HomeMy WebLinkAboutHCOA Area Agency on Aging (AAA) 4-year Plan 2023 - 2027
Hawai‘i County Office of Aging
October 1, 2023- September 30, 2027
Four Year Area Plan
As the Planning Service Area IV
In the State of Hawaiʻi
HAWAI‘I COUNTY
OFFICE OF AGING
Main Office
1055 Kino‘ole Street, Suite 101
Hilo, Hawai‘i 96720-3872
West Hawaiʻi Of?ice
74-5044 Ane Keohokalole Highway, Bldg B
Kailua Kona, HI 96740
April 2023
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FOUR-YEAR AREA PLAN
October 1, 2023- September 30, 2027
HAWAI‘I COUNTY OFFICE OF AGING
for the
COUNTY OF HAWAI‘I
In the
STATE OF HAWAI‘I
For the Administration on Aging
Planning Service Area IV
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TABLE OF CONTENTS
Table of Contents
Executive's Message
Verification of Intent
Executive Summary
Introduction
A. Orientation to Area Plan on Aging 1
B. Overview of the Aging Network 1
C. Planning Process 7
D. Glossary of Terms and Acronyms 8
Part I. Overview of the Older Adult Population, Needs Assessment, Existing Programs, Services,
Initiatives, and Unmet Needs
A. Overview of Older Adult Population - Population Profile 19
B. Overview of Older Adult Population - Needs Assessment and Unmet Needs 39
C. Description of Existing Programs, Services, and Initiatives 45
D. Description of Community Focal Points, Multi-Purpose Senior Centers, Nutrition Sites,
and Home Delivered Meal Providers 53
Part II: Recommendations
A. Framework: Laws/Governance and Targeting 55
B. Prioritization of Issues and Services 57
Part III: Topic Areas: Goals, Objectives, Strategies, Outputs, and Outcomes
A. ACL Topic Areas 59
B. Summary of Goals 60
1. Goal 1: Core OAA/Title III Programs 61
2. Goal 2: COVID-19 66
3. Goal 3: Equity 67
4. Goal 4: Expanding Access to HCBS 68
5. Goal 5: Caregiving 71
C. AAA Methodology to ensure compliance with Targeting 73
Part IV: Funding Plan
A. Previous Year Expenditures for Priority Services (FFY 2022) 85
B. Projected Service Outputs and Resources for 2023 - 2027 Allocation Levels 86
C. Minimum Percentages for Title III Part B - Categories of Services 88
Appendices
Appendix A. Waivers
Appendix B. Assurances
Appendix C. AAA Chart of Existing Services
Appendix D. Contact Information for Focal points, Congregate sites, Home Delivered Meals
providers, and Adult Day Care Centers
Appendix E. AAA Staffing and Organizational Chart
Appendix F. Public Hearings, Evaluations
Appendix G. Disaster Preparedness Plan
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Executive’s Message
Aloha,
As the baby boomer generation, continues to cross the threshold into retirement age, significant demographic,
economic, health, and social shifts pose many new challenges to our aging network. Although many challenges
exist, it also provides many new opportunities for advocacy, creativity, leadership, healthy aging, education, and
community engagement. The Administration for Community Living (ACL) has designated five national topics be
address in each State and Area Agency’s four-year Area Plan for 2023 – 2027.
1. Older Americans Act (OAA) Core Programs
2. COVID-19
3. Equity
4. Expanding Access to Home and Community Based Services (HCBS)
5. Caregiving
On behalf of the Hawaiʻi County Office of Aging, I would like to extend our appreciation to the Hawaiʻi County
aging network. This network is comprised of government employees, contracted service providers, private non-
profits, and a host of community volunteers too numerous to mention. We are committed to supporting our aging
population at every phase of the continuum of care. From the active senior to the frail and vulnerable, the Mission
and Vision of the Hawaiʻi County Office of Aging is to provide a network of services for each level. These services
will provide our older individuals the opportunity to age in place at home with independence and dignity and the
ability to continue to engage in their communities for as long as possible.
The intent of this four-year Area Plan is to reflect the values of our Mission and Vision to provide an environment
where our Kupuna can live and thrive. In this four-year Area Plan, we focus special emphasis on the goals and
objectives of the services provided to our Kupuna. This is to ensure that the environment provided allows our
Kupuna to live the Mission and Vision as set forth in the Older Americans Act. By so doing, we acknowledge our
Kupuna who have contributed and sacrificed to ensure a better life for current and future generations.
Respectfully,
William H. Farr
Executive on Aging
Hawaiʻi County
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Executive Summary
In 1973, the Area Agency on Aging (AAA) was formally established in the re-authorization of the
Older Americans Act (OAA). In the re-authorization of the Act, the AAA was recognized as the “on-
the-ground” entity charged with fulfilling the OAA mission. The mission, was to assist older
individuals to live independently and with dignity at home, while remaining active and engaged in their
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communities for as long as possible. Thus, 2023 marks the 50 anniversary of AAA’s serving as the
leaders on aging by planning, developing, funding, and implementing through the local aging network
a coordinated system of aging and home and community-based services (HCBS) for older individuals
who reside in their Planning and Service Area’s (PSA’s).
This four-year Area Plan on Aging will cover the federal funding period beginning October 1, 2023 –
September 30, 2027. The plan focuses on five topic areas developed by the Administration for
Community Living (ACL). Embracing the State Executive Office on Aging’s (EOA) overarching goals
and objectives. Developing a comprehensive service plan and delivery system, to fit the unique needs
of Hawaiʻi County’s communities, geographical makeup, and cultural needs. The following are the five
major key topic areas for this planning period:
Topic Area 1. Core OAA/Title III Programs
The Older Americans Act core programs found in Titles III (Supportive Services,
Nutrition, Disease Prevention/Health Promotion, and Caregiver Programs), VI (Native
American Programs), and VII (Elder Rights Programs) serve as the foundation of the
national aging services network which strives to optimize the health, safety, and
independence of Americas’ older adults.
Topic Area 2. COVID-19
COVID-19 highlighted the overall importance of the services that make it possible for
older adults to live independently, created national awareness of the impact of social
isolation on older adults and their caregivers, and increased awareness to plan for
future disasters.
Topic Area 3. Equity
Serving individuals with the greatest economic and social need, ensuring that all
individuals diverse groups are included served with equity is reflected in all aspects
in the administration of this plan.
Topic Area 4. Expanding Access to HCBS
Home and Community Based Services are fundamental to making it possible for older
adults to age in place.
Topic Area 5. Caregiving
Enhancing services and supports for caregivers.
Nationally the older population is expected to continue to grow significantly. Approximately two-fifths
(42%) of the “baby boom” generation is now age 65 and older. The U.S. Census Bureau released the
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2020 State and County population characteristics. As expected, Hawaiʻi is at the top of the diversity
index with 77 percent of its population a minority race. In Hawaiʻi County, Asians (alone or in
combination) accounted for 45% of the population. Hawaiʻi County also has the largest share of Native
Hawaiians and Other Pacific Islanders at 34.4%, as well as the highest share of people identifying as
White at 54.6%. Regarding language diversity, 18.7% of people speak English as a second language.
The life expectancy in Hawaiʻi County is one of the highest in the nation, with women outliving men
by almost seven years. As the aging population grows for Hawaiʻi County women will continue to
represent a larger percentage (51%) of the older population. These demographics will play an integral
part in guiding the development, implementation, and delivery of service as we strive to fulfill the five
major key topics for the 2023-2027 Area Plan.
The Area Plan is a living document. Development of this plan is to encompass one of the most historic
periods of growth in the elderly population in the State and Hawaiʻi County. Multiple approaches, and
a variety of sources will be used to continuously address the ongoing needs and areas of concern for
older individuals in the life period of the 2023 -2027 Area Plan on Aging for Hawaiʻi County.
Finally, the success of this Area Plan, is due to the incredible foundation laid by the Older Americans
Act (OAA) and the Aging Network. The mission and goals of the AAA’s programs are just as relevant
and important today as they were five decades ago. The OAA structure of “bottom up” planning
continues to ensure that our shared mission continues to reach the growing numbers of increasingly
diverse older adults and caregivers. Whether it is contracting with health care, partnering with public
health, expanding into serving people with disabilities, addressing population health and addressing
the diverse social drivers of health, or exploring other avenues, the aging network is pushing the
envelope to create new opportunities to serve more people. The missions of the AAAs programs are
the heart and soul of the aging network. It is what makes us successful at what we do, because it is
what we are all about today, and into the future.
As the designated AAA for Hawaiʻi County, and part of the national aging network, the Hawaiʻi County
Office of Aging (HCOA) will continue to fill the vital role of serving older adults and their caregivers
into the next 50 years. As the cover to our Area Plan depicts, the success of new and innovated services
will be based upon the lessons learned during the first 50 years. The solid foundations laid, will pave
the way for creative and innovative ideas that will allow the AAA to continue fulfill the mission and
vision of the OAA.
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Introduction
A. Orientation to Area Plans on Aging
Area Plans on Aging are documents submitted by Area Agencies on Aging (AAA’s) to State Units on Aging in
compliance with the Older Americans Act for the receipt of subgrants or contracts from the Older Americans
Act Title III grant funds. Area Plans on Aging contain detailed strategies outlining the Area Agency’s plan for
the development and maintenance of a comprehensive and coordinated system in accordance with all
federal and state requirements. This plan covers the period October 1, 2023 to September 30, 2027.
This Area Plan is made up of four major parts. Part I provides an overview of the older adult population,
needs assessment, current programs, services, and initiatives with the County of Hawaiʻi. Part II describes
the context in which programs and services are developed. Part III addresses the goals of the State of
Hawaiʻi that align with the 5 ACL Topic areas as mandated by the Administration on Community Living. The
Summary of Goals includes the local objectives, strategies, outcomes, and evaluation strategies. Part IV
describes the current funding allocations and the funding projections for the planning period. The
Appendices provide assurances made by the Hawaiʻi County Office of Aging and other pertinent information.
B. An Overview of the Aging Network
The Older Americans Act (OAA), enacted in 1965, created the foundation for a comprehensive system of
services and supports that enables millions of older adults in this country to continue to live independently as
they age. Today, programs funded by the OAA provide essential services to older adults, targeting those with
the greatest economic or social need, particularly low-income and minority persons, older individuals with
limited English proficiency, and older persons living in rural areas. The programs play a vital role in helping to
maintain the health and well-being of millions of seniors and their caregivers, reaching one in five older
adults. (“ACL Updates” 10/7/22) The OAA established State and Area Offices on Aging, and a nationwide
“Aging Network” was created. The purpose of this “Network” is
to assist older adults to meet physical, social, mental health, and
other needs to maintain their well-being and independence. The
OAA authorizes a wide array of service programs through a
national network of 56 state units on aging, 625 area agencies on
aging, nearly 30,000 service providers, and 574 Tribal and Native
Hawaiian Organizations. The OAA also includes community
service employment for low-income older Americans; training,
research, and demonstration activities in the field of aging; and
vulnerable elder rights protection activities. The OAA was
reauthorized in 2016 and 2020. The 2016 OAA Act included
provisions to protect vulnerable elders by strengthening the
Long-Term Care Ombudsman program and elder abuse screening
and prevention efforts. It also promotes the delivery of evidence-
based programs, such as falls prevention and chronic disease
self-management programs. The Supporting Older Americans Act
of 2020 reauthorizes programs for FY 2020 through FY 2024. It includes provisions that aim to remove
barriers to the aging network by increasing business acumen and capacity building, provide states and
localities with the flexibility of deciding the allocation of National Family Caregiver Services between the
populations served, and extends authorization of the RAISE Family Caregiver Act and the Supporting
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Grandparents Raising Grandchildren Act by one additional year.
National Aging Services Network
(“National Aging Network”, ACL, 2020).
The U.S. Department of Health and Human Services (HHS) has
designated ACL to carry out the provisions of the OAA and to
administer the OAA programs. The department also provides
funding for the OAA programs. As the primary federal agency
responsible for administering the OAA programs, the
Administration for Community Living (ACL) authorizes grants to
SUAs and AAAs to act as advocates on behalf of older persons
and to coordinate programs and services for older persons. The
ACL supports the collaboration with the aging services network,
consisting of the SUAs, AAAs, tribal organizations, and local
service providers. (Source: Administration for Community Living
(2022). Overview of Older Americans Act Title III, VI, and VII
Programs: 2020 Summary of Highlights and Accomplishments.
U.S. Department of Health and Human Services. https://acl.
gov/aging-and-disability-in-america/data-and-research.)
2020 ACL OAA Title III Program Results data show services are
reaching the most vulnerable older adults in the nation—those
most in need of services to remain independent. Specifically, the
data reported by service recipients show that Title III services
reached the following populations in 2020:
■ Older adults living in poverty—over one third of service
recipients
■ Older adults living alone—almost half of service recipients
■ Older adults living in rural areas—about one third of service
recipients
■ Older adults who require assistance with activities of daily
living (ADLs) or instrumental activities of daily living (IADLs)—
more than half of service recipients requiring assistance with
ADLs, about three out of four requiring assistance with IADLs
■ The oldest of the older adults—almost a quarter of service
recipients age 85+
(Source: Administration for Community Living (2022). Overview
of Older Americans Act Title III, VI, and VII Programs: 2020
Summary of Highlights and Accomplishments. U.S. Department
of Health and Human Services. https://acl. gov/aging-and-
disability-in-america/data-and-research.)
The State Unit on Aging in Hawaiʻi is the Executive Office on
Aging. The 2020 amendments to the Older Americans Act
require the Executive Office on Aging (EOA) to plan for and
offer leadership at both the state and local levels in the
coordination and delivery of access, home, and community
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services to the older adult population. The EOA is responsible for statewide:
Planning Research
Policy and program development Advocacy
Information and referral
Coordination of services provided by public and private agencies for our elders and their families
Chapter 349 of the Hawaiʻi Revised Statutes established the Policy Advisory Board for Elder Affairs (PABEA)
which advises the EOA on the development and administration of the State Plan.
The Executive Office on Aging has delineated the State into 4 distinct planning and service areas (PSA’s) for
purposes of planning, development, delivery, and the overall administration of services. The EOA has
designated each of the counties of the State: Kauai, Honolulu, Maui, and Hawaiʻi as planning and service
areas. Kalawao County on the island of Molokai, currently under administrative jurisdiction of the State
Department of Health, is included in the Maui Planning and Service Area.
Area Agencies on Aging (AAA)
Area Agencies on Aging (AAA’s) are the agencies designated by State Units on Aging (SUA’s) to develop and
administer Area Plans on Aging for each planning and service area. The Executive Office on Aging designated
Hawaiʻi County Office of Aging (HCOA) as the Area Agency on Aging for the County of Hawaiʻi planning and
service area (PSA 4).
State of Hawai‘i Network on Aging
Source: Ashley Muraoka-Mamaclay, State EOA - Caregiver Powerpoint 2015
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Mission of the Area Agency
HCOA’s overall mission is to help older individuals age with independence and dignity. The Older Americans
Act designates that the AAA’s shall be the leaders relative to all aging issues on behalf of all older persons in
their respective PSA’s. Under this directive, the AAA’s shall proactively carry out, under the leadership and
direction of the State agencies, a wide range of functions related to advocacy, planning, coordination, inter-
agency linkages, information sharing, brokering, monitoring and evaluation designed to lead to the
development and enhancement of comprehensive and coordinated community based systems which will
enable older persons to lead independent, meaningful and dignified lives in their own homes and
communities as long as possible. (HRS §1321.53)
Activities of the Hawaii County’s Area Agency
Specific functions that the Hawai‘i County Office of Aging undertakes in fulfilling its’ mission for the County of
Hawaiʻi’s’ older adults, their caregivers, and persons with disabilities include the following:
Assessment and Data Maintenance
Continuously assessing the needs of older persons in Hawai‘i County and developing programs aimed
at meeting those needs;
Maintain data on the profile and needs of older persons and their caregivers in Hawai‘i County and to
have this information available in this plan for other organizations and the general public to review;
Program Development
Coordinate planning with other agencies and organizations to promote new or expanded benefits
and opportunities for older persons;
Develop and administer an Area Plan on Aging for a comprehensive and coordinated service delivery
system in Hawai‘i County;
Contract Development and Monitoring
Provide technical assistance, monitor, and periodically evaluate the performance of all service
providers under the Area Plan;
Enter into sub-grants or contracts for the provision of services outlined in the Area Plan; and
Advocacy
Represent the interests of older persons to public officials and public and private agencies;
Develop and maintain a public awareness program for older persons;
Monitor, evaluate, and comment on policies, programs, hearings, and community actions which
affect older persons.
Staffing of the Hawaii County Office of Aging
The Office of Aging falls organizationally under the Mayor's office headed by an
Executive on Aging. The HCOA has an office in East Hawaiʻi and a satellite office
in West Hawai’i. HCOA is staffed by an Executive on Aging, three Aging Program
Planners, two Access Managers, seven Aging and Disability Specialists, an
Accountant, a Computer Programmer/Analyst, and four Information and
Assistance Clerks.
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ADRC receives ReferralsLogs and Activity and and referrals in Wellsky Call and documents interactions ADRC registers individuals eligible personssupport services for and/or other community
for in home supports ADRC submits referrals needs. support and other Transporation, Legal ADRC assesses need Counselingand Options provide information Disability Specialists ADRC Aging
and servicesinformation or client/caregiver or
HCOA’s Aging and Disability Resource Center
Under the direction and oversight of the Hawai’i County Office of Aging, the Aging and Disability Resource
Center (ADRC) is an access point for older individuals, individuals with disabilities, and caregivers. The ADRC
follows the Fully Functional ADRC guidelines.
The ADRC provides information, awareness, and referrals island wide. Aging and Disability Service Specialists
work from our Hilo and Kailua Kona offices.
