Running head: HEALTH POLICY

Health Policy Bill Number 2478 S.D. 1

Naomi Masuda
NURS 362
3/1/2016

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Relating to long-term care, bill number 2478 S.D. 1, was introduced in January 2016, which is to
establish a long-term care surcharge on state tax as a dedicated source of funding under the long-term care
financing program Beginning of January 1, 2018, the long-term care surcharge on state tax shall be
levied, assessed, and collected (S. 2478 SD 1, 2016). And after five years of the collections, the longterm care payments will start. This bill was proposed since Hawaiis aging issue will be significant, and
there will be additional health care system needed in addition to the current system. According to the bill,
1/3 of the States population will be 60 years or older in the next twenty years. In addition, average life
expectancy is 82 years old.
In Hawaii, many people live with multiple generations and family members are the primary
caregiver for their elderly. When their parents become dependent upon someone else to provide activities
of daily living, the children might have to move back to the parents place to take care of them. The
relocation might cause the children to give up their careers and personal lives they have built up until that
point. Maintaining the parents medical appointments, financial and legal issues with lawyers or financial
planners while they are employed could make them to use up all their vacation. They might need to
change or reduce their working hours to assist their parents. If the parents conditions get worse or they
are hospitalized, the situation will impact not only the parents finances but also their childrens assets as
well. In some cases, the children need to quit working completely to provide extended and personal care
to their parents. In such cases, Hawaii loses a taxpayer that contributes our economy. These circumstances
easily can make caregiver children overwhelmed, burned out, and even depressed. There are options to
provide 24 hour care outside of the home, however the cost of a residing in a nursing home in Hawaii
averages nearly $145,000 a year (S. 2478 SD 1, 2016). The cost of a care home where Im currently
employed starts about $3,000 a month. Affordable health care service is optimal, however, many Hawaii
elderly and their families cant afford such expenses.

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Although we have some support systems for aging population and their caregivers, like a
dedicated tax for medical expenses, the hardships of providing long term care to their parents cause great
problems physically, emotionally, and financially.
The framework of the bill provides $70 a day of 365 days for elderly and disabled people who are
cared for at home. This money is to provide economic assistance to family caregivers, hire in-home aids,
and provide safety equipment. The funds are collected as state tax surcharge which shall be 0.5 per cent
of all gross proceeds and gross income taxable (S. 2478 SD 1, 2016). For example, an elderly and
disabled persons caregiver could use the $2,100 a month benefit to pay for about half-day of home care
service.
I think that if this bill becomes law, there will be an increase in construction of care/nursing home
facilities, and a higher demand for nurses and aides to staff the facilities and provide home care options.
According to Stone (2014), there are insufficient numbers of competent licensed and direct care
staff to manage, supervise, and deliver high-quality care to the older population and younger people with
disabilities by 2030. The needs of the care providers will be increasing more than predicted. The
education and training the nurses and aides are crucial.
Also, according to the article of Star advertiser, University of Hawaii political professor
Lawrence Nitz says about 25 percent of the tax revenue comes from visitors. Which means that Hawaii
asks nonresidents to pay for their own residents health care systems.
When I read the bill, I thought this is similar to the health care system in Japan that started in
2000. Im not sure how well this system is working, since I moved to Hawaii soon after the law was
enacted, however I heard there are some issues. For example, many elderlies are not receiving their
benefits due to lack of the knowledge of the application process and/or an inadequate number of the
health care providers to provide the in home care. Japan tried to utilize nurses and aides from other
countries, such as Indonesia, Philippine, and Vietnam, however I believe this has not been extremely

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successful due to language and cultural barriers. Hawaii has many nurses and aides coming from other
countries already, and since English is a more universal language, the barriers should not be as significant.

References

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Hawaii could be first to start long-term care elderly benefit. (2016, January 21). Retrieved
February 29, 2016, from https://www.staradvertiser.com/breaking-news/hawaii-could-be-first-to-startlong-term-care-elderly-benefit/
Relating to Long-Term Care, S. 2478 SD 1. (2016)
Research and Economic Analysis Division, Department of Business, Economic Development and
Tourism. (2012, March). Population and Economic Projections for the State of Hawaii to 2040 [Press
release]. Retrieved from http://files.hawaii.gov/dbedt/economic/data_reports/2040-long-rangeforecast/2040-long-range-forecast.pdf
Stone, R. I. (2014). The Aging Services System-When It's 64. Generations, 38(2), 101-106 6p.

y Each working Increasing aging population impacts Hawaii economy and individuals because of the
healthcare needs and
a long term care stated that Long-term plan for long-term care introduced by Democratic Sens. Rosalyn
Baker
Health policy

Long-term plan for long-term care by Democratic Sens. Rosalyn Baker

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Higher taxes for a bigger social program?
First in the nation to offer long-term care benefits to seniors.
What is the bill?
0.5% increase in the states general excise tax to cover the cost. The tax is about 4% and its
o

added to most business transactions in the state.

25% of the tax revenue comes from visitors according to UH political professor

Lawrence Nitz
Long-term care benefit of $70 a day for 365 days (to provide care to Hawaiis seniors and people
o

with disabilities who are cared for at home.

Can use to pay family caregivers, hire in-home aides and help offset the cost of safety

equipment, like walkers and ramps

Every person who files a Hawaii state income tax for 10years could receive the $70, which adds
up to $2,100 a month (= half day of $20/hr caregiver service)

Taking care of elderly parents:

Need to move back to Hawaii if you are living on mainland
Give up career
Make medical appointment, taking to that
Daycare via Handi-van
Nursing home $145,000/yr

Using up vacation, money (parents & own)

Need to reduce work hours

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Lose job

If condition get worse, fall and injured?

Hospitalization
Rehab

Overwhelmed
Burned out
Depression

Most family caregivers are women => Chronic stress and harm to their employment status

RN who runs foster home

References
Relating to Long-Term Care, S. 2478 SD 1. (2016)
Stone, R. I. (2014). The Aging Services System-When It's 64. Generations, 38(2), 101-106 6p.
https://www.staradvertiser.com/breaking-news/hawaii-could-be-first-to-start-long-term-careelderly-benefit/

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Research and Economic Analysis Division, Department of Business, Economic Development and
Tourism. (2012, March). Population and Economic Projections for the State of Hawaii to 2040 [Press
release]. Retrieved from http://files.hawaii.gov/dbedt/economic/data_reports/2040-long-rangeforecast/2040-long-range-forecast.pdf