Hawaii County Case Management (CM)

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Hawaii County Case Management (CM) The Advisory Committee on Aging is pleased to have the opportunity to make recommendations on the delivery of Case Management (CM) services in Hawaii County. We first want to affirm our support for Executive Dr. Kimo Alameda, who had brought expertise, experience, and peo- ple -skills to the Office. He is a hands-on leader who himself spent many weeks helping with dis- aster relief during the volcano eruption. Under pressure from the state ever since he arrived, he has sought to comply with their demands while preserving the best practices that have made the HCOA the best AAA in the state. In that spirit, we respectfully disagree with his proposal to bring CM in-house and to disband our longstanding and successful model of contracting out those services. Our duty is more to the ku- puna of this island than to the state Department of Health, which is pushing for a one -size -fits -all model when in fact each island is very different in its demographics, urban/rural mix, relation- ship between their county councils and their Offices on Aging, history of services, resources, numbers of vendors, philosophies and business models. A size 13 foot will hurt both foot and shoe if it is required to wear a size 9! I. What does Hawaii County Office on Aging (HCOA) have that we value most and do not want to lose? A. The identity and function of the HCOA. Is it an area agency that does planning and oversees service provision to implement the plan? Or is a resource center that delivers di- rect services? We feel we should keep our focus on planning, not service delivery. We contract with other agencies for service, and monitor and evaluate their work. Because we are not both provider and evaluator, we can be objective, which ensures the quality of the services and avoids self-dealing; sometimes government agencies provide poor services and low accountability and we want to avoid that outcome. We also have more flexibility since we do not have to hire and fire service providers ourselves. B. County financial support. Almost all our staff are funded by Hawaii County. Therefore, we have competent, committed and stable employees who do not have to worry about los- ing their jobs because their grant funding will run out. The choice of the HCOA has been to use those unrestricted dollars to hire a staff with expertise in planning. Other counties must chase short-term grant dollars and have staff whose jobs are tied to those grants. We do not see the wisdom of hiring our own case managers whose jobs are dependent on Kupuna Care grant funding, while most of the rest of the staff are permanent. C. We have a large vendor pool. When an elder needs services, there are a number of ven- dor options that can be offered. For example, we know which agency has staff who speak different languages, or who may be particularly good at dealing with people with mental disabilities; we can contract for services with a variety of vendors. D. We see Kupana Care as a short-term program. Other counties and the state consider KC as a long-term program; once someone is on KC they are on it forever. We emphasize hav- ing clients and caregivers create a support network of their own, to move to private pay op- tions if they can, and/or help them fill out the extensive paperwork to apply for Medicaid if they become eligible (other counties have used KC dollars for Medicaid -eligible elders