27 October 2014, 6-7:30 p.m.
St. Elizabeth Episcopal Church; Honolulu, Hawaii
By: Dr. Clementina D. Ceria-Ulep
Good evening ladies and gentlemen, honored guests:
My name is Clementina Ceria-Ulep, a parishioner of Our Lady
of the Mount (OLM) Catholic Church in Kalihi Valley, and laity vice-president
of Faith Action for Community Equity (FACE) and an
associate professor and chair of the Department of Nursing at the
University of Hawaii School of Nursing and Dental Hygiene. It is an
honor and a privilege to be here with you this evening to talk about an
issue that is very dear to me and a concern to us all—long-term care.
Before I proceed, let me define the word “long term care.” Long-term
care is the umbrella term for the various supportive services used by
persons who need assistance to function in their daily lives. Long
term care services include nursing, home health, and personal care;
rehabilitation, adult day care, case management, social services,
assistive technology and living services. My interest on this issue
stems from my experiences while growing up and during my practice
as a nurse.
Long-term care is the umbrella term for the various supportive services used by
persons who need assistance to function in their daily lives.
My family was fortunate to immigrate to Hawaii from the
Philippines through the kindness of uncle Lawrence, a plantation
worker in the early 1900’s. In the Philippines, my family and I lived
first with my paternal and then later with my maternal grandparents.
My paternal grandfather then in his 90’s, helped my father in the farm
while the rest of my grandparents supervised the home–cooking,
cleaning, caring, and disciplining of the grandchildren. I remember
that our grandparents ruled their homes and were revered by their
children and grandchildren. To this day as my family and friends will
tell you, I am quite fanatic about keeping the house clean, a legacy
from my grandmothers.
Growing up, my first exposure to the issue of long-term care
was through my parish’s involvement in providing volunteer care for
the residents of Beverly Manor, a nursing home near Kalihi Valley
Homes. Once a week, our youth group–Junior Filipino Catholic Club,
visited and worked with the residents on arts and crafts projects. I
recall spending five years as a volunteer at Beverly Manor, where
loneliness seemed to be the order of the day. Over time, I got used
to the atmosphere. Then one day, I invited a high school friend to
accompany me on a visit to Beverly Manor. On our ride back home, 3
my friend cried all the way. She sobbed, “That’s so sad…I would
never put my grandparents or parents in a care home!” How many of
you, during your first visit to a nursing home, made the same
promise—not to put your parents in such a “horrible” place, but ended
up doing so because you simply could not help it?
While studying in Virginia, I befriended Helen who lived alone
and was in her early 90’s. She used to treat some students and I to a
musical play. One day, she broke one of her hips and became
dependent on others. Every day, I would visit and administer her
vitamin B injection. When she moved to a care home, she had to sell
all her prized possessions and used her lifetime savings to pay for
…she had to sell all her prized possessions and used her lifetime savings to pay for her nursing home.
Then, there’s Miss Perry our former Catechism (religious)
teacher, who lived alone on Perry Street. During grade school, she
arranged it with our Kalihi Uka School teachers and principal so that
every Tuesday, we would form a line and walk over to OLM Church,
to attend her class; heaven help you if you miss her class! She was
our top seller for any of our fund-raising events, and attended all of
the church’s functions until she was 90 years old. Miss Perry became
dear to my friends and I because she was very accepting of us during 4
our tender years. Like Helen, she too started to go down once she
broke one of her hips. In 1999, she fell down and had multiple skin
tears. Daily, for three months, I dressed her wounds twice a day.
Then in 2000, she needed constant care and had to be moved to a
What is the point of my talk stories? In Hawaii, the cost of
nursing home is between $10,000+ to $12,000+ per month, or
$127,568-145,270/year. Miss Perry and many others had to sell their
homes to pay for their care. Lucky for Miss Perry, she had no other
family to worry about. Others are not so fortunate. Another OLM
parishioner, Mrs. Demota, 85 with serious heart condition, had to care
for her husband, a stroke victim, age 89. They died, one after the
other, struggling “to make do” because they could not afford a care
home. In Hawaii, 1 out of 5 residents are caregivers providing about
$2 billion in unpaid care, highlighting the importance of care giving.
Caregivers spend an annual average of $5,531 out of pocket costs.
Not to mention, the physical and emotional stress. I could go on and
on, but I know many of you have stories of your own, whether you are
rich or poor…
Briefly, let me bring your attention to some stark information.
Due to increased longevity and declining fertility rates, the population
of the world is aging. By 2017, there will be more people over 65
years old than under 5 years old for the first time in human history.