Specialist are prepared to help individuals find information on supports and services provided throughout the
island. They are also available to meet with individuals, caregivers, and families to provide Options
Counseling to help people plan for long-term support needs. The ADRC makes referrals and/or connections
to resources, supports, and programs that help maintain independence, dignity, and health. ADRC
employees complete intake and assessments when required and maintain a functioning database of
registered individuals.
ADRC SERVICE MODEL
ADRC OPERATIONAL PRACTICES
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agency collaborationcommunity and other opportunities for ADRC creates and joins Islandthroughout Hawai'i services and trainings ADRC provides outreach DepartmentHCOA Planning new program
ideas with ADRC shares trends and
OUTREACH PRACTICES
Advisory Councils
The Mayor of Hawai‘i County and HCOA have established two advisory councils, the Committee on Aging and
the Committee on People with Disabilities. The Committee on Aging serves as an advisory council to advise
HCOA on the development and administration of the area plan, conduct public hearings, represent the
interests of older persons, and receive and comment on all community policies, programs, and actions which
affect older persons of Hawai‘i County. The Committee on Aging is a mandated function by the Older
Americans Act and a requirement for this plan to be approved and funding to be released. HCOA also
spearheads the Mayors’ Committee on People with Disabilities which advises the Mayor on all matters
related to persons with disabilities. As its’ primary goal, the committee reviews and recommends actions and
provides guidelines to improve the quality of life for all people with disabilities.
The County of Hawaiʻi
The Hawaiʻi County Office of Aging is one of 19 departments within the County of
Hawaiʻi organiza?on. As an Area Agency on Aging, HCOA operates under the
umbrella of the County of Hawaiʻi with the majority of agency posi?ons funded by
the County.
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Office of Aging – Organizational Chart – 2023
Mayor
Managing Director
Committee Committee
on Disability on Aging
Executive on Aging
Administration Services Planning and Program
Access Division
Division Development Division
Aging & Disability
Aging & Disability
Service Manager
Service Manager
Admin. Services
Aging Program
Information
Assistant I
Planner III
System Analyst IV
Case Management
ADRC
Information and
Computer
Assistant Clerks
Operator I
Aging Program
Aging Program
Hilo - 2
Planner II
Planner II
Kona - 1
Clerk III
Hilo - 1
Aging &
Aging & Aging & Aging &
*Aging & *Aging &
Disability
Disability
Disability Disability
Disability Disability
Specialist II
Specialist I Specialist I Specialist I
Specialist I Specialist I
ADRC
ADRC ADRC-East HI ADRC-West HI
ADRC-1/2 East HI
ADRC-1/2 West HI
C. 2023 – 2027 Area Plan on Aging HCOA Planning Process
Purpose
As an Area Agency on Aging, the Hawai‘i County Office of Aging (HCOA) is responsible for assessing the needs
of the county’s older adult population, determining the kinds and amounts of services required to meet
those needs, developing and executing contracts with service providers selected through various
procurement methods, monitoring the provision of services, and evaluation of the effectiveness, outcomes,
and impact resulting from the services delivered.
Description of the Planning Process:
The following is an outline of the planning process utilized by the Office of Aging in the development of the
2023 – 2027 Area Plan on Aging. The collection of information documenting the needs and areas of concerns
of older individuals for Hawai‘i County is conducted on an ongoing basis. This extensive research
incorporates multiple approaches. Thus, as part of the needs assessment and planning process, HCOA
conducts extensive data research from a variety of sources including, but not limited to:
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1. Needs Assessment:
Federal and State Indicators: Secondary data analysis using the U.S. Census
population data and projections; State data: Hawaiʻi Data Book 2020,
www.Hawaiihealthmatters.org; ACL; the Administration on Aging; among others;
HCOA and ADRC Indicators: WellSky Information System data and evaluation of
current program and service activities;
Key Informant Interviews: Focus groups and individual interviews; and
Community Needs Surveys: Survey Monkey was used to survey a sample of older
adults, caregivers, and key network partners via online surveys.
2. Identify Areas of Concern
3. Evaluate Effectiveness of Existing System of Services
4. Develop Area Agency Goals in conjunction with State and Federal Initiatives
5. Develop Strategies
6. Investigate Alternatives and Other Funding Sources
7. Establish Priorities
8. Develop Plan
Public Hearings
Public hearings are a requirement and play an essential role in the planning process. Public hearings afford
the general public an opportunity to comment and provide needed input to proposed Area Plans. Public
hearings were conducted in April of 2023. For details of public hearings, see Appendix F.
D. Glossary of Terms and Acronyms
AAA Area Agency on Aging
AARP American Association of Retired Persons
AD Alzheimer’s Disease
ADC Adult Day Care Program
ADLs Activities of Daily Living
ADRC Aging and Disability Resource Center
ADRD Alzheimer’s Disease and Related Disorders
AHCD Advanced Health Care Directives
AIRS Alliance of Information and Referral Specialists
AoA Administration on Aging
APS Adult Protective Services
CLP Community Living Program
CM Case Management
CMS Centers for Medicare and Medicaid Services
CNA Certified Nursing Assistant
CoA Committee on Aging
DD Developmental Disabilities
DHHS Department of Health and Human Services
DHR Department of Human Resources
DOT Department of Transportation
FFY Federal Fiscal Year (October 1 – Sept 30)
FTE Full Time Equivalent
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GRG Grandparents Raising Grandchildren
HCBS Home and Community Based Services
HDM Home Delivered Meals
HDS Home Delivered Services
HHA Home Health Agency; Home Health Aide
I & A Information, Referral and Assistances
I & R Information and Referral
IADLs Instrumental Activities of Daily Living
IFF Intra-State Funding Formula
LEP Limited English Proficiency
LPN Licensed Practical Nurse
LTCF Long Term Care Facility
LTCO Long Term Care Ombudsman
LGBTQ Lesbian, Gay, Bisexual, Transgender, and Questioning Sexual Identity and Orientation
MFP Money Follows the Person
MMA Medicare Modernization Act
N4A National Association of Area Agencies on Aging
NAPIS National Aging Program Information System
NASUAD National Association of State Units on Aging and Disability
NF Nursing Facility
NFCSP National Family Caregiver Support Program
OAA Older Americans Act
OMB Office of Management and Budget
PSA Planning and Service Area; Personal Support Aide
SAMS Social Assistance Management System
SCSEP Senior Community Service Employment Program
SFY State Fiscal Year (July 1 through June 30)
SHIP State Health Insurance Assistance Program
SMP Senior Medicare Patrol (See SHIP)
SPR State Program Reports
SUA State Unit on Aging
DEFINITIONS SEC. 102. For the purposes of this Act— As Amended Through P.L. 116-131, Enacted March
25, 2020 3 Sec. 102 OLDER AMERICANS ACT OF 1965:
(1) The term ‘‘abuse’’ means the knowing infliction of physical or psychological harm or the knowing
deprivation of goods or services that are necessary to meet essential needs or to avoid physical or
psychological harm.
(2) The term ‘‘Administration’’ means the Administration on Aging. (3) The term ‘‘adult protective services’’
means such services provided to adults as the Secretary may specify and includes services such as—
(A) receiving reports of adult abuse, neglect, or exploitation;
(B) investigating the reports described in subparagraph (A);
(C) case planning, monitoring, evaluation, and other casework and services; and
(D) providing, arranging for, or facilitating the provision of medical, social service, economic, legal,
housing, law enforcement, or other protective, emergency, or support services.
(4) The term ‘‘Aging and Disability Resource Center’’ means an entity, network, or consortium established by
a State as part of the State system of long-term care, to provide a coordinated and integrated system for
older individuals and individuals with disabilities (as defined in section 3 of the Americans with Disabilities
Act of 1990 (42 U.S.C. 12102)), and the caregivers of older individuals and individuals with disabilities, that
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provides, in collaboration with (as appropriate) area agencies on aging, centers for independent living (as
described in part C of chapter 1 of title VII of the Rehabilitation Act of 1973 (29 U.S.C. 796f et seq.)), and
other aging or disability entities—
(A) comprehensive information on the full range of available public and private long-term care
programs, options, service providers, and resources within a community, including information on
the availability of integrated long-term care services, and Federal or State programs that provide
long-term care services and supports through home and community-based service programs;
(B) person-centered counseling to assist individuals in assessing their existing or anticipated long-
term care needs and goals, and developing and implementing a person-centered plan for long-term
services, supports, and care that is consistent with the desires and choices of such an individual and
designed to meet the individual’s specific needs, goals, and circumstances;
(C) access for individuals to the full range of publicly supported long-term care services and supports
for which the individuals may be eligible, including home and community-based service options, by
serving as a convenient point of entry for such programs and supports; and
(D) in cooperation with area agencies on aging, centers for independent living described in part C of
chapter 1 of title VII of the Rehabilitation Act of 1973, and other community-based entities, including
other aging or disability entities, information and referrals regarding available home and community-
based services for individuals who are at risk for residing in, or who reside in, institutional settings, so
that the individuals have the choice to remain in or to return to the community.
(5) The term ‘‘aging network’’ means the network of—
(A) State agencies, area agencies on aging, title VI grantees, and the Administration; and
(B) organizations that—
(i) (I) are providers of direct services to older individuals; or
(II) are institutions of higher education; and
(ii) receive funding under this Act.
(6) The term ‘‘area agency on aging’’ means an area agency on aging designated under section 305(a)(2)(A)
or a State agency performing the functions of an area agency on aging under section 305(b)(5).
(7) The term ‘‘Assistant Secretary’’ means the Assistant Secretary for Aging.
(8) (A) The term ‘‘assistive device’’ includes an assistive technology device.
(B) The terms ‘‘assistive technology’’, ‘‘assistive technology device’’, and ‘‘assistive technology
service’’ have the meanings given such terms in section 3 of the Assistive Technology Act of 1998 (29
U.S.C. 3002). See amendment made by section 104(1) of Public Law 116-131.
(C) The term ‘‘State assistive technology entity’’ means the agency, office, or other entity designated
under subsection (c)(1) of section 4 of the Assistive Technology Act of 1998 (29 U.S.C. 3003) to carry
out State activities under such section.
(9) The term ‘‘at risk for institutional placement’’ means, with respect to an older individual, that such
individual is unable to perform at least 2 activities of daily living without substantial assistance (including
verbal reminding, physical cuing, or supervision) and is determined by the State involved to be in need of
placement in a long-term care facility.
(10) The term ‘‘board and care facility’’ means an institution regulated by a State pursuant to section 1616(e)
of the Social Security Act (42 U.S.C. 1382e(e)).
(11) The term ‘‘case management service’’—
(A) means a service provided to an older individual, at the direction of the older individual or a family
member of the individual—
(i) by an individual who is trained or experienced in the case management skills that are
required to deliver the services and coordination described in subparagraph (B); and
(ii) to assess the needs, and to arrange, coordinate, and monitor an optimum package of
services to meet the needs, of the older individual; and
10
(B) includes services and coordination such as—
(i) comprehensive assessment of the older individual (including the physical, psychological,
and social needs of the individual);
(ii) development and implementation of a service plan with the older individual to mobilize
the formal and informal resources and services identified in the assessment to meet the
needs of the older individual, including coordination of the resources and services—
(I) with any other plans that exist for various formal services, such as hospital
discharge plans; and
(II) with the information and assistance services provided under this Act;
(iii) coordination and monitoring of formal and informal service delivery, including
coordination and monitoring to ensure that services specified in the plan are being provided;
(iv) periodic reassessment and revision of the status of the older individual with—
(I) the older individual; or
(II) if necessary, a primary caregiver or family member of the older individual;
and
(III) in accordance with the wishes of the older individual, advocacy on behalf of
the older individual for needed services or resources.
(12) The term ‘‘civic engagement’’ means an individual or collective action designed to address a public
concern or an unmet human, educational, health care, environmental, or public safety need.
(13) The term ‘‘disability’’ means (except when such term is used in the phrase ‘‘severe disability’’,
‘‘developmental disabilities’’, ‘‘physical or mental disability’’, ‘‘physical and mental disabilities’’, or ‘‘physical
disabilities’’) a disability attributable to mental or physical impairment, or a combination of mental and
physical impairments, that results in substantial functional limitations in 1 or more of the following areas of
major life activity:
(A) self-care,
(B) receptive and expressive language,
(C) learning,
(D) mobility,
(E) self-direction,
(F) capacity for independent living,
(G) economic self-sufficiency,
(H) cognitive functioning, and
(I) emotional adjustment.
(14) The term ‘‘disease prevention and health promotion services’’ means—
(A) health risk assessments;
(B) routine health screening, which may include hypertension, glaucoma, cholesterol, cancer, vision,
hearing, diabetes, bone density, oral health, immunization status, and nutrition screening (including
screening for malnutrition);
(C) nutritional counseling and educational services for individuals and their primary caregivers;
(D) evidence-based health promotion programs, including programs related to the prevention and
mitigation of the effects of chronic disease (including osteoporosis, hypertension, obesity, diabetes,
and cardiovascular disease), infectious disease, and vaccine-preventable disease, prevention of
sexually transmitted diseases, as well as alcohol and substance abuse reduction, chronic pain
management, smoking cessation, weight loss and control, stress management, falls prevention,
physical activity, and improved nutrition;
(E) programs regarding physical fitness, group exercise, and music therapy, art therapy, and dance-
movement therapy, including programs for multigenerational participation that are provided by—
(i) an institution of higher education;
11
(ii) a local educational agency, as defined in section 14101 of the Elementary and Secondary
Education Act of 1965 (20 U.S.C. 8801); or
(iii) a community-based organization;
(F) home injury control services, including screening of high-risk home environments and provision of
educational programs on injury prevention (including fall and fracture prevention) in the home
environment;
(G) screening for the prevention of depression and screening for suicide risk, coordination of
community mental and behavioral health services, provision of educational activities, and referral to
psychiatric and psychological services;
(H) screening for fall-related traumatic brain injury and other fall-related injuries, coordination of
treatment, rehabilitation and related services, and referral services related to such injury or injuries;
(I) educational programs on the availability, benefits, and appropriate use of preventive health
services covered under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.);
(J) medication management screening and education to prevent incorrect medication and adverse
drug reactions;
(K) information concerning diagnosis, prevention, treatment, and rehabilitation concerning age-
related diseases and chronic disabling conditions, including osteoporosis, cardiovascular diseases,
diabetes, and Alzheimer’s disease and related disorders with neurological and organic brain
dysfunction;
(L) services that are a part of responses to a public health emergency or emerging health threat;
(M) gerontological counseling;
(N) screening for the prevention of negative health effects associated with social isolation and
coordination of supportive services and health care to address negative health effects associated
with social isolation; and
(O) counseling regarding social services and follow-up health services based on any of the services
described in subparagraphs (A) through (N). The term shall not include services for which payment
may be made under titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq., 1396 et
seq.).
(15) The term ‘‘elder abuse’’ means abuse of an older individual.
(16) The term ‘‘elder abuse, neglect, and exploitation’’ means abuse, neglect, and exploitation, of an older
individual.
(17) The term ‘‘elder justice’’ means—
(A) from a societal perspective, efforts to—
(i) prevent, detect, treat, intervene in, and prosecute elder abuse, neglect, and exploitation;
and
(ii) protect older individuals with diminished capacity while maximizing their autonomy; and
(B) from an individual perspective, the recognition of an older individual’s rights, including the right
to be free of abuse, neglect, and exploitation.
(18) (A) The terms ‘‘exploitation’’ and ‘‘financial exploitation’’ mean the fraudulent or otherwise illegal,
unauthorized, or improper act or process of an individual, including a caregiver or fiduciary, that uses
the resources of an older individual for monetary or personal benefit, profit, or gain, or that results in
depriving an older individual of rightful access to, or use of, benefits, resources, belongings, or assets.
(B) In subparagraph (A), the term ‘‘caregiver’’ means an individual who has the responsibility for the
care of an older individual, either voluntarily, by contract, by receipt of payment for care, or as a
result of the operation of law and means a family member or other individual who provides (on
behalf of such individual or of a public or private agency, organization, or institution) compensated or
uncompensated care to an older individual.
(19) The term ‘‘family violence’’ has the same meaning given the term in the Family Violence Prevention and
12
Services Act.
(20) The term ‘‘fiduciary’’—
(A) means a person or entity with the legal responsibility—
(i) to make decisions on behalf of and for the benefit of another person; and (ii) to act in
good faith and with fairness; and
(B) includes a trustee, a guardian, a conservator, an executor, an agent under a financial power of
attorney or health care power of attorney, or a representative payee.
(21) The term ‘‘focal point’’ means a facility established to encourage the maximum collocation and
coordination of services for older individuals.
(22) The term ‘‘frail’’ means, with respect to an older individual in a State, that the older individual is
determined to be functionally impaired because the individual—
(A) (i) is unable to perform at least two activities of daily living without substantial human
assistance, including verbal reminding, physical cueing, or supervision; or
(ii) at the option of the State, is unable to perform at least three such activities without such
assistance; or
(B) due to a cognitive or other mental impairment, requires substantial supervision because the
individual behaves in a manner that poses a serious health or safety hazard to the individual or to
another individual.
(23) The term ‘‘greatest economic need’’ means the need resulting from an income level at or below the
poverty line.
(24) The term ‘‘greatest social need’’ means the need caused by noneconomic factors, which include—
(A) physical and mental disabilities;
(B) language barriers; and
(C) cultural, social, or geographical isolation, including isolation caused by racial or ethnic status
that—
(i) restricts the ability of an individual to perform normal daily tasks; or
(ii) threatens the capacity of the individual to live independently.
NOTE: According to the supplemental update to the resource guide ‘Strengthen Your State and Local
Aging Plan: A Practical Guide for Expanding the Inclusion of LGBT Older Adults’, published by the
National Resource center on LGBT in 2017, ACL clarified its longstanding guidance that the following
populations are included in the definition of “greatest social need”:
• individuals who are Black, Latino, and Indigenous and Native American persons, Asian
Americans and Pacific Islanders, and other persons of color
• members of religious minorities
• lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons
• persons with disabilities
• persons who live in rural areas
(7/10/12 AoA Guidance retrieved from SAGE website 2/27/23.)
