Report Title:

Family Caregivers; Omnibus Package

 

Description:

Strengthens support of family caregivers by, among other things:  extending the joint legislative committee on family caregiving, requiring the executive office on aging to conduct a comprehensive assessment of care recipients' needs and the needs of their family caregivers, and appropriating funds to expand services for care recipients and their family caregivers.  Expands SAGE Plus program to the neighbor islands.  (SD2)

 


HOUSE OF REPRESENTATIVES

H.B. NO.

825

TWENTY-FOURTH LEGISLATURE, 2007

H.D. 1

STATE OF HAWAII

S.D. 2

 

 

 

 

A BILL FOR AN ACT

 

 

RELATING TO CAREGIVING.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 


PART I

FINDINGS AND PURPOSE

     SECTION 1.  The legislature finds that, due to a shortage of care providers in Hawaii, family caregiving has become a critical element of our health and long-term care system.  By 2020, more than one in four individuals is expected to be sixty years old or older.  The need for personal care assistance due to physical, sensory, cognitive, and self-care disabilities increases with age.  As Hawaii's population ages, many more families will be providing higher levels of long-term care to frail and disabled older adults at home.

     A comprehensive public policy to strengthen support for family caregivers is essential.  The joint legislative committee on family caregiving was established under Act 285, Session Laws of Hawaii 2006, to develop a comprehensive public policy to strengthen support for family caregivers in Hawaii.

     The committee held numerous meetings during the fall of 2006 and submitted a special committee report to the legislature outlining its proposal for the establishment of a comprehensive and sustainable, community-based family caregiver support system that will maximize resources in all communities.  However, it is still necessary to gather more information on this subject to enable the State to apply resources and services in a more efficacious manner.  The committee should be extended to enable it to continue work on its proposal for the establishment of a comprehensive and sustainable, community-based family caregiver support system.

     Numerous testifiers appeared before the committee on behalf of grandparents in support of recognizing their role as family caregivers for their grandchildren.  According to the United States Census Bureau, between 1990 and 2000, there was an over thirty per cent increase in the number of children under age eighteen living in grandparent-headed households in Hawaii.  Of the 14,029 grandparents in Hawaii who report that they are responsible for their resident grandchildren, over one-fifth also report that the children's parents are not present in the household.

     The national family caregiver support program under the reauthorized Older Americans Act includes grandparents of grandchildren age eighteen years and younger or nineteen years of age or older with physical or cognitive limitations.  Grandparents who are caregivers experience similar support needs and caregiving costs as do family caregivers who provide unpaid, informal assistance to older adults with physical or cognitive disabilities.  Custodial grandparenting has emotional, physical, and financial costs.  Custodial grandparents report more anxiety, depression, and physical health problems than their non-caregiving peers, and they need accurate and accessible information on a myriad of issues.

     A crucial element in the design and implementation of a comprehensive and sustainable, community-based family caregiver support system is an assessment of the needs of family caregivers and the care recipients.  A thorough needs assessment is imperative to appropriately encourage, support, and strengthen the provision of family caregiving.

     Family caregivers who provide care to recipients with chronic or disabling conditions are themselves at risk for physical, emotional, and financial problems.  The daily challenges and health risks that family caregivers face can impede the family caregiver's ability to provide care, lead to higher health care costs, and affect the family caregiver's quality of life and the quality of life of the care recipient.

     For many family caregivers, their role as family caregiver arises as suddenly as the care recipient's health declines, leaving family caregivers with an immediate need for services, but little preparation or education regarding who to contact for assistance or what services are available to them.  In addition, the family caregivers may not know who is capable or qualified to provide them with the services that they or the care recipients need.  Family caregivers themselves need support services, including respite services and training, education, and counseling in areas such as caregiving and dealing with end‑of-life issues.

     Kupuna care is a statewide long-term care program, administered by the executive office on aging, which was developed in partnership with the county area agencies on aging to address the growing numbers of elders with long-term care needs.  Services provided by kupuna care are intended to help meet the needs of older adults who cannot live at home without adequate help from family or formal caregiving services, and include services such as adult day care, respite care, assisted transportation, attendant care, case management, chore, home delivered meals, homemaker, transportation, and personal care.  In addition to the services provided to the elderly, direct services to family caregivers can be provided to educate and assist family caregivers in coping with their roles as a caregiver.