The United States is also aging. In the year 2000, 12.5% of U. S.
population was 65 years and older which will increase to 16.6% in the
year 2020. This is a 33% increase. In 2012, 15.1% of Hawaii’s
population of 1.39 million, were 65 years and older (U.S. Census
Bureau, 2014). Since Hawaii’s statehood in 1959, over 55 years
ago, there has been a 300% increase in individuals 65 years and
older in Hawaii (State of Hawaii Healthcare Innovation Plan, 2013)
In 1996, you will recall the emergence of FACE in our public
life. I was chair of FACE twice, in 1996 & 1998. During my first
tenure, George Honjiyo, from Nuuanu Congregational Church, who
was President of the Coalition for Affordable Long-Term Care,
brought the issue of long term care to FACE. Institutionally, in FACE,
long term care as an issue came out of its listening process as
conducted by member units such as Nuuanu. Last year, long-term
care was again one of the most important issues identified by FACE
members in their listening process.
An abiding passion for ensuring that our elders will live their golden years with dignity and some measure of comfort.
Now you ask me, what does a Kalihi girl from a working class
parish like OLM have in common with a member of an affluent
congregation, Nuuanu Congregational Church? An abiding passion
for ensuring that our elders will live their golden years with dignity and
some measure of comfort.
How can we bring this about?
First, complete the actuarial study on the feasibility of public
long-term in Hawaii that was recommended by the Hawaii Long-Term
Care Commission. AARP in Hawaii has also proposed a limited,
mandatory public long-term care insurance program. There are
several countries in the world with successful public long-term care
insurance—West Germany (1994), Japan (2000) and South Korea
(2008). Public long-term care insurance is something that FACE is
wanting to support as well.
Second, look into alternatives that address quality of life issues
for nursing home residents, such as the Eden Alternative. Eden
Alternative is a simulation of a home in a care home. Another is the
Intergenerational Model. In such a model, nursing home residents 7
have an opportunity to interact with grade school children who can
learn from them and in turn enrich elders’ lives with their youthful
exuberance. Still the most recent innovative model is the Green
House model wherein the schedule of the nursing facility revolves
around the resident, and not the other way around—eating, bathing
when they want to. In the Green House model, there are more
nursing hours provided yet care is less costly and better than in the
traditional nursing home.
Third, explore more community based care, as most people
would like to live out in a community, instead of a care home. This is
consistent with a new concept, the idea of aging in place. Of all the
alternatives in the long run, this is the cheapest: adult day care is
about $78/day; adult day health is a little higher. Remember that
presently, this cost is primarily paid by elders or their families.
Another is the Adult Residential Care Homes (ARCH) option where
elders are taken care of in a private home. Still another is the
Assisted Living Facility (ALF) which is $50,400/year for those who are
able to live independently if some support services are available
while Home Health Aide is $57,200/year.
Fourth, there are federal funds available to compensate family
caregivers. Although limited, it’s a good start. There is a need,
however, for educating and training family caregivers which could be
done through our churches. For example, FACE members such as
Kilohana UMC and OLM spearheaded a training program for Certified
Nurses’ Aide in 1999 and in the early 2000. From Kilohana, 17 (15
Tongan & 2 Samoan women) went through training; sixteen passed
the certification exam. Recently, these women formed the Kilohana
Angels Cooperative with the mission to provide home care for the frail
elderly in our community. They are now open for business!
Fifth, locally and nationally, there is research being done to
study predictors of disability in the elderly which needs continuous
funding. At the same time however, we also need to look at
interventions to prevent disability and in the long run
institutionalization of the elderly.
Sixth, we need to make sure that we have enough beds—
nursing home, ARCHs, ALFs, and day care centers to accommodate
our growing elderly population. From my own experience, sometimes
we do not have enough hospital beds because we cannot discharge
an elderly to a care home, or other community setting. This is very 9
expensive care, ~ $1,000 to $2,000/day and tax an already
overburdened hospital industry.
Last, let me ask a few questions. Why do we seem to be
dragging our feet on this issue that affects everybody, rich and poor?
This is the only issue that FACE has not moved forward since 1996
when FACE came into being. That was 18 years ago! We speak of
government indifference or bad economy, or corporate greed or
something else as we struggle with long term care. What about
talking, feeling and thinking about US? My parents, your
grandparents; your aunts, my uncles; you and I, when we get old…
May our Creator endow us with wisdom and compassion do to
the right thing—Bring about a caring haven for all our elders and
ourselves, here and now, in our beautiful island home and state.