(25) The term ‘‘Hispanic-serving institution’’ has the meaning given the term in section 502 of the Higher
Education Act of 1965 (20 U.S.C. 1101a).
(26) The term ‘‘Indian’’ means a person who is a member of an Indian tribe.
(27) Except for the purposes of title VI of this Act, the term ‘‘Indian tribe’’ means any tribe, band, nation, or
other organized group or community of Indians (including any Alaska Native village or regional or village
corporation as defined in or established pursuant to the Alaska Native Claims Settlement Act (Public Law 92–
203; 85 Stat. 688) which
(A) is recognized as eligible for the special programs and services provided by the United States to
Indians because of their status as Indians; or
13
(B) is located on, or in proximity to, a Federal or State reservation or rancheria.
(28) The term ‘‘information and assistance service’’ means a service for older individuals that—
(A) provides the individuals with current information on opportunities and services available to the
individuals within their communities, including information relating to assistive technology;
(B) assesses the problems and capacities of the individuals;
(C) links the individuals to the opportunities and services that are available;
(D) to the maximum extent practicable, ensures that the individuals receive the services needed by
the individuals, and are aware of the opportunities available to the individuals, by establishing
adequate follow-up procedures; and
(E) serves the entire community of older individuals, particularly—
(i) older individuals with greatest social need;
(ii) older individuals with greatest economic need; and
(iii) older individuals at risk for institutional placement.
(29) The term ‘‘information and referral’’ includes information relating to assistive technology.
(30) The term ‘‘in-home services’’ includes—
(A) services of homemakers and home health aides;
(B) visiting and telephone reassurance;
(C) chore maintenance;
(D) in-home respite care for families, and adult day care as a respite service for families;
(E) minor modification of homes that is necessary to facilitate the ability of older individuals to
remain at home and that is not available under another program (other than a program carried out
under this Act);
(F) personal care services; and
(G) other in-home services as defined—
(i) by the State agency in the State plan submitted in accordance with section 307; and
(ii) by the area agency on aging in the area plan submitted in accordance with section 306.
(31) The term ‘‘institution of higher education’’ has the meaning given the term in section 101 of the Higher
Education Act of 1965.
(32) The term ‘‘integrated long-term care’’—
(A) means items and services that consist of—
(i) with respect to long-term care—
(I) long-term care items or services provided under a State plan for medical
assistance under the Medicaid program established under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.), including nursing facility services, home and
community-based services, personal care services, and case management services
provided under the plan; and
(II) any other supports, items, or services that are available under any federally
funded long-term care program; and
(ii) with respect to other health care, items and services covered under—
(I) the Medicare program established under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.);
(II) the State plan for medical assistance under the Medicaid program; or
(III) any other federally funded health care program; and
(B) includes items or services described in subparagraph (A) that are provided under a public or
private managed care plan or through any other service provider.
(33) The term ‘‘legal assistance’’—
(A) means legal advice and representation provided by an attorney to older individuals with
economic or social needs; and
14
(B) includes—
(i) to the extent feasible, counseling or other appropriate assistance by a paralegal or law
student under the direct supervision of an attorney; and
(ii) counseling or representation by a nonlawyer where permitted by law.
(34) The term ‘‘long-term care’’ means any service, care, or item (including an assistive device), including a
disease prevention and health promotion service, an in-home service, and a case management service—
(A) intended to assist individuals in coping with, and to the extent practicable compensate for, a
functional impairment in carrying out activities of daily living;
(B) furnished at home, in a community care setting (including a small community care setting as
defined in subsection (g)(1), and a large community care setting as defined in subsection (h)(1), of
section 1929 of the Social Security Act (42 U.S.C. 1396t)), or in a long-term care facility; and
(C) not furnished to prevent, diagnose, treat, or cure a medical disease or condition.
(35) The term ‘‘long-term care facility’’ means—
(A) any skilled nursing facility, as defined in section 1819(a) of the Social Security Act (42 U.S.C.
1395i–3(a));
(B) any nursing facility, as defined in section 1919(a) of the Social Security Act (42 U.S.C. 1396r(a));
(C) a board and care facility; and
(D) any other adult care home, including an assisted living facility, similar to a facility or institution
described in subparagraphs (A) through (C).
(36) The term ‘‘multipurpose senior center’’ means a community facility for the organization and provision
of a broad spectrum of services, which shall include provision of health (including mental and behavioral
health), social, nutritional, and educational services and the provision of facilities for recreational activities
for older individuals.
(37) The term ‘‘Native American’’ means—
(A) an Indian as defined in paragraph (26); and
(B) a Native Hawaiian, as defined in section 625.
(38) The term ‘‘neglect’’ means—
(A) the failure of a caregiver (as defined in paragraph (18)(B)) or fiduciary to provide the goods or
services that are necessary to maintain the health or safety of an older individual; or
(B) self-neglect.
(39) The term ‘‘nonprofit’’ as applied to any agency, institution, or organization means an agency, institution,
or organization which is, or is owned and operated by, one or more corporations or associations no part of
the net earnings of which inures, or may lawfully inure, to the benefit of any private shareholder or
individual.
(40) The term ‘‘older individual’’ means an individual who is 60 years of age or older.
(41) The term ‘‘person-centered, trauma-informed’’, with respect to services, means services provided
through an aging program that—
(A) use a holistic approach to providing services or care;
(B) promote the dignity, strength, and empowerment of victims of trauma; and
(C) incorporate evidence-based practices based on knowledge about the role of trauma in trauma
victims’ lives.
(42) The term ‘‘physical harm’’ means bodily injury, impairment, or disease.
(43) The term ‘‘planning and service area’’ means an area designated by a State agency under section
305(a)(1)(E), including a single planning and service area described in section 305(b)(5)(A).
(44) The term ‘‘poverty line’’ means the official poverty line (as defined by the Office of Management and
Budget, and adjusted by the Secretary in accordance with section 673(2) of the Community Services Block
Grant Act (42 U.S.C. 9902(2)).
15
(45) The term ‘‘representative payee’’ means a person who is appointed by a governmental entity to receive,
on behalf of an older individual who is unable to manage funds by reason of a physical or mental incapacity,
any funds owed to such individual by such entity.
(46) The term ‘‘Secretary’’ means the Secretary of Health and Human Services, expect that for purposes of
title V such term means the Secretary of Labor.
(47) The term ‘‘self-directed care’’ means an approach to providing services (including programs, benefits,
supports, and technology) under this Act intended to assist an individual with activities of daily living, in
which—
(A) such services (including the amount, duration, scope, provider, and location of such services) are
planned, budgeted, and purchased under the direction and control of such individual;
(B) such individual is provided with such information and assistance as are necessary and appropriate
to enable such individual to make informed decisions about the individual’s care options;
(C) the needs, capabilities, and preferences of such individual with respect to such services, and such
individual’s ability to direct and control the individual’s receipt of such services, are assessed by the
area agency on aging (or other agency designated by the area agency on aging) involved;
(D) based on the assessment made under subparagraph (C), the area agency on aging (or other
agency designated by the area agency on aging) develops together with such individual and the
individual’s family, caregiver (as defined in paragraph (18)(B)), or legal representative—
(i) a plan of services for such individual that specifies which services such individual will be
responsible for directing;
(ii) a determination of the role of family members (and others whose participation is sought
by such individual) in providing services under such plan; and
(iii) a budget for such services; and
(E) the area agency on aging or State agency provides for oversight of such individual’s self-directed
receipt of services, including steps to ensure the quality of services provided and the appropriate use
of funds under this Act.
(48) The term ‘‘self-neglect’’ means an adult’s inability, due to physical or mental impairment or diminished
capacity, to perform essential self-care tasks including—
(A) obtaining essential food, clothing, shelter, and medical care;
(B) obtaining goods and services necessary to maintain physical health, mental and behavioral health,
or general safety; or
(C) managing one’s own financial affairs.
(49) The term ‘‘severe disability’’ means a severe, chronic disability attributable to mental or physical
impairment, or a combination of mental and physical impairments, that—
(A) is likely to continue indefinitely; and
(B) results in substantial functional limitation in 3 or more of the major life activities specified in
subparagraphs (A) through (G) of paragraph (8).
(50) The term ‘‘sexual assault’’ has the meaning given the term in section 2003 of the Omnibus Crime
Control and Safe Streets Act of 1968 (42 U.S.C. 3796gg–2).
(51) The term ‘‘State’’ means any of the several States, the District of Columbia, the Virgin Islands of the
United States, the Commonwealth of Puerto Rico, Guam, American Samoa, and the Commonwealth of the
Northern Mariana Islands.
(52) The term ‘‘State agency’’ means the agency designated under section 305(a)(1).
(53) The term ‘‘State system of long-term care’’ means the Federal, State, and local programs and activities
administered by a State that provide, support, or facilitate access to long-term care for individuals in such
State.
(54) The term ‘‘supportive service’’ means a service described in section 321(a).
16
(55) The term ‘‘traumatic brain injury’’ has the meaning given such term in section 393B(d) of the Public
Health Service Act (42 U.S.C. 280b–1c(d)).
(56) Except for the purposes of title VI of this Act, the term ‘‘tribal organization’’ means the recognized
governing body of any Indian tribe, or any legally established organization of Indians which is controlled,
sanctioned, or chartered by such governing body. In any case in which a contract is let or grant made to an
organization to perform services benefiting more than one Indian tribe, the approval of each such Indian
tribe shall be a prerequisite to the letting or making of such contract or grant.
17
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18
Projection to 2040Figure 1. Hawaiʻi State 60+ Popula?on Source: The State of Hawai'i Data Book 2020 466,636 434,959 371,105 281,210
PART I
Overview of the Older Adult Population, Existing Programs,
Services, Initiatives, and Unmet Needs
A. Overview of the Older Adult Population
Population Profile
The national older population is expected to continue to grow significantly in the
near future. More than two-fifths (41%) of the “baby boom” generation is now
age 65 and older. The population age 65 and older increased from 39.6 million in
2009 to 54.1 million in 2019 (a 36% increase) and is projected to reach 94.7 million
in 2060. By 2040, there will be about 80.8 million older persons, more than twice
as many as in 2000. People aged 65 and older represented 16% of the population
in the year 2019 but are expected to grow to be 21.6% of the population by 2040.
The 85 and older population is projected to more than double from 6.6 million in
2019 to 14.4 million in 2040 (a 118% increase). (2020 Profile of Older Americans, ACL)
The aging American population will have wide-ranging implications socially and economically for families,
businesses, health care, and service providers. The projected growth of the older population will present
challenges to policy makers and programs, including Social Security, Medicare, and Medicaid. There will also
be large increases in the need for elderly housing, transportation, recreation, education, health, nutrition,
and in-home services, among others. From 2010 to 2040, the elderly population of the State of Hawaiʻi is
expected to grow by 73%. (Figure 1)
19
85+60+as Percentage of 60+Figure 2. Hawaii State Growth of 85+ 22%20%13%11%11%107,648 94,823 56,704 41,954 30,903 482,667 466,636 434,959 371,105 281,210 Population Growth Figure
3. Hawaii County Age 60+ 2040203020202010200072,51569,51461,04441,45726,352 Female by GenderFigure 5. Hawaiʻi County 60+ 51.5%48.5%Life ExpectancyFigure 4. Hawaiʻi County
Female
From 2020 to 2045, the
percentage of older adults
85 and older is expected to
double from 11% in 2020 to
22% in 2045 statewide. The
projected increase in life
expectancy will have great
impacts on our in-home and
LTC support systems.
Nationally, a relatively small
number of people (1.2
million) age 65 and older
lived in nursing homes in
Source: The Hawaiʻi State Data Book 2020
2019. However, the
percentage increases with age, ranging from 1% for persons ages 65-74 to 2% for persons ages 75-84 and 8%
for persons over age 85. (2020 Profile of Older Americans, ACL) In Hawaiʻi, the 85+ cohort is expected to nearly
double in the next two decades from 11% in 2020 to 20% in 2040. (Figure 2)
The population over the age of sixty in Hawaiʻi
County is expected to almost triple from the years
2000 to 2040 to over 70,000 older adults (Figure 3).
Life expectancy in Hawaiʻi County is one of the
highest in the nation, with women outliving men by
almost seven years (Figure 4). In Hawaiʻi County,
older women represent over 51% of the older
population. (Figure 5) As the population grows,
women continue to represent a larger percentage
of the older population.
Source: The Hawaiʻi State Data Book 2020
Source: U.S. Census Bureau, 2016-2020
American Community Survey 5-Year Estimates
Source: Kevin Y. Kawamoto, MSW, Ph.D. “Our
Changing Community by the Numbers” Presentation
for EOA/AAA’s, 9/ 14/22.
20
FemaleMale Figure 6. Hawaiʻi County Age 70+ by Sex 8580757002,7222,4613,3675,2661,7701,5103,5605,464
From age 70 to 75, the male to female ratio of
Hawaiʻi County residents is rela?vely even.
After age 75, women outnumber men by over
50%. (Figure 6) The higher male mortality rate
can lead to a higher number of older women
living alone, with less financial supports, and at
higher risk for institutionalization.
The population pyramid graph shows that the
largest population cohorts of the County of
Hawaiʻi are the 60-64 and 65-69 age groups.
(ACS 2121 5-Year estimate) (Figure 7) The
oldest of the Baby Boomers reached age 76 in 2022. As these groups age into their later sixties and
seventies, the demand for services and supports will have a great impact on the aging networks’ social and
human services programs.
Figure 7
21
150% FPLAt or Above100 - 149% FPLBelow 100% FPL i County ʻHawaiFigure 9. 60+ Poverty Level Status 82%8%10%Hawaiʻi County Figure 8. 60+ Living Alone OthersLive withLive Alone80%60%40%20%0%65%35%
Area Agencies on Aging use social determinants of health indicators to determine program and service needs
in the community. They include: living alone, income (at or below Federal Poverty Level), limited English
speaking ability, race and ethnicity, disabilities, living with grandchildren, health status and chronic
conditions, living in rural areas, social isolation, sexual orientation and identity, and family caregivers, among
others. Note: Data for Figures 8, 9, 10, 11, and 12 obtained from U.S. Census Bureau, 2016-2020 American
Community Survey 5- year Estimates.
Nationally, about 27% of all older adults living in the community in
2020 lived alone. They represented 20% of older men and 33% of older
women. The proportion living alone increases with age for both men
and women. Among women aged 75 and older, 42% lived alone. In
Hawaiʻi County, 35% of the sixty and over popula?on lives alone.
(Figure 8) Although living alone in itself is not a predictor of decline in
health and safety as one ages, a combination of factors including living
alone can lead to having unmet needs and a higher risk of
institutionalization. One’s support network and available resources can
assist in living alone safely in the home.
National studies show that as people age, the more
likely they are to have reduced incomes. Living on a
fixed income, increased medical expenditures, and
death of a spouse can lead to limited income
available for basic needs. Any family/individual with
total income less than an amount deemed to be
sufficient to purchase food, shelter, clothing, and
other essential goods and services is classified as
below the Federal Poverty Level (FPL). In Hawaiʻi
County, 10% of the 60+ population lives below the
Federal Poverty Level (FPL), 8% live below 150% of
the FPL, and 82% live at or above the FPL. (Figure 9)
In Hawaiʻi County, there are pockets of
Figure 10. Hawaiʻi County 60+ Below Federal Poverty Level
residents aged 60 and over whose incomes
are below the Federal Poverty Level. The
areas with the highest numbers are disbursed
across the island including census tracts 210,
213, and 218, in Puna, South Kona, and North
Kohala, respectively. Another large area with
high levels of residents living below poverty
level is Ka’u, which includes Hawaiian Ocean
View Estates, Na’alehu, Pahala, and Volcano.
(Figure 10)
22
Figure 12. Hawai'i County 65+ with a Disability INDEPENDENT LIVING DIFFICULTYCARE DIFFICULTY-SELFAMBULATORY DIFFICULTYCOGNITIVE DIFFICULTYVISION DIFFICULTYHEARING DIFFICULTYWITH A DISABILITY35%30%25
%20%15%10%5%0%Two or More RacesSome other RaceOther Pacific IslanderNative Hawaiian andAsianand Alaska NativeAmerican IndianAfrican AmericanBlack orWhite Race 2020
Figure 11. Hawaiʻi County 60+ Popula?on by 12.9%28.9%48.3%than "very well"Speak English lessthan EnglishLanguage otherEnglish Only Hawaiʻi County Figure 10. 60+
Limited English Proficiency 7%17%83%
Race is an important social factor in
understanding disparities in the well-
being of older adults in many areas of
life including: income, employment,
health, housing, and criminal justice.
The COVID-19 pandemic brought to
light disparities in national health
systems with varying degrees of success
in treatment and loss of life due to
ones’ race and economic status. Some
racial and ethnic groups receive poorer
medical care, are less healthy, have
shorter life expectancies, and reduced
quality of life. The ethnic composition
of Hawaiʻi Countys’ 60+ popula?on is
made up of nearly 50% White, 30% Asian, 13% two or more races, 9% Hawaiian, and less than 1% Black and
American Indian. (Figure 11)
Older adults who experience limited English proficiency are at risk for greater economic insecurity and
inequality of access to services. Barriers of language and culture often impede eligible seniors’ ability to
access benefits and services. Limited English speaking older adults are twice as likely to fall below the FPL as
other older adults. Government programs must make special efforts to ensure that limited English speaking
populations have equitable access to services.
Visual impairment, reduced motor skills, hearing and memory loss are common in the progression of aging.
