathing errands, things like that. Do you. Is there maybe on Maui?

It seems like there is more of that care being provided. Could we get help seeing like what rate, at what rate people are willing to actually provide that service?

So you're looking at like the unit costs. What are our current unit costs compared to what Medicare, Medicare Medicaid. I'm sorry? Medicaid is paying three.

DHS understand there's very, very Low utilization of Medicaid for those services in our state because nobody can provide it because we don't pay.

And sometimes. Yeah, and sometimes we're competing for the same providers too. But we. We'd be happy to provide our unit costs.

You know, not here, but I'd love to get some data so that we have additional data to justify an appropriate price point.

Right. Okay. So you would like the unit cost for the various kupuna care services and what we're paying in home services. Right. Okay. Yeah, we can get that for you. zero, I'm sorry, representative. Do you want it by county? And then the over like what the average would be. We could do that by. Okay. To understand.

Right. You know, at what price point people actually are able to provide the services.

We'd be happy to get that for you.

Okay. So whatever you provide her, could you provide the rest of us? Definitely. Thank you.

Thank you.

Any other questions? Okay, I thank you, folks. And I am gonna hold you to the rules. Okay. Because we're talking seven years. Yeah. And. Yeah, Covid is an. Is. Is an excuse for maybe two, possibly three, but not seven. Okay. Thank you.

Okay, we are adjourned.

Thank you, Senator.

Sa.