     Under Act 262, Session Laws of Hawaii 2006, the executive office on aging is required to coordinate a statewide system of caregiver support services.  An appropriation should be made to assist the executive office on aging's caregiver's resource initiative project to enable it to continue its efforts in that regard.

     A number of approaches have been suggested as a means to help family caregivers with the financial costs of family caregiving, including a cash and counseling program and a family caregiver refundable tax credit.  However, more research and analyses of these different approaches are necessary to ensure that the State applies its resources and services toward helping family caregivers in the most efficacious manner.

     The purpose of this Act is to strengthen support of family caregiving by:

     (1)  Extending the life of the joint legislative committee on family caregiving;

     (2)  Authorizing the joint legislative committee to explore establishing a paid family leave program under the state temporary disability insurance law;

     (3)  Providing a broader definition of "family caregiver" by including grandparents who are caregivers for grandchildren who are age eighteen years or younger or nineteen years of age or older with physical or cognitive limitations;

     (4)  Requiring the executive office on aging to conduct a comprehensive assessment of the needs of care recipients who are age sixty and older with physical or cognitive disabilities, and the needs of their family caregivers;

     (5)  Appropriating funds for the executive office on aging to conduct a comprehensive assessment of the issues facing, and the needs of, grandparents raising grandchildren who are age eighteen years or younger or who are eighteen years of age or older with physical or cognitive limitations;

     (6)  Appropriating funds to expand the kupuna care program's in-home and access services for qualified care recipients;

     (7)  Appropriating funds to provide direct services to family caregivers;

     (8)  Appropriating funds for the operation and delivery of the Sage PLUS program on the neighbor islands, and for the recruitment, training, and retention of volunteers to augment the program staff;

     (9)  Appropriating funds to the executive office on aging for the caregiver's resource initiative project, including the continuation of its efforts to coordinate a statewide system of family caregiver policies and support services; and

    (10)  Appropriating funds to the executive office on aging to provide analyses of two different approaches to helping family caregivers with their financial needs.

PART II

JOINT LEGISLATIVE COMMITTEE ON FAMILY CAREGIVING

     SECTION 2.  Act 285, Session Laws of Hawaii 2006, is amended by amending section 2 to read as follows:

     "SECTION 2.  (a)  There is established a joint legislative committee on family caregiving.  The committee shall be composed of eight members as follows:

     (1)  Four members of the house of representatives, consisting of three members from the majority party and one member from the minority party, who shall be appointed by the speaker of the house of representatives; and

     (2)  Four members of the senate, consisting of three members from the majority party and one member from the minority party, who shall be appointed by the president of the senate.

     The committee shall select a chairperson from its membership.

     (b)  The joint legislative committee shall develop comprehensive public policy to strengthen support for family caregivers [who provide unpaid, informal assistance to persons age sixty and older with physical or cognitive disabilities].  For purposes of this Act, "family caregiver" means:

     (1)  A person, including a non-relative such as a friend or neighbor, who provides unpaid, informal assistance to a person age sixty and older with physical or cognitive disabilities; and

     (2)  A grandparent who is a caregiver for a grandchild who is age eighteen years or younger, or who is nineteen years of age or older with physical or cognitive limitations.

     (c)  The joint legislative committee shall [consider]:

     (1)  Consider providing support in categories including [but not limited to]:

    [(1)] (A)  Coordinated services and policies;

    [(2)] (B)  Training and education;

    [(3)] (C)  Respite services;

    [(4)] (D)  Financial incentives; and

    [(5)] (E)  Balancing work and caregiving[.]; and

     (2)  Explore establishing a paid family leave program under the state temporary disability insurance law, similar to the California Paid Family Leave Program, to provide wage replacement benefits to employees who take time off from work to care for a seriously ill family member.

     (d)  The joint legislative committee shall seek input from the department of health, the department of human services, the department of taxation, the University of Hawaii, the executive office on aging, and the elderly, disability, business, and faith-based communities.

     (e)  The joint legislative committee shall submit its findings and recommendations to the legislature no later than twenty days prior to the convening of the regular [session] sessions of 2007[.] and 2008.