Many elderly adults live with a comorbidity of physical and health related conditions that make self-care
more difficult. (Figure 12) Through the Older Americans Act grants and the State’s Kupuna Care Program,
funding is available for
programs that aid in the
promotion of
independence for those
who may be experiencing
difficulties in performing
activities of daily living and
their caregivers. They
include: supportive home
and community-based
services, nutrition
programs, legal assistance,
disease prevention
campaigns, health
promotion services, and
caregiver support
programs.
Source: U.S. Census Bureau, 2021 American Community Survey 1-Year Estimates
23
0% Aged 65+Figure 13. National Leading Chronic Conditions Adults STROKEMYOCARDIAL INFARCTIONCHRONIC LUNG DISEASEHEART DISEASECANCERDIABETESARTHRITIS60%50%40%30%20%10%
Chronic Conditions
90% of adults over age 65 have at least one chronic condition and many have multiple conditions which can
lead to challenges in daily living. Of people aged 65 and older, 68% have a lifetime probability of becoming
disabled in at least two activities of daily living (ADLs) or of becoming cognitively impaired. (RHIhub; AARP
(2003); DHHS & DOL (2003) Leading chronic conditions among adults age 65 and older include arthritis
(48%); coronary heart disease (14%); myocardial infarction (9%); angina (4%); any cancer (25%); COPD,
emphysema, or chronic bronchitis (10%); stroke (9%); and physician-diagnosed and undiagnosed diabetes
(29%). (Figure 13)
Many older adults
experience challenges in
daily living due to
chronic illness or
disability. According to
the Center for Disease
Control and Prevention
(CDC), about 80% of
older adults have one
chronic condition, and
50% have at least two.
(Figure 14) The CDC also
states that infectious
diseases (including
COVID-19, influenza,
and pneumococcal
disease) and injuries (often due to falls) disproportionately affect older adults. Physical and health related
conditions can lead to difficulties that restrict the ability to perform basic self-care, or activities of daily living
(ADL’s) and Instrumental Activities of Daily Living (IADL’s). ADL’s include: eating, dressing, bathing, toileting,
transferring, and walking. IADL’s include: cooking, housekeeping, shopping, managing money, ability to use
transportation, medication management, and using the telephone and/or Internet.
Figure 14
24
Ability to Live Independently
According to the AARP Second Half of Life Study, June 2022, fears about living independently increase as
adults age. AARP asked 2,580 qualified respondents if they feared needing help with caring for self, driving,
visiting family, household chores, and staying in current home. The results revealed that as respondents
increased in age, so did their fears about living independently. (Figure 15)
Figure 15
COVID-19
In early 2020, the world was hit
by a public health emergency
caused by the COVID-19 virus.
As the initial 2019 Novel Corona
(2019-nCoV) virus rapidly spread
across the country and the
world, governments took action
to try to mitigate the spread of
this deadly virus that was taking
peoples’ lives at an alarming
rate.
On February 28, 2020, the
Hawaiʻi County Mayor issued an Emergency Proclama?on declaring “a state of emergency due to the
outbreak of COVID-19 being recognized as a public health emergency of international concern and a public
health emergency for the United States”. March 4, 2020, the Governor of Hawaiʻi issued a Proclama?on
“declaring a state of emergency based on the actions and directives of the President of the United States, the
World Health Organization, and the Centers for Disease Control and Prevention, and current conditions
warranting preemptive and protective actions related to the outbreak of COVID-19”. The Secretary of Health
25
and Human Services (HHS) is one of the lead federal agencies that determines when a public health
emergency exists. The first HHS Public Health Emergency Declaration, issued January 31, 2020, stated that “a
public health emergency exists and has existed since January 27, 2020, nationwide”. At that time, there were
108 confirmed cases in the U.S. and 93,090 cases worldwide. As of Feb. 28, 2023, the U.S. has had
102,019,564 confirmed cases, 1,109,145 deaths, and 662,514,513 vaccines administered. (World Health
Organization (WHO) website. Retrieved 3/2/23.) Worldwide, there have been 758,390,564 confirmed cases,
6,859,093 deaths, and 13,266,873,459 vaccines administered. (WHO) The HHS 90-day Public Health
Emergency Declarations have been reissued 14 times throughout the duration of the pandemic. The last
declaration will expire on May 11, 2023. The federal government has determined that the number of COVID-
19 cases and deaths have declined to an acceptable level and is not planning to issue future declarations of
public health emergencies related to the COVID-19 virus. Hawaiʻi County’s Emergency Rule No. 20 was
repealed effective February 28, 2022.
The reduction in cases and subsequent deaths can be attributed to the advent of COVID-19 vaccines, the
prevalence of milder variants of 2019-nCoV, social distancing practices, the use of PPE’s (face coverings),
sanitation efforts, and herd immunity, among others. Mitigation efforts included rather drastic measures
that had a tremendous effect on the world and how people were able to live their daily lives. Mandated
lockdowns, travel bans, stay-at-home orders, business and school closures, social distancing guidelines, and
quarantining when sick changed how many people have lived from the beginning of the pandemic to today.
COVID-19 mitigation levels of success vary greatly from state to state and country to country. Hawaiʻi’s inter-
state and international travel ban helped keep COVID-19 cases and deaths to one of the lowest in rates the
country. Other Pacific Island nations including New Zealand, Tonga, and Samoa had great success by issuing
total travel bans as well.
Increased Risk for Severe COVID-19 Illness
Those most at risk of severe outcomes of COVID-19, including hospitalization or death, are the elderly,
people with underlying medical conditions, minorities, and people living in rural areas with limited access to
healthcare (including testing and vaccines), among others. The pandemic brought to the forefront inequities
in healthcare and access to services and resources. When determining the risk of severe COVID-19
outcomes, providers consider a persons’ age, presence of underlying conditions, and other risk factors.
Age
The risk of severe outcomes from COVID-19 increases in people who are 50 years and older, with the risk
increasing substantially at ages older than 65 years. The risk of developing dangerous symptoms increases
with age, with those who are age 85 and older at the highest risk of serious symptoms. In the U.S., about
81% of deaths from the disease have been in people age 65 and older. (www.mayoclinic.org/diseases-
conditions/coronavirus/in-depth/coronavirus-who-is-at-risk/art-20483301. Retrieved 3/13/23) Residents of
long-term care facilities are also at heightened risk of severe outcomes from COVID-19.
Race and Ethnicity
People from racial and ethnic minority groups (Native Hawaiian, Pacific Islander, American Indian, Alaska
Native, Asian, Black, and Hispanic/Latino) have been disproportionately affected by the COVID-19 pandemic.
Compared to non-Hispanic whites, people from minority groups are more likely to be hospitalized and die
from COVID-19 at younger ages. (CDC data: Risk for COVID-19 Infection, Hospitalization, and Death By
Race/Ethnicity)
26
Underlying Medical Conditions
Many underlying medical conditions have been associated with increased risk for severe COVID-19. Key
underlying conditions include:
Chronic heart, lung, kidney, and liver disease
Diabetes
Obesity and physical inactivity
Disabilities
Neurological conditions including dementia and stroke
Immunocompromising conditions or medications
Smoking (former or current)
(www.health.state.mn.us/diseases/coronavirus/hcp/conditions.html)
Recent Hawaiʻi Department of Health reports that the State of Hawaiʻi had 380,098 confirmed cases, 1,834
deaths, and a testing positivity rate 4.4%. The latest COVID-19 data for Hawaiʻi County is 42,529 cases, 231
deaths, and a testing positivity rate of 3.0% (as of 3/2/23). Of the 1,834 deaths in the state, 79% were age 60
and over, 97% had one or more underlying conditions, 60% male, 40% female, 24% Filipino, 18% Japanese,
17% Native Hawaiian, 14% Pacific Islander, 13% White alone, 6% Chinese, 5% other, 4% other Asian, and 1%
Black. (Figure 16)
Figure 16
27
Vaccination Status
Persons who are unvaccinated or who are not up to date with COVID-19 vaccines, including recommended
boosters, are at increased risk for severe COVID-19 illness. In Hawaiʻi County, the COVID-19 vaccination rate
is 78.6% overall. Although there are variable rates of vaccination across the island, the areas with the highest
vaccination rates are: North Kohala 96%, Kealakekua 94%, Honokaa 89%, and the Hamakua Coast 99%, 94%,
and 88% . (The higher rates near some hospitals could be attributed to the data being collected by zip code
at vaccination sites.) The areas with the lowest vaccination rates are Ocean View (HOVE) 33%, Mountain
View 47%, Na ʽ alehu 54%, Volcano 54%, Pahala 55%, Captain Cook 55% (which includes nearly half of HOVE),
Pau ʽ uilo 57%, and Pahoa 58%. (Figure 17)
Hawaiʻi County Vaccina?on Efforts
According to the EOA SFY21 Annual Legislative Report, Hawai‘i County government, primarily through its Civil
Defense Agency, and Eric Honda, the District Health Officer for Hawai‘i County, led vaccination efforts and
were quick to onboard as many vaccine providers as possible. The Civil Defense Agency was the liaison and
coordinator for all county resources and arranged the use of County facilities for vaccine distribution. In
Phase 1a, the island’s three hospitals (Hilo Medical Center, Kona Community Hospital, and the Queen’s North
Hawai‘i Community Hospital) had the capacity to store the Pfizer Vaccine and vaccinated the medical
community, while the District Health Office received and stored the Moderna vaccine and vaccinated the first
responders. Mass vaccination clinics were then established in Hilo at the Afook-Chinen Civic Auditorium and
Edith Kānaka‘ole Multi-Purpose Stadium; and in Kona at the Kona Aquatic Complex. Concurrently, the District
Health Office started to communicate with community partners to broaden vaccination capacity. Key
community vaccination partners including the three FQHCs on the island (the Bay Clinic, the Hāmākua-Kohala
Health Centers, and the West Hawai‘i Community Health Center) and the local pharmacies, including KTA
Super Stores Pharmacies, which took responsibility to vaccinate residents of ARCHs, CCFFHs, DD Domiciliary
and Foster Homes, and the homebound. The District Health Office set up clinics at all low-income senior
housing projects. The Hawai‘i National Guard also played a significant role, providing manpower, traffic
control, and medics for vaccine administration. As vaccination demand decreased, focus shifted from mass
vaccination sites to community pop-up clinics in targeted communities.
Under the leadership of Horace Farr, County Executive on Aging, the Hawai‘i County Office of Aging (HCOA)
spent a lot of energy providing education to kūpuna through written materials, newsletters, and public
service announcements (PSAs), as well as calls to clients in their ADRC database. HCOA directed kūpuna to
call centers that could help them schedule vaccination appointments and assisted kūpuna who had
difficulties getting appointments. HCOA also organized transportation for those kūpuna who couldn’t get to
clinics independently. They provided lists of senior housing projects to the District Health Office, which
organized vaccinations there.
Throughout the vaccination effort, a community-based organization, Community First Hawai‘i, hosted weekly
meetings so all the providers could strategize together to target their efforts and reduce overlap. This group
linked closely with the state and county sources of information to keep abreast of vaccine supply and
availability for Hawai‘i County and track vaccination venues and events, which they forwarded to the Civil
Defense for posting on their website. Community First also developed and disseminated public service
announcements to promote vaccination.
(EOA SFY21 Annual Legislative Report)
28
Figure 17
COVID-19 Risk Continuum
The risk of severe COVID-19 illness increases as the number of comorbid conditions and risk factors increase.
According to the ACL 2020 Profile of Older Americans, 71% of people age 65 and older reported that they
received an influenza vaccination during the past 12 months and 67% reported that they had ever received a
pneumococcal vaccination. In 2019, 8.2% of persons aged 65 and older reported that they were current
smokers. In 2015-2018, 32% of men aged 75 and over and 36% of women aged 75 and over were obese. In
2019, 13% of people aged 65 and older reported taking prescription medicine for feelings of worry,
nervousness, or anxiety and 12% reported taking prescription medicine for depression. In 2019, 96% of
persons aged 65 and older reported that they had a usual place to go for medical care, 26% had a hospital
emergency department visit in the past year, and only 3% said that they failed to obtain needed medical care
during the previous 12 months due to cost (this report was written pre-COVID-19).
29
(www.health.state.mn.us/diseases/coronavirus/hcp/conditions.html. Retrieved on 3/14/23)
Clinical Recommendations for Living with COVID-19
Continue to receive vaccinations for COVID-19, including all recommended boosters.
Persons with mild to moderate symptoms and underlying risk factors for severe illness should
consider antiviral therapies.
Persons with underlying risk factors for severe illness are encouraged to continue practicing
preventive measures, including when to wear a high-quality mask, to decrease the risk of infection.
Persons with underlying risk factors are encouraged to have a COVID-19 plan in place, including
testing at the first sign of symptoms and knowing how to access treatment if needed.
(www.health.state.mn.us/diseases/coronavirus/hcp/conditions.html)
National Impacts of COVID-19 Disease Pandemic on Title III Services Funding Use
The president declared the coronavirus disease of 2019 (COVID-19) pandemic as a national emergency on
March 13, 2020, authorizing states to use OAA Title III funds for disaster relief as they saw fit without having
30
to submit a transfer request to ACL. As a result, states were allowed to use Title III-B, C, D, and/or E funds
for any disaster relief activities for older individuals or family caregivers served under the OAA, such as
providing:
■ drive-through, take-out, or home-delivered meals;
■ well-being checks via phone, in person, or via virtual means; and
■ homemaker, chore, grocery/pharmacy/supply delivery, or other services.
OAA Title III grantees have described in the Older Americans Act Title III 2020 Program Results Report how
the COVID-19 pandemic has impacted their programs. Below is a summary of the information shared by
grantees for how the pandemic impacted Title III service needs and service provision:
■ Shifted to remote work. Many providers, such as legal assistance providers, shifted to remote
work to continue operations and keep clients and staff safe. For remote legal work, this shift entailed
ensuring access to communication tools, files, documents, case management systems, and
mechanisms to have meetings.
■ Experienced increase/decrease in demand for services. In Fiscal Year (FY) 2020, states overall
provided about 24 million more meals overall and about 32% more home-delivered meals—using
COVID-19 and other funds—compared to FY 2019. Grantees also reported a large increase in calls for
information, assistance, and referrals to services during the pandemic. The demand for in-home
services decreased early in the pandemic, and public health orders led to the suspension of many in-
person services, such adult day care centers. In Hawaiʻi County, two of the three adult day care
centers closed due to the economic effects of the pandemic, most notably, workforce shortages.
■ Changed spending patterns. Grantees reported spending more funds for meal programs as food
costs increased and providers needed to purchase additional supplies, such as personal protective
equipment and food delivery containers. Expenditures for some in-person services, such as
homemaker services, remained steady, but expenditures for adult day care and transportation
decreased.
■ Transformed meal programs. Most states replaced congregate meals with home-delivered meals
during the pandemic. While the number of congregate meals dropped, some states continued to
provide congregate meals during the pandemic, and some providers replaced meals in traditional
congregate settings with grab-and-go meals paired with in-person or virtual socialization. Grantees
also adjusted meal delivery approaches. For instance, some localities made single deliveries with
multiple days’ worth of meals, and some provided frozen meals instead of hot meals to limit the
number of times they needed to make contact with the client.
■ Delivered food boxes and groceries and care packages. Grantees provided groceries, food boxes,
and care packages to their clients as either a supplement or an alternative to home-delivered meals.
Care packages included shelf-stable foods and household items such as toilet paper, along with
puzzles and games to provide their clients with activities during the stay-at-home order.
■ Experienced staff shortages. Grantees reported experiencing shortages of staff and volunteers and
implementing alternative solutions to continue providing essential services. For instance, some
grantees reported that many of their traditional volunteers, often older adults themselves, no longer
felt comfortable serving during the pandemic or were directed by state or local orders to stay at
31
home. In response, grantees shifted staff roles to address most critical needs, used COVID-19 funding
to hire additional delivery drivers for their home-delivered meals, or used their transportation
services’ vans to deliver meals to their clients.
■ Modified transportation services. Many grantees reported suspending or significantly reducing
their transportation services early in the pandemic due to safety concerns. However, as the
pandemic continued, some localities modified transportation services to comply with social
distancing measures and ensure older adults were able to get to their medical appointments. Once
COVID-19 vaccines were available for older adults, grantees provided transportation services for
older adults going to and from their vaccination appointments.
■ Cancelled in-person activities. Evidence-based disease prevention and health promotion services
program grantees reported having to cancel workshops that had already been initiated and were
scheduled to be provided.
■ Shifted to virtual programs: Programs provided virtual activities, including trainings, workshops,
and wellness classes (e.g., tai chi, chronic disease self-management, diabetes self-management). As
part of this effort, grantees tested different platforms to determine whether programs were
accessible to older adults. Grantees also developed statewide marketing tools to promote the use of
technology and to reach target audiences, engaged a range of existing and new partners to deliver
virtual programs, and developed materials to support activities and enhance communication with
clients.
■ Temporarily suspended or reduced in-home care services. Grantees reported temporarily
stopping or reducing in-home supportive services for clients at the beginning of the pandemic.
■ Conducted phone/virtual check-ins. Most programs reported conducting well-being checks via
telephone instead of going into clients’ homes. These calls allowed them to assess the needs of their
clients and make sure clients had the support they needed during stay-at-home orders.
■ Temporarily suspended or reduced caregiver support services. Early during the pandemic, several
grantees reported shutting down caregiver support groups and respite care services. As the
pandemic continued, most programs shifted to provide virtual support groups for caregivers and
resumed offering limited respite care services to caregivers. (Administration for Community Living (2022).
Overview of Older Americans Act Title III, VI, and VII Programs: 2020 Summary of Highlights and
Accomplishments. U.S. Department of Health and Human Services. https://acl. gov/aging-and-disability-in-
america/data-and-research.)
