Analysis of November 2016 ADRC Report to the Legislature On The Effectiveness of the ADRC System
Pursuant to HB 1878, ACT 138 Requiring the Executive Office on Aging (EOA) to Evaluate the Effectiveness of the Aging and Disability Resource Centers. This can be found on the web at:
http://health.hawaii.gov/opppd/files/2016/10/Act-138-EOA-Annual-Report-111416.pdf
Background. According to statistics provided by the University of Hawaii’s Center on the Family, Hawaii’s aging population is heavily weighted towards females.
For Example.
· There are Approximately 138,000 seniors aged 70 or older.
· Of the 138,000, 80,000 (58%) are female, and 58,000 (42%) male.
· Of those aged 75 or above, there are about 97,000.
· Of the 97,000, 57,000 (59%) are female, and 39,000 (40%) male.
· Of those aged 80 or above, there are 62,000.
· Of those 62,000, 38,000 (61%) are female, and 24,000 (39%) are male.
KEY TAKEAWAY: Whatever programs and services provided, and their quality, older women are a majority of the customers. Therefore, if Hawaii's efforts to serve the elderly are less than expected, women are greatly disadvantaged as a group.
The November 2016 EOA Report on the effectiveness of the ADRC System looks at so called Long Term Support Options and Benefits (LTSS) between August 15 – October 25 – a two month snapshot of first time Kupuna Care Customers.
Kupuna Care services are adult day care, assisted transportation, attendant care, case management, chore, home delivered meals, homemaker, personal care, and transportation. It is easy to see that those needing one service might well need others.
EOA Study Demographics By County
| Demographics | Hawaii | Honolulu | Kauai | Maui |
| Median Age | 87 n=20 | 82 n=486 | 85 n=20 | 76 n=76 |
| Male | 40% | 34% | 45% | 30.6% |
| Female | 60% | 65.8% | 55% | 67.3% |
| Live Alone | 45% | 29.9% | 25% | 37.8% |
KEY TAKEAWAY: These demographics suggest that those seeking services were generally 80 years of age or older, and, similar to our statewide gender breakdown, 60% female and 40% male.
KEY TAKEAWAY: The report indicates that there were 11,400 contacts to ADRCs during the study period. Therefore, we must ask why only 626 were "qualified" or only 5% received services. Overall, for this two-month period, attention was paid to creating a service plan for this 5%, yet only 14.4% of these customers received a first service. The lowest was for Honolulu with only 5.7%. Clearly, the ADRCs are not yet a major factor in coordinating or providing services to our most vulnerable elders.
KEY TAKEAWAY: From the time a senior consumer requests assistance, it is not taking an extraordinary amount of time to receive an assessment and support plan - at least for 75% of the customers. However, for the last 25%, these can take well over a month in Hawaii and Honolulu counties. Why it takes so much longer is not well explained. This is before services are even delivered.
KEY TAKEAWAY: Clearly, for those who qualify for more than one service, the ability of ADRCs to deliver more than one service is limited. Because 80 year olds are most likely to require support in multiple of areas of Instrumental Activities of Daily Living and even more fundamental Activities of Daily Living, it is not clear how ADRCs are able to service the full needs of these customers.
CONCLUSIONS:
While it is important to see raw data, the report is not strong on analysis of systems or policies that might be helpful to administrative, legislative, and stakeholder oversight. The statistic that stands out the most, is that for over 11,000 contacts by consumers, only 5% entered the ADRC system. Discussion in the report is often confined to observing what the tables say, but not why. In other words, when services are not timely or complete: What should be done about it? This leads to the following observations:
It is not clear from the report why EOA and the ADRCs were not able to provide statistics on at least one full year of their operations. Acknowledging that there is a gradual phase in of these operations, more data should be available. It is not clear if we can safely multiply the numbers by six for a relatively accurate picture of ADRC annual effectiveness. Context is meaning. How do these data compare or relate to other sources of data such as census data? Is a particular number unexpectedly high or low?
First, it is not clear from the report why EOA and the ADRCs were not able to provide statistics on at least one full year of their operations. Acknowledging that there is a gradual phase in of these operations, more data should be available. It is not clear if we can safely multiply the numbers by six for a relatively accurate picture of ADRC annual effectiveness. Context is meaning. How do these data compare or relate to other sources of data such as census data? Is a particular number unexpectedly high or low?
Second, it is not clear from the report if each ADRC has the same criteria in assessing the needs of seniors, in qualifying them for services, in “counting” services provided, or in removing seniors from the proverbial wait list. Senior advocates report anecdotally that if a customer does not return a call immediately, some ADRCs will remove them from the waiting list. In the past, it was reported that if a senior qualified, for example, for bathing services once a week, but did not receive it but once every month, it was still counted as “delivered.” There are no data or analysis that clarify whether these issues are significant or persistent.
Third, the report does not address financial or administrative roadblocks. These include the timeliness of the release of funds from the State Department of Budget and Finance to Executive Office on Aging and then when each ADRC actually receives the funds. And then contracts must be signed. This is especially relevant in executing contracts for community-based services.
Fourth, the report does not reflect the extent to which each county contributes or does not contribute to ADRC funding, or county services provided directly to the elderly. It is well known, for example, that the City and County of Honolulu does not contribute. Community based bloc grants are relevant to the mix, yet not mentioned.
Fifth, the report does not clarify whether its staff is adequate to assess, plan, coordinate and follow up on services.
Sixth, the report comments on but does not analyze with data the capacity of county community-based services to provide services called for in the individual plans, or whether they have the skilled workers to even hire for such services. There is a theoretical speculation about certain skill sets, but we do not know if the available pool of workers relates to compensation, cost of living, or lack of attractiveness of the work. Or, are most workers in private pay situations? Presumably, capacity would vary from county to county. Therefore, it is impossible to know if the inability to deliver services lies with the county ADRC or the general lack of services available geographically. A specific ADRC may be doing a great job, but simply cannot find services or skilled workers. On the other hand, capacity may not be the reason why a particular ADRC is not performing as hoped.
Seventh, the issue of gender begins to emerge as an important factor in serving our frailest elders. It is very difficult to access data on the gender demographics for state licensed residential facilities. However, anecdotally, the overwhelming number of residents are female. Are widows and those living alone less able or willing to traverse the red tape to enter the system? Conversely, are we simply less focused or effective in reaching out to males?
Eighth, the State’s Kupuna Care program, and the movement of financial resources through administrative pipelines to each county, do not exist in a vacuum. Recent revelations as to the inadequacy of quality control, licensing, unannounced inspections, and heavily redacted reports that are of little use to consumers, are part of a larger picture of how well the State is serving our elders, particularly older women. When the State’s Long Term Care Ombudsman is responsible for being the eyes and ears of oversight for over 12,000 residential seniors, this means that each element in the State’s matrix of services cannot be seen in isolation. If ADRCs are not filling in the gaps, who is?
Kokua Council