     (f)  The joint legislative committee shall cease to exist on [June 30, 2007.] June 30, 2008."

PART III

NEEDS ASSESSMENT OF FAMILY CAREGIVERS

     SECTION 3.  (a)  The executive office on aging shall conduct a comprehensive assessment of the needs of care recipients who are age sixty and older with physical or cognitive disabilities and the needs of their family caregivers.  The needs assessment should include an evaluation of:

     (1)  The extent of the unmet caregiving needs of persons age sixty and older with physical or cognitive disabilities;

     (2)  The size of the current family caregiver population;

     (3)  The percentage of care recipients' needs being met by paid versus unpaid caregivers; and

     (4)  The impact of caregiving on family caregivers' employment and income.

     (b)  In conducting the needs assessment, the executive office on aging shall identify and review past surveys, such as the 2003 Hawaii Health Survey, include focus groups, and develop policy questions to guide the focus of the needs assessment.

     (c)  In conducting the needs assessment, the executive office on aging may utilize telephone surveys or other methods of gathering reliable data regarding care recipients' needs and the needs of their family caregivers, including purchasing additional questions for the upcoming Hawaii Health Survey.

     (d)  The executive office on aging shall submit the completed needs assessment to the joint legislative committee on family caregiving no later than twenty days prior to the convening of the regular session of 2008 to facilitate the development of a comprehensive, sustainable, and community-based family caregiver support system.

     (e)  For purposes of this section, "family caregiver" means a person, including a non-relative such as a friend or neighbor, who provides unpaid, informal assistance to a person age sixty and older with physical or cognitive disabilities.

     SECTION 4.  The executive office on aging shall submit a report, including the completed needs assessment pursuant to section 3 and any proposed legislation, to the legislature no later than twenty days prior to the convening of the regular session of 2008.

     SECTION 5.  There is appropriated out of the general revenues of the State of Hawaii the following sums or so much thereof as may be necessary for fiscal year 2007-2008 for the executive office on aging to conduct a comprehensive needs assessment pursuant to section 3.

     Senate                       $

     House of representatives          $

     The sum appropriated shall be expended by the senate and the house of representatives to assist the executive office on aging for the purposes of this part.

PART IV

NEEDS ASSESSMENT OF GRANDPARENTS RAISING GRANDCHILDREN

     SECTION 6.  There is appropriated out of the general revenues of the State of Hawaii the sum of $           or so much thereof as may be necessary for fiscal year 2007-2008 for the executive office on aging to conduct an assessment of the issues facing, and the needs of, grandparents raising grandchildren in Hawaii.

     Senate                       $

     House of representatives          $

     The sum appropriated shall be expended by the senate and the house of representatives to assist the executive office on aging for the purposes of this part.

     SECTION 7.  The executive office on aging shall submit a report, including the completed needs assessment pursuant to section 6 and any proposed legislation, to the legislature no later than twenty days prior to the convening of the regular session of 2008.

PART V

SERVICES

     SECTION 8.  There is appropriated out of the general revenues of the State of Hawaii the sum of $           or so much thereof as may be necessary for fiscal year 2007-2008 and the same sum or so much thereof as may be necessary for fiscal year 2008-2009 to the executive office on aging to expand the kupuna care program's in-home and access services to qualified care recipients.

     The sums appropriated shall be expended by the department of health for the purposes of this part.

     SECTION 9.  There is appropriated out of the general revenues of the State of Hawaii the sum of $           or so much thereof as may be necessary for fiscal year 2007-2008 and the same sum or so much thereof as may be necessary for fiscal year 2008-2009 to the executive office on aging to provide direct services to family caregivers.

     The sums appropriated shall be expended by the department of health for the purposes of this Act.

     SECTION 10.  There is appropriated out of the general revenues of the State of Hawaii the sum of $           or so much thereof as may be necessary for fiscal year 2007-2008 and the same sum or so much thereof as may be necessary for fiscal year 2008-2009 to the executive office on aging for the caregiver's resource initiative project, including the continuation of its efforts to coordinate a statewide system of family caregiver policies and support services.

     The sums appropriated shall be expended by the department of health for the purposes of this part.

