SUPPORTIVE SERVICES

(See Appendix V for additional information)

There exist in Hawaii examples of the spectrum of services which, if applied in sufficient quantity, could prevent unnecessary institutionalization of chronically ill persons. However, many of these services, currently existing as demonstration models, are limited in the number that they can serve and do not seem to be readily available. The continuum of care referred to can be reviewed in the charts on pages 7 and 8. These charts diagram the levels of long term care and note the continuum of support and alternative care services necessary to assist people at risk of institutionalization to remain independent and in the home setting.

The following is a description of some of the more innovative examples of support services for long term care which, in the opinion of the Long Term Care Task Force, should be developed, expanded and financed by a combination of public and private financing.

Independent Group Homes

Catholic Social Service has developed a program which is called Small Group Homes for Older Adults. This program is designed to provide living arrangements for independent adults who are at risk of social and emotional isolation from the community and/or need assistance with some activities of daily living (adl) skills. By choice, these adults agree to live together, to help each other, and to contribute to the maintenance and operations of a home. As a pilot project it has been very successful. The project now serves sixteen people, but more than one hundred people have expressed an interest in this type of living arrangement and are waiting to be accommodated by this project.

This demonstration program is worthy of support on a continuing basis by the State. In addition to the lack of funding, the lack of appropriate houses is also a major handicap. The cooperation of the City and County Department of Housing and Community Development, the Hawaii Housing Authority of the DSSH, and the Neighborhood Boards is needed to facilitate locating and/or renovating housing for group homes.

Sheltered Housing

Maui County and the State of Hawaii, as well as Catholic Social Service (on Oahu), are in the process of developing sheltered housing on a limited

DEFINITIONS OF SERVICES IN THE LONG TERM CARE CONTINUUM (continued)

DEFINITION

Counseling and assistance for senior citizens
eligible for subsidized food purchases.

Hot meals served in congregate style five days a week at community centers; donations accepted.

Intermittent skilled services (medical, rehabilitative and/or therapeutic services) provided in the home by Registered Nurses, Licensed Practical Nurses and Nurses Aides, as prescribed by a physician.

Limited personal care of client and light housekeeping for a short period of time.

More regular assistance with personal care and housekeeping.

Home delivered hot meals to people unable to prepare own hot meal at noon.

In-home, fellowship, information and referral, limited health aide services to potentially isolated adults.

Temporary taking in of or providing care to a frail or impaired person in order to give regular caretakers a vacation.

Families trained to and reimbursed for care of
health impaired adults in their own homes.

scale in Hawaii. Sheltered housing is defined by the International Center for Social Gerontology as a concept of assisted residential living combining shelter and services. It provides older people with an additional choice in selecting a living environment best suited to their personal and social needs, functional capacities, and financial resources.

The following goals for sheltered housing were outlined by Catholic Social Service (CSS) in a recent grant request to local trusts and foundations: "1. The broad goal of sheltered housing for the elderly is to provide a

physical and social environment that will extend the time span during which older people can live independently in comfort and safety, with sustained interest in life.

"2. Specifically, sheltered housing is designed:

a. to sustain independent or semi-independent functioning of older

b.

C.

d.

e.

people as they grow older;

to prevent institutionalization of older people;

to make available to older people a choice of living arrangements
among independent living facilities and hence to bridge a gap
in the housing continuum;

to provide environments of housing and services especially designed
to accommodate declining functioning capacities;

to relieve family members of the sometimes overwhelming burden

of trying to provide assistance to older relatives and of the sense

of guilt associated with the consigning of aged parents to a nursing home."

(Taken from a grant proposal for sheltered housing, CSS, June 1979).

CSS notes that an additional emphasis on self-help and mutual assistance will be added to the above goals.

Loans are available for sheltered housing in Hawaii through the Federal Housing and Urban Development Program; however, land must be made available for the project before a loan will be granted. Public and private service agencies should be encouraged to approach the private sector for land, to apply for these loans, and to expand this supportive service for persons at The concept of sheltered housing needs to be

risk of institutionalization.

examined and compared over time with Hawaii's care and boarding home facilities. The administration and organization of care and boarding homes should include more elements encouraging resident self-help and mutual assistance, necessary ingredients in the prevention of functional dependency.

Maui County and the State of Hawaii are currently collaborating to provide leadership in the establishment of sheltered housing for Maui residents (Hale Mahaolu Project). Support services, including congregate meals and homemaker services, will be provided to these sheltered housing residents.

Senior Companion Services (Home Visiting)

The recently established DSSH-sponsored Senior Companion Program is designed to pair mobile seniors with seniors who request companionship, fellowship, information and referral, and limited home-aide services. This program is a vital service in preventing isolation among disabled seniors and has been recognized as an integral part of the continuum of home support services.

Meals on Wheels

This program is designed to provide and deliver hot meals to chronically ill homebound patients who, because of illness, cannot cook for themselves. This description also applies to a homebound patient whose family or caretaker is unavailable to cook for the disabled person because of work during the day. On Oahu, a variation of Meals on Wheels is provided through the Honolulu Area Agency on Aging as an extension of the Congregate Dining Sites. Under this program, volunteers deliver meals to people who have become homebound because of illness, if they were known to have used a Congregate Meal Site.

A new pilot program has been established for the Makiki-Punchbowl-Manoa area by a consortium of churches in Honolulu. The program presently is serving twenty-six people. At a cost of $2.50 per meal, volunteers deliver hot meals to homebound, chronically ill persons. Initial experience with the program indicates that the $2.50 cost may be too high for some people in need of the Case finding has also been a problem. Fortunately, the Meals on Wheels and Congregate Dining Sites accept food stamps as do Honolulu Burger Kings and some other restaurants.

Transportation Services

Oahu has a very good public transportation system (TheBus) for persons who are ambulatory and independent. This system services the entire island. For persons with conditions limiting their mobility, van transportation is available through the Honolulu Community Action Program, the Honolulu City and County HandiVan, and the privately-run Handicab program. Catholic Social Service, the Areawide Horizons for Senior Citizens programs (targeting senior citizens in Kalihi-Palama and Chinatown and Oahu's North Shore respectively), and the volunteer programs of FISH also provide some transportation assistance. However, transportation services are still in short supply for chronically ill persons and should be expanded.

One suggestion is to equip TheBus with lifts to accommodate handicapped people and to establish bus routes that will pass in front of all long term care facilities and housing projects. Increasing regular service to and from these homes will encourage residents to travel to social centers and medical facilities as well as provide sure transportation for homemakers, companions, home health aides and other visitors to such homes.