Impacts of COVID-19 Disease Pandemic in Hawaiʻi County Include:
FOOD SECURITY
Nutrition and Elderly Activities Division - Title III Services Funding
The Hawaiʻi County Nutri?on Program (HCNP) developed an Elderly Activities Division (EAD)
Emergency Meal Program to deliver meals to all kupuna 60 years and older facing possible food
insecurity beginning in 2020. All 15 congregate meal sites were closed and HCNP delivered frozen
meals to all congregate and home-delivered meal program participants, with staffing assistance from
other EAD programs. The EAD Coordinated Services for the Elderly Program (CSE) staff teamed up
32
with HCNP to assist with outreach, meal delivery, tracking, ordering, conducting wellness checks,
providing activity packets to combat isolation, etc. Concerted outreach efforts were made to identify
residents not previously enrolled in the HCNP programs who were potentially in need of food. HCNP
also offered Grab’N’Go meals as an alternative option. From March 2020 through March 2022, the
program provided 118,736 frozen meals to 760 congregate meal participants, 531 Grab’N’Go meals
to 29 congregate participants, and 190,280 Home Delivered meals to 990 home delivered meal
participants. When conducting the COVID-19 EAD Emergency Meal Program outreach and re-
assessments, some participants resigned from the program due to various reasons: they felt others
needed the meals more than themselves, they didn’t want outsiders coming to their homes, they
moved in with family, family moved in with them, they moved away to be with family (to the
mainland), they entered assisted living or LTC, or passed away.
The Aging and Disability Resource Center Food Resources Guide (COVID-19 Supplement) and Map
The Executive Office on Aging created the Aging and Disability Resource Center Food Resources
Guide (COVID-19 Supplement). The Guide includes food resources for all four counties in the State of
Hawaiʻi. The lis?ng describes services currently available at the ?me as organiza?ons altered
availability of services due to social distancing guidelines. A Food Resources MAP is also available on
the HCOA website.
Community Food Resources Pivoted to Meet Emerging Needs
The Hawaiʻi Food Basket worked hard to meet the needs of the community from the beginning of the
pandemic by serving up to 50,000 people a month, a 357% increase from the 14,000 served monthly
pre-COVID-19 pandemic. Monthly drive-through food distributions were held with assistance from
local community and government agencies including the Hawaiʻi Na?onal Guard. 35# food boxes
were distributed at various locations island-wide. Food Pantries and soup kitchens were held two
times per week during lockdown at various public and private agencies island-wide including:
community centers, schools, gyms, churches, civic centers, state and county facilities. Home delivery
was also provided for those who had no transportation, no proxy, or were experiencing
compromised health. Hawaiʻi Food Basket Emergency distributions also included household
essentials and personal protective equipment (PPE) ie. masks, gloves, sanitizer, toilet paper, etc.
Kahiau Together: IRONMAN World Championship Steps Up To Help
When the pandemic roared on in 2020, the impact on the Island of Hawai`i became clear as hotels
closed, restaurants and shops were shuttered, and the volunteers who help make the IRONMAN®
World Championship® happen became some of the hardest hit. The local IRONMAN Hawai`i team
created Kahiau Together, an aid station and drive-through food distribution effort to feed as many
members of the community as possible. The mission of the program was built from the Hawaiian
word Kahiau, meaning to give generously or lavishly from the heart while not expecting anything in
return.
In support of the IRONMAN Hawai`i team’s mission, the IRONMAN Foundation pledged $1 million to
help feed the Island of Hawai`i community, home of the IRONMAN World Championship, through
Kahiau Together’s local food distribution program. The Kahiau Together Aid Station drive-through
events, which first began July, 2020, continued to distribute over 600 food bundles of locally sourced
fresh proteins, fruits, vegetables, and starches. As of Feb, 2021, over 35,000 meals had been served
through 14 distribution events.
Kahiau Together also assisted local nonprofit organizations with grants to help with critical funding to
33
fill food banks, meet ongoing food insecurity needs, and provide long-term support for the Hawai’i
Island community. Kahiau Together Grant applications were available to local nonprofit organizations
to specifically support hunger relief on the Island of Hawai`i.
(https://bigislandnow.com/2021/02/07/ironman-foundation-pledges-donation-of-1-million/
Retrieved 4/6/23.)
Additional Federal Supplemental Nutrition Assistance Program (SNAP) and Streamlined Application
and Recertification Procedures
The Governor of Hawaiʻi issued the first Emergency Proclamation Related to Supplemental Nutrition
Assistance Program March 24, 2022 in order for Hawaiʻi residents to be able to con?nue to receive
the federal additional SNAP emergency benefits. The Emergency Proclamation stated that without
the additional federal SNAP emergency allotments, families suffering from food insecurity may not
be able to adequately feed their families. The federal SNAP emergency supplemental payments to
Hawaiʻi residents were significant. For the month of December, 2022, for example, additional
benefits of $16,967,311 in federally authorized SNAP emergency allotments was provided for 83,395
families (156,390 individuals). The last SNAP Emergency Proclamation ended on March 27, 2023.
The application process for SNAP benefits was streamlined to accommodate those in need during the
pandemic. Through March, 2023, all initial, recertification, and face-to-face interviews were waived;
expedited service interviews were postponed; telephonic signatures were allowed; remote benefit
issuance deployed; all recertifications and applications were on-line and telephonic and no one was
removed from the program for non-compliance.
Grocery and Medication Delivery Community Partnership
Hawaii County Economic Opportunity Council partnered with KTA Superstores to provide delivery
service for groceries and medications to help 60 at-risk older adults stay safely in their homes.
Service provision shifted from in person congregate settings to virtual, no-contact, and/or limited contact
models
ZOOM became the norm
Telehealth ramped up to meet the needs
Healthy Aging programs offered virtual classes via telephone
Caregiver Support Groups/Classes are now in person or virtual
Due to the closure of the Congregate Meal Sites, participants were provided 5 frozen meals per week
through no-contact delivery and assurance check methods
Transportation services vehicle capacity was reduced to less than 50% due to distancing measures
When sites reopened, limited contact distancing measures reduced capacity for all in-person group
programs and services (no more than 10 people allowed together indoors and 25 people outdoors)
HCEOC partnered with KTA Superstores to deliver groceries and medications to at-risk older adults
Impacts on Aging Network in Hawaiʻi County
Two of the three Adult Day Care Centers on the island closed permanently
Demand for most Title III services decreased severely
Staff shortages led to increased gaps in services
TIII-E funded Caregiver Support Groups/Classes were cancelled until February, 2023
34
HCOA/ADRC COVID-19 Activities
HCOA/ADRC provided 900 Emergency Tool Kits that included: development of a person-centered
Emergency Support Plan, pandemic resource information, other emergency preparedness resource
information including: grocery delivery, prepaid cell phones/smart phones, fall detection devices,
tote bag, sanitizer, gloves, masks, canned goods, toilet paper, pill cases, etc.
HCOA/ADRC distributed 325 Wellness Activity Kits to combat isolation that included: word searches,
puzzles, sudoku, large print crossword puzzle books, deck of cards, exercise books, coloring books,
cookbooks, colored pencils, word search puzzles, and informational pamphlets on combating social
isolation. Of the respondents to the Wellness Activity Kits satisfaction survey, 92% reported that the
kits made them feel less isolated, 93% reported that the kits helped decrease their feelings of
loneliness, and 98% reported that the kits provided some entertainment in their home.
HCOA/ADRC used CARES ACT funding to purchase 30 automatic medication-dispensing devices.
ADRC Case Managers determined distribution of devices based on select eligibility criteria that
included living alone and reliance on caregivers to set up medication boxes for them.
HCOA/ADRC developed a Pilot Telecommunications Smart Phone Program. Prepaid smart phones
and prepaid phone cards were provided to assist 20 Kupuna in connecting with virtual support
groups and trainings, telemedicine, social connection with relatives and friends, and the ability to
order food through phone apps. Results of a sampling pre and post (30 days) DeJong Gierveld
Loneliness Scale survey revealed a significant decrease (50%) in feelings of loneliness.
HCOA Better Choices Better Health (BCBH) program pivoted to a telephone based program geared
for those that lived alone in rural areas. The Toolkit for Active Living with Chronic Conditions and the
Toolkit for Active Living with Diabetes had smaller class sizes of 3-5 people with one lay leader
instead of the normal requirement of two leaders.
Case Management and HCBS Service Provider Agencies – Kupuna Care Services Funding
February 28, 2020, Mayor Harry Kim declared a state of emergency exists due to the imminent
danger or threat of the COVID-19 pandemic. Following the Mayor’s emergency declaration, the
Hawaii County Office of Aging established and invoked enhanced Case Management and Home and
Community Based Service (HCBS) Provider Agency safety protocols to manage operations and
continuum of care of HCBS services in a safer and more effective manner throughout the Covid -19
pandemic.
Centers for Disease Control and Prevention (CDC), State and County guidelines
Enhanced health and safety protocols and requirements for HCOA contracted case management
agency/case managers and HCBS service providers
Universal use of face masks/PPE during home visit– additional PPE supplies provided by HCOA
Physical distancing/interaction during home visit
Enhanced hand hygiene, cleaning, sanitizing and disinfection prior to/after each home visit
Completed SARS-CoV-2 dose vaccination
35
Increased promotion/awareness on the importance testing, screening, monitoring of vulnerable
Elder clients
Prompt notification/reporting to the DOH of person(s) testing positive for Covid-19 (contact
tracing)
Isolation/quarantine policy (CDC) travel, exposure/interaction others/self, exhibiting symptoms
and/or diagnosed with covid-19
Distribution of informational brochures provided by the County of Hawaii and CDC guidelines
(included CDC guideline updates)
Implementation of the above CDC, State and County guidelines helped to bolster health and safety
measures to mitigate transmission and/or exposure risks due to SARS-CoV-2. Applying these
precautionary measures, ensured a continuum of care for Elders enrolled in the Kupuna Care
program during this public health emergency.
Health Equity Index
The 2021 Health Equity Index (formerly SocioNeeds Index), created by Conduent Healthy Communities
Institute, is a measure of socioeconomic need that is correlated with poor health outcomes. The index is part
of the Conduent's SocioNeeds Index Suite, which provides analytics around social determinants of health to
advance equitable outcomes for a range of topics. The Health Equity Index is calculated by Conduent Healthy
Communities Institute using data from Claritas, 2021. The Health Equity Index identified the areas of
greatest need for Hawaiʻi County: Puna, South Kona, Ocean View, Naalehu, and Pahala. (2021 Hawaiʻi
County Health Equity Index Map below)
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Figure 18. Hawaii County 60+ Population by District N HILON KOHALAHAMAKUAKAUKONASOUTH S KOHALAKONA NORTH PUNAS HILO 16,000 14,000 12,000 10,000 -
Hawaiʻi County 60+ Population Per District
According to the AoA criteria, the majority of the County of Hawaiʻi is defined as “rural” with the excep?on of
the Hilo CDP (Census Designated Place). (County of Hawaiʻi Data Portal, Department of Research and Development.
Retrieved 1/9/19.)
Table 1. Hawaiʻi County Age 60+ Popula?on per District
Percent
District Percent Total 55-59 60-84 85+ Total 60+ 60+
S Hilo 26% 52,121 3,043 12,971 1,819 14,790 25.87%
Puna 23% 47,211 3,222 12,991 787 13,778 24.10%
Kau 5% 9,773 436 2,355 164 2,519 4.41%
North Kona 23% 47,252 3,437 12,439 875 13,314 23.29%
South Kona 6% 11,421 935 3,176 229 3,405 5.96%
S Kohala 10% 19,960 1,666 4,728 249 4,977 8.71%
N Kohala 3% 5,906 449 1,626 152 1,778 3.11%
Hamakua 3% 6,056 436 1,745 232 1,977 3.46%
N Hilo 1% 1,650 159 572 63 635 1.11%
100% 201,350 13,783 52,603 6,389 57,173 28.66%
Percent of Population 60+ ~28.66%
Total Population ~201,350
Source: U.S. Census Bureau, 2020 American Community Survey
Note: Population total figures vary due to US Census tract data tabulations.
37
Figure 19. Hawai‘i County 60+ Population Distribution Map
County of Hawaii
Population Distribution by Judicial District
U.S. Census Bureau, 2022 American Community Survey
Total Population (All Ages) – 200,381
and
Total Older Individuals (60+) Population – 57,173 (28.66% of Hawaii County’s Total Population)
5,998 (3.01%)
6,113 (3.06%)
1,778 (3.11%)
1,977 (3.46%)
20,289 (10.17%) 1,580 (0.79%)
4,977 (8.71%) 635 (1.11%)
51,917 (26.03%)
14,790 (25.87)
34,082 (17.09%)
9,957 (17.42%)
45,882 (23.00%)
13,314 (23.29%) L OWER
P UNA
U PPER
P UNA
12,686 (6.36%)
3,821 (6.68%)
11,027 (5.53%)
3,405 (5.96%)
9,885 (4.96%)
2,519 (4.41%)
Prepared by
Hawaii County Office of Aging
3/22
38
B. Needs Assessment and Unmet Needs
In order to identify issues and areas of need for Hawaiʻi County, HCOA conducted community focus groups
and surveyed key network stakeholders. EOA also assisted Hawaiʻi’s AAA’s with two state-wide Needs
Assessment Surveys of older adults (60+) and caregivers. The utilization of various data collection methods
yielded a good cross-section of community viewpoints and identification of unmet needs. Aging Network
Partners and the Hawaiʻi County Commi?ee on Aging were surveyed via an on-line survey and community
focus groups were held in-person at the West Hawaiʻi Civic Center on March 10, 2022 and at the County
Building Puna Conference Room in East Hawai’i on March 30, 2022. The State-wide EOA surveys were
distributed online and manually from August – September, 2022.
Focus Groups and Surveys
HCOA conducted two community focus groups, one in East Hawaiʻi and one in West Hawaiʻi.
West Hawaiʻi Community Focus Group:
West Hawaiʻi Civic Center
Mayor’s Conference Room, Bldg. B
75-5044 Ane Keohokalole Hwy.
Kailua-Kona, HI. 96740
March 10, 2022
10:30am to 12:30pm
Facilitator: Debbie Wills, HCOA
East Hawaiʻi Community Focus Group:
Hawaiʻi County Building
Puna Conference Room
25 Aupuni Street
Hilo, HI. 96720
March 30, 2022
10:30am to 12:00pm
Facilitator: Debbie Wills, HCOA
Facilitator provided information on the Older Americans Act, the National Aging Network, State Units on
Aging, Area Agencies on Aging, and Area Plans on Aging. An icebreaker included a discussion of the 2022
OAM Theme, “Age My Way”, to begin brainstorming issues and areas of concern for the elderly population of
the Big Island communities. Results of the qualitative data gathered at both focus groups’ are given in Part II
of this plan. The results of the on-line surveys were also presented to the focus groups. The focus group size
was kept to a maximum of 10 participants in order to comply with the existing COVID-19 indoor gathering
limitations. The participants represented core agencies that provide case management and LTSS services to
the most frail and vulnerable older adults of the Big Island. The groups’ knowledge of our clients’ unmet
needs and areas of concern for their respective communities is evidenced in the data compiled.
39
40
41
0 Figure 20. Network Survey: Top 10 Greatest Unmet Needs Weighted Average908070605040302010
The following issues and areas of concern for older adults and their caregivers were identified based on the
Top 10 Greatest Unmet Needs, the Top 5 Services Ranked by Overall Importance to their Communities, and
the top areas of concern from the focus group discussions. (Figures 20, 21, and 22)
Results of Aging Network Stakeholder on-line survey:
The Top 10 Unmet Needs identified by the Aging Network Stakeholder on-line survey:
1. Transportation 6. Home Delivered Meals
2. Elderly Housing 7. Information on Where to Find Services
3. Food Security 8. Adult Day Care
4. Assisted Living Facilities 9. Homemaker Services
5. Financial Benefits Assistance 10. In-Home Personal Care
Focus Group Issues of Importance:
Analysis of the East Hawaii focus group qualitative data identified the following common issues of
importance ranked by frequency of occurrence:
1. Funding 4. Caregiver Workshops / Conferences / Health Fairs
2. Policy Reform 5. Training / Education
3. Workforce Development 6. Sharing / Partnering of resources
42
0 Top Issues of ImportanceFigure 21. East Hawaii Focus Group FUNDINGPOLICY REFORMWORKFORCE DEVELOPMENTCAREGIVER WORKSHOPS/CONFERENCESTRAINING/EDUCATIONSHARING/PARTNERING
OF RESOURCES35302520151050 Top Issues of Importance Figure 22. West Hawaii Focus Group FUNDING TRANSPORTATIONADULT DAY CARECAREGIVER SUPPORTSAFFORDABLE HOUSINGHOME SERVICES-CAREGIVER
INIMPROVE MEDICAL CAREINTERACTION/GOVERNMENTPURPOSE SENIOR CENTER-MULTIACCESSIBLE COMMUNITY INFRASTRUCTURE252015105
Analysis of the West Hawaii focus group qualitative data identified the following common issues of
importance ranked by frequency of occurrence:
1. Funding 6. Caregiver Professional Services (In-Home Care)
2. Transportation 7. Improve Medical Care
3. Adult Day Care 8. Interaction / Government
4. Caregiver Supports 9. Multi-Purpose Senior Center
5. Affordable Housing 10. Accessible Community Infrastructure
43
Ideas to Improve Aging in Home or CommunityFigure 23. EOA Older Adults Survey HI County:HOME CARE SERVICES TRANSPORTATIONMEDICAL CAREAFFORDABLE HOUSINGHANDYMAN / HOME MODIFICATION
INFORMATION & RESOURCESWALKABILITY & ZONINGADULT DAY CARESENIOR CENTERSMORE SERVICES OUTSIDE OF HILOINTERNET ACCESSVOLUNTEER ACTIVITIESCOMMUNITY EVENTSINTERGENERATIONAL ACTIVITIESLEGAL
ASSISTANCE
Evaluation of Community Needs Assessment
Discussions held in both focus groups raised similar issues and concerns, although the ranking of importance
varied between the groups. Funding and transportation ranked highest in West Hawaiʻi, whereas funding
and policy reform ranked highest in East Hawaiʻi. Both focus groups felt that the majority of the issues, areas
of concern, and unmet needs stemmed from systemic issues that need to be addressed at the funding and
policy making levels in order to have any impact on the issues our network faces. Both groups, as well as the
on-line survey results, identified funding, transportation, affordable elderly housing, in-home care workforce
shortages, caregiver supports, government interaction and support, partnering of resources, and adult day
care as common issues and greatest areas of need. The EOA Older Adults Needs Assessment Survey
identified home care services, transportation, medical care, affordable housing, and home modification as
the top five areas of improvement for aging in the home or community. (Figure 23)
44
0 Figure 24. Overall Top Needs Identified TransportationFundingAffordable/Elderly HousingIn-Home ServicesPolicy ReformWorkforce DevelopmentAdult Day CareFood SecurityImprove Medical
Care1412108642
Overall evaluation of the
various needs assessment
results yielded the
following highest ranked
needs identified:
transportation, funding,
affordable housing,
funding, in-home care
services, policy reform, lack
of workers, adult day care,
food security, and
improving medical care.