     SECTION 11.  There is appropriated out of the general revenues of the State of Hawaii the sum of $           or so much thereof as may be necessary for fiscal year 2007-2008 and the same sum or so much thereof as may be necessary for fiscal year 2008-2009 for operation and delivery of the Sage PLUS program on the neighbor islands.

     The sums appropriated shall be expended by the department of health for the purposes of this section.

     SECTION 12.  There is appropriated out of the general revenues of the State of Hawaii the sum of $           or so much thereof as may be necessary for fiscal year 2007-2008 and the same sum or so much thereof as may be necessary for fiscal year 2008-2009 for the recruitment, training, and sustaining of volunteers to augment the Sage PLUS program staff, and for operating costs of the neighbor island Sage PLUS program staff.

     The sums appropriated shall be expended by the department of health for the purposes of this section.

PART VI

APPROACHES TO FINANCIAL NEEDS OF FAMILY CAREGIVERS

     SECTION 13.  (a)  The cash and counseling program is a national initiative sponsored by the Robert Wood Johnson Foundation; the United States Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation; and the Administration on Aging.  Under the program, recipients of medicaid personal care services or home- and community-based services receive a flexible monthly allowance and decide who to hire and what services they want to receive.

     The program's innovative approach enables participants to direct and manage their personal assistance services according to their own specific needs.  Participants can choose a family member or friend, in lieu of an agency worker, to provide the services.  They receive counseling and fiscal assistance to help them manage their allowance and responsibilities.  The program was first implemented in Arkansas, New Jersey, and Florida, and has since expanded to include twelve other states.

     The potential exists to establish a similar program here in Hawaii to serve the needs of residents receiving medicaid personal care services or home‑ and community‑based services, as well as residents who are not medicaid recipients.

     (b)  A tax credit to caregivers who care for qualified care recipients is another approach to helping family caregivers defray some of the cost of providing invaluable caregiving services.  One measure introduced during the 2007 legislative session, Senate Bill No. 1199, S.D. 2 (2007), provides eligible taxpayers with a refundable income tax credit on a sliding scale basis.

     SECTION 14.  (a)  The executive office on aging shall:

     (1)  Research the cash and counseling program and its implementation in other states, including Arkansas, New Jersey, and Florida;

     (2)  In completing its research:

         (A)  Contact the national program office at the Boston college graduate school of social work, which coordinates replications of the program;

         (B)  Consult with the Robert Wood Johnson Foundation, the Office of the Assistant Secretary for Planning and Evaluation at the United States Department of Health and Human Services, the Administration on Aging, the department of human services, and the department of health; and

         (C)  Examine models that include individuals receiving medicaid personal care services or home‑ and community‑based services, as well as individuals who are not medicaid recipients;

     (3)  Submit an interim report of its research findings to the legislature no later than twenty days prior to the convening of the 2008 regular session;

     (4)  Use the report of its research findings to:

         (A)  Develop a plan for how to implement a similar program here in Hawaii to serve the needs of residents who are not medicaid recipients; and

         (B)  Prepare a cost‑benefit analysis of implementing a similar program here in Hawaii to serve the needs of residents who are not medicaid recipients; and

     (5)  Submit a final report, including the plan and cost benefit analysis, to the legislature no later than twenty days prior to the convening of the 2009 regular session.

     (b)  The executive office on aging shall also:

     (1)  Prepare a cost‑benefit analysis of a $1,000, $750, and $500 family caregiver refundable tax credit as proposed in Senate Bill No. 1199, S.D. 2 (2007); and

     (2)  Submit a report, including the results of the cost‑benefit analysis, to the legislature no later than twenty days prior to the convening of the 2008 regular session.

     SECTION 15.  There is appropriated out of the general revenues of the State of Hawaii the sum of $           or so much thereof as may be necessary for fiscal year 2007-2008 and the same sum or so much thereof as may be necessary for fiscal year 2008-2009 to the executive office on aging for the purposes of section 14 of this Act.

     The sums appropriated shall be expended by the department of health for the purposes of this part.

PART VII

MISCELLANEOUS PROVISIONS

     SECTION 16.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 17.  This Act shall take effect upon its approval; provided that sections 5, 6, 8, 9, 10, 11, 12, and 15 shall take effect on July 1, 2007; and further provided that section 2 shall take effect on June 29, 2007.