(Figure 24)
Workforce shortages
According to WellSky’s Tip Sheet: Workforce development: Meeting the growing demand for aging and
disability services, the in-home caregiver workforce shortage has reached a tipping point. Low pay rates and
difficult working conditions have always made it challenging to staff programs; now the problem has
been exacerbated by agency closings, shortages in the broader employment market, and the lingering
effects of the COVID-19 pandemic. Workforce shortages have obstructed the delivery of aging services for
decades. And the problem has only intensified due to COVID-19. Any solution to the problem must combine
short-term fixes to the lagging pay rates of direct service providers with long-term solutions that increase
recruitment, productivity, and retention though well-defined career paths and better working conditions.
Any effective solution to the workforce crisis requires collaboration between the federal government, state
agencies, and provider partners, also identified by the focus groups. (https://info.wellsky.com/HMS-CT-
2023-01-17-Workforce-Management-HSTS010.html. Retrieved 2/2/23)
C. Description of Existing Programs, Services, and Initiatives
Aging and Disability Resource Center
The Aging and Disability Resource Center Program (ADRC), a
collaborative effort of AoA and the Centers for Medicare &
Medicaid Services (CMS), is designed to streamline access to long-
term care. CMS originally provided funding for the ADRC program
through the Real Choice Systems Change Initiative. ADRC funding
is now supported through the State legislature. The ADRC program working in conjunction with the AAA’s
provide an opportunity to effectively integrate the full range of long-term supports and services into a single,
“no wrong door”, coordinated system. By simplifying access to long-term care systems, ADRC’s are serving as
the cornerstone for long-term care reform in many states. AoA and CMS envision ADRC’s as highly visible
and trusted places available in every community across the country where people of all ages, incomes and
disabilities go to get information on the full range of long-term support options. Nationally, ADRC programs
have taken important steps towards meeting AoA and CMS’s vision by:
45
Creating a person-centered, community-based environment that promotes independence and
dignity for individuals;
Providing easy access to information to assist consumers in exploring a full range of long-term
support options; and
Providing resources and services that support the range of needs for family caregivers.
ADRC targets services or supports to all elderly aged sixty years or older, persons with disabilities, and their
caregivers. The ultimate goal of the ADRCs is to serve all individuals with long-term care needs regardless of
their age, disability, income, race, sexual orientation/identity, rural residence, and ability to speak English.
ADRC programs provide information and assistance to individuals needing either public or private resources,
professionals seeking assistance on behalf of their clients, and individuals planning for their future long-term
care needs. ADRC programs also serve as the entry point to publicly administered long-term supports
including those funded under Medicaid, the Older Americans Act, as amended Through P.L. 116-131, Enacted
March 25, 2020, and state revenue programs. (aoa.gov)
Older Americans Act (OAA) Title III-B: Supportive Services and Senior
Centers Program
The program is designed to ensure that local communities can meet the individual needs
of older adults and caregivers in their communities. The services are intended to help
older adults remain independent in their own homes and communities. Established in
1973, Long Term Services and Supports (LTSS) provide grants to States and Territories
using a formula based primarily on their share of the national population aged 60 and over. The grants fund a
broad array of services that enable seniors to remain in their homes for as long as possible. These services
include but are not limited to:
Access services such as transportation, case management, and information and assistance;
In-home services such as home delivered meals, personal care, chore, homemaker assistance; and
Community services such as legal services, congregate meals, and adult day care.
This program also funds multi-purpose senior centers that coordinate and integrate services for older adults
such as nutrition programs, community education, health screening, exercise/health promotion programs
and transportation. Hawaii County, through its Elderly Activities Division has senior centers that provide
many of the services listed above with support from the county. With regard to each States’ federal funding
stream, an intrastate funding formula to fairly allocate funds is used by EOA. Area agencies on aging (AAA’s)
have the flexibility to use their funds to provide the supportive services that best meet the needs of seniors
in their planning and service areas (PSA’s).
Older Americans Act Title III-C: Nutrition Programs
Nutrition services are authorized under Title III-C of the OAA. The programs are designed to promote the
general health and well-being of older individuals, and the services aim to:
Reduce hunger, food insecurity, and malnutrition of older adults,
Promote socialization of older individuals, and
Promote the health and well-being of older people by:
Assisting them in gaining access to nutrition and other disease prevention and health
promotion services and
Delaying the onset of adverse health conditions resulting from poor nutritional health or
46
sedentary behavior.
Through the OAA nutrition program, ACL’s AoA provides grants to states to help support nutrition services
for older people throughout the country. The nutrition program is the oldest, largest, and best-known of all
OAA programs. It is funded (in part) by AoA, as well as state and local governments, foundations, direct
payment for services, fundraising, and participants’ voluntary contributions (time and/or money). Program
services at the local level include the Congregate Nutrition Program and the Home-Delivered Nutrition
Program, which provide healthy meals in group settings such as senior centers and faith-based locations, as
well as in the homes of at-risk older adults. Through the aging network’s meal providers, the programs
provide a range of services, including nutrition screening and assessment as well as nutrition education and
counseling. Title III also funds the Nutrition Services Incentive Program, which provides incentives to
encourage and reward effective performance by states in the efficient delivery of nutritious meals to older
individuals. In addition, nutrition services provide an important link to other supportive in-home and
community-based supports, such as homemaker and home health aide services, transportation, physical
activity and chronic disease self-management programs, home repair and modification, and falls prevention
programs.
Congregate Nutrition Services (OAA Section 331, sometimes called C1) The Congregate Nutrition Services
section of the OAA authorizes meals and related nutrition services in group settings, which help to keep older
Americans healthy and prevent the need for more costly medical interventions. The Congregate Nutrition
Program, established in 1972, serves healthy meals while also presenting opportunities for social
engagement, health and wellness activities, and meaningful volunteer roles, all of which contribute to health
and well-being. The program serves individuals aged 60 and older, their spouses, and, in some cases, their
caregivers and/or persons with disabilities who reside in housing facilities occupied primarily by older
individuals at which congregate nutrition services are provided. Meals may also be provided to volunteers
during meal hours.
Home-Delivered Nutrition Services (OAA Section 336, sometimes called C2) Established in 1978, The Home-
Delivered Nutrition Services section of the OAA authorizes meals and related nutrition services for older
individuals and their spouses of any age. Home-delivered meals are often the first in-home service that an
older adult receives, and the program is a primary access point for other home- and community-based
services. The program often serves frail, food-insecure, or isolated individuals aged 60 and over, their
spouses, and, in some cases, their caregivers, and/or persons with disabilities. This program serves much
more than food. It provides a safety check and sometimes the only opportunity for face-to-face contact or
conversation that day. (Administration for Community Living (2022). Overview of Older Americans Act Title
III, VI, and VII Programs: 2020 Summary of Highlights and Accomplishments. U.S. Department of Health and
Human Services. https://acl.gov/ aging-and-disability-in-america/data-and-research.)
Older Americans Act Title III-D: Evidence-Based Disease Prevention & Healthy
Promotion Services
The Disease Prevention and Health Promotion Services Program (Title III D) provides disease prevention
services or health promotion programs. Title III D supports programs to assist older adults prevent illness and
manage chronic physical conditions. Although illness and disability rates increase with age, research has
demonstrated that health promotion and disease prevention activities can help promote healthy and
independent lives for older individuals. Disease Prevention and Health Promotion Services promote benefit
healthy aging and the maintenance of optimal physical, mental, and social well-being in older adults. An
active healthy lifestyle can help older adults prolong their independence and improve their quality of life. All
OAA Title III-D funded activities must be evidenced-based.
47
Older Americans Act Title III-E: National Family Caregiver Support Program
The National Family Caregiver Support Program (NFCSP), established in 2000, provides grants to States and
Territories, based on their share of the population aged 70 and over, to fund a range of supports that assist
family and informal caregivers to care for their loved ones at home for as long as possible. Families are the
major provider of long-term care and research has shown that caregiving exacts a heavy emotional, physical,
and financial toll. Many caregivers who work and provide care experience conflicts between these
responsibilities. Of caregivers nationwide, 15 % of caregivers are assisting two individuals, while 3 % are
caring for three or more. Almost half of all caregivers are over age 50, making them more vulnerable to a
decline in their own health, and one-third describe their own health as fair to poor.
The NFCSP offers a range of services to support family caregivers. Under this program, States shall provide
five types of services:
Information to caregivers about available services,
Assistance to caregivers in gaining access to the services,
Individual counseling, organization of support groups, and caregiver training,
Respite care
Supplemental services
These services work in conjunction with other State and Community-Based Services to provide a coordinated
set of supports. Studies have shown that these services can reduce caregiver depression, anxiety, and stress
and enable them to provide care longer, thereby avoiding or delaying the need for costly institutional care.
According to the 2006 Amendments to the OAA, priority for NFCSP services must be given to caregivers who
are older individuals with greatest social and economic needs, and who are providing care to individuals with
severe disabilities, including children with severe disabilities.
Data from AoA’s national surveys of caregivers of elderly clients shows similar patterns of service:
OAA services provided through the National Family Caregiver Support Program are effective in
helping caregivers keep their loved ones at home.
77 % of NFCSP caregivers report that services enabled them to provide care longer than otherwise
would have been possible and 77 % reported that the services have “helped a lot”.
89 % of caregivers reported that services helped them to be a better caregiver.
Nearly half the caregivers of nursing home eligible care recipients indicated that the care recipient
would be unable to remain at home without the support services.
OAA Title IV: Discretionary Funds Program
The Discretionary Funds Program, although no funds are distributed to the AAA (Hawaii County), the Title IV
funds constitute the major research, demonstration, training and development effort of the Administration
on Aging, led by the Assistant Secretary for Aging. The Title IV mandate is aimed, generally, at building
knowledge, developing innovative model programs and training personnel for service in the field of aging and
matching these resources to the changing needs of older persons and their families in the coming decades. In
particular, AoA's research, demonstrations, training and other discretionary projects are focused on:
48
Advancing our knowledge and understanding of current program and policy issues, such as
community and in-home long term care service systems and programs, significant to the well-being
of the older population.
Improving the effectiveness of Older Americans Act programs by testing new models, systems and
approaches for providing and delivering better services to older persons.
Providing training, technical assistance and information that will increase our ability to serve older
Americans with skill, care and compassion.
OAA Title V: Senior Community Service Employment Program
Under Title V, the Senior Community Service Employment Program (SCSEP) is a community service and work
based training program for older workers. Authorized by the Older Americans Act Title V, the program
provides subsidized, service-based training for low-income persons 55 or older who are unemployed and
have poor employment prospects. SCSEP provides both community services and work-based training.
Participants work an average of 20 hours a week, and are paid the highest of federal, state or local minimum
wage. They are placed in a wide variety of community service activities at non-profit and public facilities,
including day-care centers, senior centers, schools and hospitals. It is intended that community service
training serves as a bridge to unsubsidized employment opportunities; SCSEP's goal is to place 30% of its
authorized positions into unsubsidized employment annually.
OAA Title VI: Native Hawaiians
Under Title VI, the ACL awards funds to tribes and native organizations to meet the needs of older American
Indians, Aleuts, Eskimos, and Hawaiians. For the State of Hawaii, Alu Like has been the recipient of these
funds targeting Hawaiians.
OAA Title VII-A3: Prevention of Elder Abuse, Neglect, and Exploitation
In 1987 AoA established the Prevention of Elder Abuse, Neglect, and Exploitation program. Through the
program, AoA provides federal leadership in strengthening elder justice strategic planning and direction for
programs, activities, and research related to elder abuse awareness and prevention. This program trains law
enforcement officers, health care providers, and other professionals on how to recognize and respond to
elder abuse; supports outreach and education campaigns to increase public awareness of elder abuse and
how to prevent it; and supports the efforts of state and local elder abuse prevention coalitions and
multidisciplinary teams.
Although recognized by OAA, funding for elder abuse has not come to Hawaii County in the form it does with
other AAA’s. Funds from OAA supports the Statewide Ombudsman position that works out of the State
Executive Office of Aging. Also, Hawaii County works closely with the State Department of Health’s Adult
Protective Services when concerns of elder abuse, neglect, and exploitation become apparent. If there are
housing concerns of exploitation, HCOA works with Hawaii County Housing’s Fair Housing Officer.
Other Federal Partners and Programs: Corporation for National and Community Service (CNCS)
Established in 1993, the Corporation for National and Community Service (CNCS) is a federal agency that
engages more than 5 million Americans in service through its core programs -- Senior Corps, AmeriCorps, and
the Social Innovation Fund. As the nation’s largest grant maker for service and volunteering, CNCS plays a
critical role in strengthening America’s nonprofit sector and addressing our nation’s challenges through
service. Three volunteer programs offered in Hawaii County include:
Foster Grandparents serve as role models, mentors, and friends to children with exceptional needs.
49
The program with approximately 20 volunteers island-wide provides a way for volunteers aged 55
and over to stay active by serving children and youth in their communities;
Senior Companions are volunteers aged 55 and over who make a difference by providing assistance
and friendship to adults who have difficulty with daily living tasks, such as shopping or paying bills.
Volunteers island wide help our kupuna remain independent in their homes instead of having to
move to more costly institutional care. Senior Companions also give families or professional
caregivers a much needed respite.
Retired Senior Volunteer Program (RSVP) is one of the largest volunteer networks in the nation for
people 55 and over. Established in 1971 and later moved into the Senior Corps program, RSVP
harnesses the skills and talents of kupuna to serve in a variety of volunteer activities within Hawaii
County.
State Programs
Kupuna Care (KC) Program
The Kupuna Care (KC) program was enacted in 1999 to address the needs of Hawaii's aging population and
the issues arising from those needs. The KC program is considered to be an alternative to traditional long-
term care options. The goal of KC parallels the mission of OAA which helps seniors to lead independent,
meaningful, and dignified lives in their own homes and communities. Services offered by the KC program
provide a safety net for Kupuna that we would consider part of the “gap group” of those who earn too much
to qualify for Medicaid but too little to be able to pay for their own long term care costs. By drawing upon
both formal and informal supports, these services help older adults live independently in a safe and healthy
environment, thus avoiding costly institutionalization for as long as possible. Kupuna Care funds provide
services for individuals who meet the following eligibility requirements:
U.S citizen or legal alien.
60 years of age or older.
Not covered by any comparable government or private home and community–based care
services.
Not residing in an institution, such as an intermediate care facility, skilled nursing facility,
foster family, hospital, or adult residential care home.
Have impairment of at least two ADL’s, IADL’s, or substantive cognitive impairment and
having an unmet need of at least one or more ADL’s or IADL’s.
Activities of Daily Living (ADL’s) include: eating, bathing, dressing, transferring from bed to chair, controlling
bowel and bladder, and moving about the house safely on their own.
Instrumental Activities of Daily Living (IADL’s) include: preparing meals, shopping for food and essential
items, taking medications, managing finances, using the telephone, doing housework, and using public
transportation.
The Kupuna Care Case Management program provides assistance to clients, families, and caregivers in
identifying needs, exploring options, and mobilizing informal as well as formal supports to achieve the
highest possible level of client independence. Case Management assistance includes assessing needs,
developing care plans, coordinating provision of services among Kupuna Care (KC) and National Family
50
Caregiver Support Program Vendor Pool providers, monitoring, and providing follow-up and reassessment as
needed.
Federal Initiatives
In an effort to meet future challenges of the Aging Services Network, the Administration on Aging develops
initiatives to meet federally established goals and objectives. Based on the Administration on Aging’s (AoA)
initiatives, the State Executive Office on Aging (EOA) and all Hawaiʻi Area Agencies on Aging (AAA’s) are
focusing on the following key topic areas for this planning period:
Topic Area 1. Core OAA/Title III Programs
The Older Americans Act core programs found in Titles III (Supportive Services,
Nutrition, Disease Prevention/Health Promotion, and Caregiver Programs), VI (Native
American Programs), and VII (Elder Rights Programs) serve as the foundation of the
national aging services network which strives to optimize the health, safety, and
independence of Americas’ older adults.
Topic Area 2. COVID-19
COVID-19 highlighted the overall importance of the services that make it possible for older adults to
live independently, created national awareness of the impact of social isolation on older adults and
their caregivers, and increased awareness to plan for future disasters.
Topic Area 3. Equity
Serving individuals with the greatest economic and social need means ensuring equity in all aspects
of plan administration.
Topic Area 4. Expanding Access to HCBS
Home and Community Based Services are fundamental to making it possible for older adults to age in
place.
Topic Area 5. Caregiving
Enhancing services and supports for caregivers.
State Initiatives & Goals
The State Executive Office on Aging, together with Hawaiʻi’s AAA’s, developed the following Area Plan Goals
in congruence with the ACL Topic Areas:
GOAL 1: Hawaiʻi ’s older adults have opportunities to live well.
ACL Topic Area: Core OAA/Title III Programs
GOAL 2: Hawaiʻi ’s older adults are prepared for health threats and disasters.
ACL Topic Area: COVID-19
GOAL 3: Hawaiʻi ’s underserved populations have equitable access to programs and
services.
ACL Topic Area: Equity
GOAL 4: Hawaiʻi’s older adults and people with disabilities will age in place.
ACL Topic Area: Expanding Access to HCBS
51
(Note: objectives for this goal will include ADRC activities.)
GOAL 5: Hawaiʻi ’s caregivers have a broad array of services and supports to effectively
care for their loved ones.
ACL Topic Area: Caregiving
52
D. Community Focal Points, Multi-Purpose Centers, Nutrition Sites, and Home Delivered
Meal Providers
Community focal points, multi-purpose centers, nutrition sites, and home delivered meal providers are
located island-wide. There are ten County Parks & Recreation facility sites, seven elderly housing facility
sites, and one community center site. There are seven Multi-Purpose Senior Centers and fifteen community
nutrition sites. The Home Delivered meal providers vary from year to year based on the annual Price-Term
Agreements. The program ensures that meal delivery is provided island-wide.
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54
PART II Recommendations
A. Framework: Laws/Governance and Targeting
The Area Agency on Aging’s recommendations adhere to the general guidelines for program and service
delivery for older adults developed throughout the State by the Executive Office on Aging, including
directives and initiatives of the Administration on Aging. This framework is drawn from the Older Americans
Act (as amended Through P.L. 116-131, Enacted March 25, 2020), and Chapter 349, Hawai‘i Revised Statutes.
Recent trends in AoA and EOA initiatives and grants lean towards the concept that the needs of dependent
elderly can be met through the provision of home and community-based care for institutional nursing home
care and family, friends, and neighbors as caregivers for private caregivers.
The Older Americans Act
One of the primary and contributing federal legislation designed to address the needs of older Americans is
the Older Americans Act. The Older Americans Act of 1965, as amended Through P.L. 116-131, Enacted
March 25, 2020, states that in keeping with the traditional American concept of the inherent dignity of the
individual in our democratic society, the older people of our Nation are entitled to the full and free
enjoyment of the following objectives:
1. An adequate retirement income in accordance with the American standard of living;
2. The best possible physical and mental health which science can make available without regard to
economic status;
3. Obtaining and maintaining suitable affordable housing, independently selected, designed and
located with reference to older citizens special needs;
4. Full restorative services for those who require institutional care, and a comprehensive array of
community-based, long-term care services adequate to appropriately sustain older people in
their communities and in their homes, including support to family members and other persons
providing voluntary care to older individuals needing long-term care services;
5. Employment opportunities with no age discriminatory personnel practices;
6. Retirement with health, honor, and dignity;
7. Participating in and contributing to meaningful activity within the widest range of civic, cultural,
educational, training, and recreational opportunities;
8. Efficient community services, including access to low cost transportation, which provide a choice
in supported living arrangements and social assistance in a coordinated manner and which are
readily available when needed, with emphasis on maintaining a continuum of care for the
vulnerable older individuals;
9. Immediate benefit from proven research knowledge which can sustain and improve health and
happiness; and
10. Freedom, independence, and the free exercise of individual initiative in planning and managing
their own lives, full participation in the planning and operation of community-based services and
programs provided for their benefit, and protection against abuse, neglect, and exploitation.
55
Targeting of Services
The Older Americans Act, as amended Through P.L. 116-131, Enacted March 25, 2020, reemphasized the
intention of the Congress to target services and resources on the needs and problems of those older
individuals identified as having the greatest economic need, the greatest social need, and those who are low-
income minority and older individuals residing in rural areas with additional emphasis on targeting older
individuals with limited English proficiency and older individuals at risk of institutional placement. Special
emphasis has been placed on using outreach methods to target services to:
older individuals residing in rural areas;
older individuals with greatest economic needs (with particular attention to low-income minority
individuals and older individuals residing in rural areas);
older individuals with greatest social need (with particular attention to low-income minority
individuals, older individuals residing in rural areas, and who identify as LGBTQ+);
older individuals with severe disabilities;
older individuals with limited English proficiency;
older individuals with Alzheimer’s disease or related disorders with neurological and organic brain
dysfunction (and the caretakers of such individuals); and informing these individuals and the
caregivers of such individuals, of the availability of assistance; and
older individuals at risk of institutional placement.
Targeting Services
The Next Four Years (2024, ‘25, ‘26, ‘27)
The Hawaii Revised Statutes Section 349-1 declares that older adults are entitled to secure equal opportunity
to the full and free enjoyment of the following:
an adequate income in retirement in accordance with the American standard of living;
the best possible physical and mental health which science can make available, without regard to
economic status;
suitable housing, independently selected, designed, and located with reference to special needs and
available at costs which older citizens can afford;
full restorative services for those who require institutional care;
opportunity for employment with no discriminatory personnel practices because of age;
retirement in health, honor, and dignity;
pursuit of meaningful activity within the widest range of civic, cultural, and recreational
opportunities;
efficient community services which provide social assistance in a coordinated manner and which are
readily available when needed;
immediate benefit from proven research knowledge which can sustain and improve health and
happiness; and
freedom, independence, and the free exercise of individual initiative in planning and managing their
own lives.
In support of the declaration mentioned above, it is the policy of the State and its counties to:
make available comprehensive programs which include a full range of health, education, and social
services to our older residents who need them;
give full and special consideration to older residents with special needs in planning such programs;
and, pending the availability of such programs for all older residents, give priority to the elderly with
the greatest economic and social needs;
provide comprehensive programs which will assure the coordinated delivery of a full range of
essential services to our older residents, and where applicable, also furnish meaningful employment
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opportunities for individuals, including older persons from the community; and
insure that the planning and operation of such programs will be undertaken as a partnership of older
residents, the at-large community, and the State and its counties with appropriate assistance from
the federal government.
With respect to targeting services to older individuals:
with the greatest economic or social needs; (including those who identify as LGBTQ+)
who are from rural areas;
who are low income minority;
who are Native Americans (American Indians, Alaskan Natives, and Native Hawaiians)
at risk for institutional placement;
with limited English proficiency;
B. Prioritization of Issues and Services
HCOA Prioritization of Services for Funding
HCOA utilized predetermined criteria to determine funding priorities based on several indicators:
1) Title III-B Priority
Title III-B of the Older Americans Act, as amended Through P.L. 116-131, Enacted March 25, 2020,
contains service priorities in the areas of Access, In-Home, Community Based, and Legal services.
Following the OAA prioritization guidelines, Adult Day Care, Caregiver Support, Case Management,
Chore, Elder Abuse Prevention and Awareness, Health Promotion and Disease prevention, Home
Modification, Homemaker, Information and Assistance, Legal Assistance, Congregate Meals, Home
Delivered Meals, Nutrition Education, Outreach, Personal Care, and Transportation. These service
priorities align with service needs identified through the various needs assessments conducted for
the development of this area plan.
2) Greatest Economic/Social Need and Low Income Minority
Older individuals with the Greatest Economic Need (GEN), individuals with Greatest Social Need
(GSN), and Low-Income Minority (LIM) individuals are mandated to be given preference by Title III-B
regulations. Measurements are based on the extent to which services address isolation, physical or
mental limitations, racial or cultural barriers, inadequate income, or sexual orientation and identity.
3) Instrumental Activities of Daily Living
National standards to determine the extent of disability based on ability to perform Activities of Daily
Living (ADL’s) without assistance including: bathing, dressing, toileting, eating, transferring, and
walking and Instrumental Activities of Daily Living (IADL’s) which include: essential shopping, meal
preparation, laundry, light and/or heavy housework, money management, medication management,
telephone use, and ability to utilize transportation, all without assistance.
4) Gap Filling Services
The planning process employed by the HCOA seeks to identify gaps in the service delivery system and
to seek solutions either through advocacy, coordination, or funding. Services identified that promote
filling gaps in vital in-home and community based services which delay or prevent institutionalization
ranked highest.
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5) Documented Needs
HCOA utilized various needs assessments for this planning period. The community recommendations
were taken into consideration during the prioritization process based on various factors including
available resources, feasibility, and sustainability, among others.
6) Approaches used in meeting community needs.
The following methodologies are used to meet priority service needs:
1. Advocate for the elderly, encouraging the use of community resources to service priorities;
2. Coordinate resources to make them more accessible to the elderly; and
3. Issue Title III grants and contracts to supplement community resources, or as “seed money”
to attract additional community resources.
4. Utilize a person-centered approach to meet individual needs.
Considerations for Title III Funding Usage
Although there are many factors to consider in the distribution of limited Title III funds, including
capabilities of service providers and level of service requirements, the HCOA utilizes the following
basic factors in determining funding priorities:
1. Is the service determined to fill an identified gap?
2. Are there adequate funding sources other than Title III?
3. Are existing community resources utilized to the fullest extent possible?
4. Are there adequate volunteer resources to support the service (as an alternative to Title III
funding?).
5. Is the service cost effective?
6. Does the service address the HCOA target group?
7. Is the service needed by that target group?
8. Are there other support services in place to complement this service?
9. Are there enough Title III funds to support this service?
10. Are the proposed funds for “seed money” or permanent funding?
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PART III Goals, Objectives, Strategies, Outputs, and Outcomes
A. ACL Topic Areas
The Administration for Community Living (ACL) State Plan guidance incorporated 5 topic areas to guide the
development of SUA’s and AAA’s area plan goals and objectives for their respective area plans on aging 2023-
2027:
Topic Area 1: Core OAA/Title III Programs: OAA Core programs in Title III
(Supportive Services, Nutrition, Disease Prevention/Health Promotion,
Caregiver Programs), VI (Native American Programs), VII (Elder Rights
Programs) and serve as the foundation of the national aging services
network.
Topic Area 2. COVID-19: COVID-19 highlighted the overall importance of
the services that make it possible for older adults to live independently,
created a national awareness of the impact of social isolation on older
adults and caregivers, and increased awareness of the need to plan for
future disasters. It also transformed the aging network; drove rapid
innovation and creation of new approaches that will endure beyond
recovery; and increased awareness of the need to plan for future disasters.
Finally, Congress provided increases in funding some of which remain
available until expended.
Topic Area 3. Equity: Serving individuals with the greatest economic and
social need means ensuring equity in all aspects of plan administration. The
State Plan should address activities to support these goals.
Topic Area 4. Expanding Access to HCBS: Home and Community-Based
Services are fundamental to making it possible for older adults to age in
place.
Topic Area 5. Caregiving: Enhancing services and supports for caregivers.
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B. Summary of Goals
HCOA 2023 - 2027 Goals, Objectives, and Strategies
The State Executive Office on Aging (EOA) and the Area Agencies on Aging (AAA) developed the following
statewide Goals for the planning period 2023-2027:
GOAL 1: Hawaiʻi ’s older adults have opportunities to live well.
ACL Topic Area: OAA
GOAL 2: Hawaiʻi ’s older adults are prepared for health threats and disasters.
ACL Topic Area: COVID
GOAL 3: Hawaiʻi ’s underserved populations have equitable access to programs and
services.
ACL Topic Area: EQUITY
GOAL 4: Hawaiʻi’s older adults and people with disabilities will age in place.
ACL Topic Area: Expand HCBS
GOAL 5: Hawaiʻi ’s caregivers have a broad array of services and supports to
effectively care for their loved ones.
ACL Topic Area: Caregivers
Goals and Objectives
In accordance with the topics developed by the ACL and the goals developed by EOA for the State of Hawai‘I
AAA’s, HCOA developed the following objectives for this planning period. Each objective includes strategies,
outcomes, and evaluation measures.
Topic Area 1. Core OAA/Title III Programs:
Older Americans Act Core programs in Title III
(TIII-B Supportive Services, TIII-C Nutrition, TIII-D
Disease Prevention/Health Promotion, TIII-E
Caregiver Programs), VI (Native American
Programs), and VII (Elder Rights Programs) serve
as the foundation of the national aging services
network.
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AAA Goal 1: Hawaiʻi ’s older adults have opportunities to live well.
Nutrition: Health & Well-Being
GOAL: To improve the health and well-being of older individuals by reducing hunger, food
insecurity, and malnutrition among older individuals.
Objective 1:
70% of older individuals enrolled will be able to maintain or increase food security through
participation in the nutrition meal programs.
Outcome 1:
70% of nutrition program enrollees who completed the nutritional risk assessment surveys reported
that they were able to maintain or increase food security as a result of participation in the nutrition
program.
50% of participants in the nutrition program were able to maintain or improve their nutrition as a
result of enrollment in the nutrition program as reported through the program evaluation surveys.
35% of participants in the nutrition program were able to improve their health status as a result of
participation in the nutrition program as reported through the program evaluation surveys.
Strategies:
(1) Provide a meal five (5) or more days a week, unless a waiver has been granted by the STATE,
to an older adult in a congregate or group setting. All meals provided shall be consumed at
the congregate site during the meal period.
(2) Provide a home delivered meal five (5) or more days per week, unless a waiver has been
granted by the STATE, to a home bound older adult.
(3) Implement Nutritional Risk Assessment tool upon enrollment in the nutrition program and
annually thereafter.
(4) Implement annual program evaluation surveys for a random sampling of nutrition program
participants.
Evaluation:
1. The percentage of program enrollees who report increased food security as a result of the
nutrition program meals provided.
2. The percentage of participants who report improved nutrition as a result of the nutrition
program activities.
3. The percentage of participants who report improved health status as a result of participation
in the nutrition program.
Nutrition: Social Well-Being & Reduced Isolation
Goal: To maintain or improve the social well-being and reduce isolation of older adults.
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Objective 1:
50% of program participants will maintain or improve their social well-being and reduce feelings of
isolation through nutrition socialization, recreational, and educational activities.
Outcome 1:
50% of nutrition program participants indicate they maintained or improved their social well-being
and reduced feelings of isolation as a result of participating in the meal programs as reported
through the annual program evaluation surveys.
Strategies:
(1) Provide socialization, recreational, and educational activities five (5) or more days a week,
unless a waiver has been granted by the STATE, to an older adult in a congregate or group
setting.
(2) Conduct assurance checks when delivering the home delivered meals.
(3) Include site participation in program evaluation surveys.
(4) Conduct annual program evaluation surveys.
Evaluation:
1. The percentage of congregate meal site participants who report maintained or improved
social well-being.
2. The percentage of participants who report increased opportunities for socialization and
reduced isolation through participation in the nutrition programs.
Health Promotion: Fall Prevention
GOAL: To improve the health and wellbeing of our older individuals through promotion of Fall
Prevention Awareness.
Objective 1:
65% of seniors who receive information and/or training on fall prevention awareness and practices
will increase their knowledge of potential fall risks in the home.
Outcome 1:
65% of seniors who received information and/or training on fall prevention awareness and practices
are able to identify potential fall risks in the home as identified through the post-training
questionnaire.
Objective 2:
50% of seniors who receive information and/or training on fall prevention awareness and practices
will decrease their risk of falls by making changes to their environment.
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Outcome 2:
50% of seniors who received information and/or training on fall prevention awareness and practices
reduced their risk of falls because they made changes to their environment as identified through
post-training questionnaires.
Objective 3:
50% of seniors who received fall prevention awareness will be able to increase their feeling of
safety.
Outcome 3:
50% of seniors who participate in a Fall Prevention training program were able to increase their
feeling of safety as identified through post-training questionnaires.
Strategies:
(1) Provide educational materials pertaining to fall prevention to aging population and
caregivers.
(2) Develop and/or update fall prevention videos and increase accessibility of videos.
(3) Implement a Fall Prevention training program, which may include evidence based Fall
Prevention programs such as; CAPABLE, HARP, FallsTalk, YMCA Moving for Better Balance,
among others.
(4) Focus on securing funding to implement and maintain fall prevention efforts and enhance
quality of program(s) implementations.
(5) Conduct post-training questionnaires at 30 days after completion of training.
Evaluation:
1. Recipients reported increase in knowledge about Fall Protection Awareness.
2. Recipients reported they improved their household environment after learning about Fall
Prevention practices for the home.
3. Recipients reported increased feeling of safety in their homes after receiving information
and/or training about fall prevention.
Legal Services
Goal: To provide legal assistance on issues including, but not limited to: income security, health
care, long-term care, nutrition, housing, utilities, protective services, defense of guardianship,
abuse, neglect, and age discrimination. Legal assistance is targeted towards older individuals in
social and economic need.
Objective 1:
Eligible older Individuals requesting legal services will be referred for legal assistance.
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Outcome 1:
70% of older Individuals who received referrals for legal assistance will be linked to the appropriate
legal service determined through a review of monthly invoices.
Objective 2:
50% of older adults referred for legal services will report satisfaction with the legal assistance
provided.
Outcome 2:
50% of older adults who received legal services reported satisfaction with the legal assistance
provided as determined by the legal survey reports.
Strategies:
(1) Provide the intake venue to link older adults who request information about legal advice,
counseling, and representation to the appropriate legal resources.
(2) Secure contractor to provide information of entitlement programs, the legal process, and/or
individual rights.
Evaluation:
1. The percentage of participants linked to the appropriate legal resource(s) as a result of
participation in the Legal services program.
2. The percentage of participants who report satisfaction with the legal assistance provided.
Healthy Aging
Goal: Increase awareness of Better Choices, Better Health Program (BCBH) island-wide.
Objective 1:
Conduct outreach and marketing activities to increase awareness of BCBH program.
Outcome 1:
50% of outreach activities will include information to increase awareness of the BCBH program
through HCOA/ADRC publications and activities.
Objective 2:
Identify and refer potential trainers to increase the level of BCBH Lay Leaders.
Outcome 2:
The number of new Lay Leaders recruited and trained increased by one (1).
Strategies:
(1) Develop and implement a recruitment and marketing plan to increase participation in the
Better Choices, Better Health Program Island wide.
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(2) Provide training for identified lay leaders island-wide.
Evaluation:
1. The number of qualified individuals who registered for the BCBH workshops including:
Chronic Disease Self-Management Program (CDSMP), Diabetes Self-Management Program
(DSMP), or Cancer Thriving and Surviving Self-Management (CTS) workshops delivered via
face-to-face, tool kit- telephone, or on-line courses.
2. By adhering to their BCBH Action Plans, participants reported decreased medical visits,
increased exercise, and experienced fewer symptoms.
Transportation:
Goal: Promote access to community resources and human services for older individuals that
will strengthen their ability to live, thrive, and remain independent in their community.
Objective 1:
Older individuals will receive transportation to medical health services, shopping assistance, and
access to other community resources, including congregate meal sites and recreation activities.
Outcome 1:
75% older individuals who received transportation to medical health services, shopping assistance,
and other community resources, including congregate meal sites and recreation activities, reported
they were satisfied with the services through a satisfaction survey.
Strategies:
(1) Transport older individuals to medical health services, shopping assistance, and access to
other community resources, including congregate meal sites.
(2) Conduct annual satisfaction survey.
Evaluation:
1. The percentage of participants provided transportation services that were linked to
community resources, human services programs, and activities.
2. The percentage of participants who reported that they were satisfied with the
service.
Outreach:
Goal: To provide older adults and or their caregivers with information and access to an array of
health and social supports.
Objective 1:
Older adults and/or caregivers who receive outreach services and resources will be registered.
Outcome 1:
45% or more of older adults and/or caregivers who received information on appropriate programs
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and services were registered.
Strategies:
(1) Complete the Hawaii County Registration Form for older adults and/or their caregivers.
(2) Provide information for older adults and/or caregivers on appropriate resources and
services.
Evaluation:
1. The percentage of participants who reported they were satisfied with the information on
an array of health and social supports and access provided upon request.
2. The number of consumers registered.
Topic Area 2. COVID-19
AAA Goal: Hawaiʻi’s older adults are prepared for health threats and disasters.
GOAL: The HCOA and ADRC support efforts to assist Hawaiʻi County residents in preparation
for future natural and/or public health emergencies.
Objective 1:
HCOA/ADRC will increase access to emergency preparedness and response information via the
website so older adults and people with disabilities will be better informed of disaster preparedness
protocols and procedures, and how to be safe in the event of a natural or man-made disaster.
Outcome 1:
Older adults and people with disabilities are better informed of disaster preparedness protocols and
procedures, and how to be safe in the event of a natural or man-made disaster through the
HCOA/ADRC website increased access portals to emergency preparedness and response
information, as measured by the HCOA/ADRC website survey and increased number of hits to those
links on the website.
Strategies:
(1) HCOA/ADRC will update the website to include emergency preparedness and response
documents, links, tabs, category on “Find Services” page, “Kahi Malama ADRC Partners”
page, “Public Documents” page, and others as needed.
(2) HCOA/ADRC will update the Person-Centered Emergency Plan as needed.
(3) HCOA/ADRC will have the Person-Centered Emergency Kits available in hard copy at both
locations.
(4) HCOA/ADRC will collaborate with emergency service entities to assist in sharing emergency
preparedness information on an on-going basis.
(5) HCOA/ADRC will solicit disaster preparedness outreach and training opportunities that
target older adults and people with disabilities.
(6) During emergencies, HCOA/ADRC will obtain and disseminate relevant information to its
constituents.
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(7) HCOA/ADRC will be prepared to implement adaptive operations including scheduling and
workplace locations as needed during emergency events, whether in-person, via telephone,
or virtually.
(8) In partnership with Civil Defense, update the county-wide/ inter-agency emergency disaster
plan and protocols for older adults and people with disabilities, as needed.
Evaluation:
1. An increase in Hawaiʻi County residents’ preparedness for health threats and emergencies.
2. An increase in Hawaiʻi County residents’ awareness of HCOA/ADRC as a trusted resource for
assistance before, during, and after emergency events.
3. The HCOA/ADRC website is a trusted resource for Emergency Preparedness and Response
assistance and information.
Topic Area 3: Equity
AAA Goal 3: Hawaiʻi ’s underserved populations have equitable access to programs and
services.
Goal: To increase visibility of HCOA/ADRC services in diverse communities to improve access
to aging services within these communities.
Objective 1:
Annually increase by 25% HCOA/ADRC outreach activities focused towards reaching diverse older
adults.
Outcome 1:
An annual increase of 25% of diverse older adults will have increased awareness of ADRC services
and resources through ADRC outreach activities. This increase will be measured by the increased
amount of outreach activities provided to rural and diverse communities.
Objective 2:
HCOA/ADRC will increase language options for educational and informational written materials by
35%.
Outcome 2:
At end of FFY27, 35% of written materials provided to the community by the ADRC will be offered in
several languages as measured by the percentage of HCOA/ADRC materials with alternative
language options.
Objective 3:
By the end of FFY24, ADRC will create and implement a need assessment questionnaire designed to
capture the needs of diverse older adults.
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Outcome 3:
At the end of FFY24, 95% of ADRC needs assessment questionnaires will be analyzed to determine
needs of diverse older adults.
Objective 4:
By the end of FFY27, 75% of materials produced and/or distributed by the HCOA/ADRC will be
revised to include an ADRC Equality Statement.
Outcome 4:
At the end of FFY27, the ADRC Equality Statement will be included in 75% of materials/information
distributed by the ADRC as measured by the percentage of HCOA/ADRC materials produced that
include our Equality Statement.
Strategies:
(1) Implement outreach strategies to increase awareness of aging services and resources for
diverse persons/groups/communities.
(2) Increase language options for educational and awareness materials offered by ADRC.
(3) Create and implement a data tracking tool to capture needs of aging and disabled diverse
persons/groups/communities.
(4) Increase relationship building between ADRC and Hawai’i Island communities to improve
equity.
Evaluation:
1. Targeted populations reported an increase in knowledge about ADRC programs and
resources.
2. Targeted populations reported they were able to access information in their native
language.
3. HCOA/ADRC will have compiled information on needs of diverse aging and disabled
community members.
Topic Area 4. Expanding Access to HCBS: Home and Community-Based Services are
fundamental to making it possible for older adults to age in place.
AAA Goal 4: Hawaiʻi ’s older adults and people with disabilities will age in place.
ADRC Outreach
Goal: Increase awareness of long-term support services, Home and Community Based Services,
and other resources available to Hawai’i islands aging and disabled populations.
Objective 1:
ADRC will host, market, and/or participate in a minimum of seven (7) outreach activities each year
across Hawai’i Island.
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Outcome 1:
A minimum of seven (7) outreach activities were completed yearly and will be reflected on the
ADRC outreach calendar.
Objective 2:
ADRC will gather information on outreach topics preferred by ADRC’s target population and create
outreach efforts in accordance with the desired topics.
Outcome 2:
A minimum of 50% of Outreach efforts will meet the requested need of ADRC’s target populations
as identified through a needs assessment.
Objective 3:
ADRC will facilitate collaboration between ADRC and outside entities to enhance connections to
services and resources for individuals.
Outcome 3:
ADRC will remain a viable partner in the aging and disabled Hawai’i Island network as determined by
the number of MOU’s with collaborative entities.
Strategies:
(1) Host outreach activities and trainings across Hawai’i Island.
(2) Market ADRC services and offerings through Website, Silver Bulletin, flyers, and other
marketing materials.
(3) Create and implement a questionnaire to solicit topics of interest of targeted populations.
(4) Lead task force meetings regularly with ADRC and outside entities.
(5) Maintain MOU’s with collaborative entities.
Evaluation:
1. ADRC will have completed a minimum of seven outreach activities across Hawai’i Island
yearly.
2. ADRC will have collected data on preferred topics of interest for outreach activities.
3. ADRC will have signed MOA’s filed with collaborating entities.
Home and Community Based Services
Goal: Provide awareness and connection to long-term support services (LTSS), Home and
Community Based Services (HCBS), and other resources available to Hawai’i islands aging and
disabled populations.
Objective 1:
The Aging and Disabilities Resource Center will provide Option Counseling sessions to seniors,
caregivers, and disabled individuals to provide awareness of LTSS and HCBS programs and services.
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Outcome 1:
50% of incoming interactions will include options counseling sessions as reported in the required
database.
Objective 2:
ADRC practices will support the connection of individuals to LTSS and HCBS for eligible individuals.
Outcome 2:
A minimum of 40% of ADRC practices will result in a formal connection to community resources,
programs and/or LTSS and/or HCBS annually.
Objective 3:
HCOA will provide Kupuna Care services to eligible seniors requiring HCBS to promote their ability to
age in place safely and with dignity.
Outcome 3:
The Kupuna Care Program provided HCBS supports that allowed 75% of referred seniors to age in
place safely and with dignity as identified through data-capturing.
Objective 4:
Authorized Kupuna Care cases will meet internal performance and quality standards as referenced
in the Kupuna Care Guidelines.
Outcome 4:
60% of Kupuna Care cases reviewed met quality assurance standards as referenced in the Kupuna
Care Guidelines.
Strategies:
(1) Promote Option Counseling services offered by ADRC
(2) Ensure ADRC staff are trained and skilled on providing Options Counseling services and are
knowledgeable and up to date on current LTSS/HCBS programs.
(3) HCOA/ADRC will maintain a fully functional and operational ADRC department.
(4) HCOA will support elders at home by authorizing Kupuna Care program HCBS services.
(5) Distribute and collect Kupuna Care satisfaction survey.
(6) Conduct monthly monitoring of Kupuna Care cases.
Evaluation:
1. Data collected will show the number of Option Counseling sessions provided to requesting
parties.
2. Data collected will show referrals made on behalf of targeted population to programs and
resources.
3. Through data analysis, HCOA will be able to identify quality of service as well as identify gap
areas and will work towards adapting program (as allowed) to assure high levels of quality
service delivery.
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Goal: Eligible Hawaii County residents have the opportunity to obtain a Disability
Parking Placard
Objective 1:
Provide access for submittal of Parking Placard applications island-wide.
Outcome 1:
Maintained a minimum of two (2) locations to submit Parking Placard applications.
Strategies:
(1) Process all Parking Placard applications in person or by mail.
(2) HCOA and ADRC brochures to include information about the placard program.
(3) Update the ADRC website with information on how to apply for a disability placard.
(4) Include information about the placard program in ADRC presentations to the public.
Evaluation:
1. # of placards per month island-wide and per HCOA/ADRC location.
Topic Area 5. Caregiving: Enhancing services and supports for caregivers.
AAA Goal 5: Hawaiʻi ’s caregivers have a broad array of services and supports to
effectively care for their loved ones.
GOAL: Reduce caregiver related stress and burnout for family and informal caregivers through
information, education, and services.
Objective 1:
Caregivers who receive supports such as counseling, training, and information provided by
HCOA/ADRC will indicate that they are better prepared to perform caregiver duties.
Outcome 1:
Annually, 25% of caregivers who received supports such as counseling, training, and information
provided by HCOA/ADRC indicated that they were better prepared to perform caregiver duties.
Objective 2:
Annually, caregivers who received caregiver respite services will be able to report they feel a
decrease in caregiver burnout.
Outcome2:
25% of caregivers who received caregiver respite services reported a decrease in caregiver burnout
as indicated in Burden Scale Assessment.
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Objective 3:
Caregivers served will be able to identify self-care needs and implement best practices to maintain
personal self-care needs.
Outcome 3:
40% of caregivers served identified self-care needs and implemented best practices to maintain
personal self-care needs as reported through satisfaction surveys.
Strategies:
(1) Provide information on a range of caregiver supports available on Hawaii Island.
(2) Refer caregivers to programs that provide caregiver respite, caregiver counseling, and
caregiver training.
(3) Provide caregiver trainings, conferences, and printed materials.
Evaluation:
1. The percentage of caregivers feel better equipped to care for their aging family members.
2. The percentage of caregivers who received respite support experience decreased levels of
caregiver burnout.
3. The percentages of caregivers reported an increase in knowledge of available resources.
4. The percentage of reporting caregivers who are able to identify their self-care needs in
regards to caregiving.
Grandparents Raising Grandchildren
Goal: To provide respite support to older relative caregivers with a qualifying youth 18 years
or younger with summer, fall, winter, or spring break program tuition.
Objective 1:
Older relative caregivers in Hawaii County will receive support services that provide a respite from
caregiving.
Outcome 1:
50% of older relative caregivers who received support services indicated they received a respite
from caregiving through the outcome of client service satisfaction surveys.
Strategies:
(1) Promote caregiver respite services and programs through Hawaii County’s Aging network.
(2) Register qualified caregivers and care recipients receiving respite services using HCOA’s
approved consumer registration form.
(3) Complete all activities required to accept and process referrals for caregivers interested in
participating in the program. (Intake, screening, linkage to appropriate program, registration
in program, setting up payment method, invoicing procedures)
(4) Document services provided. Prepare and submit required reports in a timely manner to
HCOA through a computerized system endorsed by HCOA.
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(5) Administer, collect, analyze, and submit report of Client Satisfaction Survey results.
Evaluation:
1. Caregivers who participated in the respite program report an increase in time for
themselves.
2. Caregivers who participated in the respite program reported stress relief.
C. HCOA Methodology to ensure compliance with Targeting
Targeting of Services
The Older Americans Act, as amended Through P.L. 116-131, Enacted March 25, 2020, reemphasized the
intention of the Congress to target services and resources on the needs and problems of those older
individuals identified as having the greatest economic need, the greatest social need, and those who are low-
income minority, and older individuals residing in rural areas with additional emphasis on targeting older
individuals with limited English proficiency and older individuals at risk of institutional placement. Special
emphasis has been placed on using outreach methods to target services to:
older individuals residing in rural areas;
older individuals with greatest economic needs (with particular attention to low-income minority
individuals and older individuals residing in rural areas);
older individuals with greatest social need (with particular attention to low-income minority
individuals, older individuals residing in rural areas, and those who identify as LGBTQ+);
older individuals with severe disabilities;
older individuals with limited English proficiency;
older individuals with Alzheimer’s disease or related disorders with neurological and organic brain
dysfunction (and the caretakers of such individuals); and informing these individuals and the
caregivers of such individuals, of the availability of assistance; and
older individuals at risk of institutional placement.
Targeting Services
The Next Four Years (2024, ‘25, ‘26, ‘27)
The Hawaii Revised Statutes Section 349-1 declares that older adults are entitled to secure equal opportunity
to the full and free enjoyment of the following:
an adequate income in retirement in accordance with the American standard of living;
the best possible physical and mental health which science can make available, without regard to
economic status;
suitable housing, independently selected, designed, and located with reference to special needs and
available at costs which older citizens can afford;
full restorative services for those who require institutional care;
opportunity for employment with no discriminatory personnel practices because of age;
retirement in health, honor, and dignity;
pursuit of meaningful activity within the widest range of civic, cultural, and recreational
opportunities;
efficient community services which provide social assistance in a coordinated manner and which are
readily available when needed;
immediate benefit from proven research knowledge which can sustain and improve health and
happiness; and
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freedom, independence, and the free exercise of individual initiative in planning and managing their
own lives.
In support of the declaration mentioned above, it is the policy of the State and its counties to:
make available comprehensive programs which include a full range of health, education, and social
services to our older residents who need them;
give full and special consideration to older residents with special needs in planning such programs;
and, pending the availability of such programs for all older residents, give priority to the elderly with
the greatest economic and social needs;
provide comprehensive programs which will assure the coordinated delivery of a full range of
essential services to our older residents, and where applicable, also furnish meaningful employment
opportunities for individuals, including older persons from the community; and
insure that the planning and operation of such programs will be undertaken as a partnership of older
residents, the at-large community, and the State and its counties with appropriate assistance from
the federal government.
With respect to targeting services to older individuals:
with the greatest economic or social needs; who identify as LGBTQ+
who are from rural areas;
who are low income minority;
who are Native Americans (American Indians, Alaskan Natives, and Native Hawaiians)
at risk for institutional placement;
with limited English proficiency;
The following methods for assuring service preference will apply:
I. Methods for Assuring Service Preference to Older Individuals with the Greatest Economic or
Social Needs
A. Declaration of Compliance
With respect to older individuals with the greatest economic or social needs, the Executive Office on
Aging, the State agency for the State of Hawaii, through all designated Area Agencies on Aging, will
conduct the Title III program under the Older Americans Act of 1965, as amended Through P.L. 116-
131, Enacted March 25, 2020, in such a manner as to ensure that this target group will be given service
preference. A means test normally used by other programs will not be imposed by this program.
Services under the Act are provided through a comprehensive and coordinated service system under
area plans, towards attainment of the following statutory goals for such individuals and families:
1. To secure and maintain maximum independence and dignity in a home environment for
older individuals capable of self-care with appropriate supportive services;
2. To remove individual and social barriers to economic and personal independence for older
individuals; and
3. To provide a continuum of care for the vulnerable elderly.
B. Definitions
1. Greatest Economic Need means the need resulting from an income level at or below the
poverty levels established by the Office of Management and Budget. \[OAA, Sec. 302(20)\]
2. Greatest Social Need means the need caused by non-economic factors which include
physical and mental disabilities, language barriers and cultural, social or geographical
isolation including that caused by racial, ethnic, or LGBTQ+ status which restricts an
individual’s ability to perform normal daily tasks or which threatens such individual’s
capacity to live independently. \[OAA, Sec. 302(21)\] (“Greatest social need” has the same
meaning as “socially disadvantaged.”)
3. Both Greatest Social Need and Low-Income should be self-explanatory from the definitions
provided above. This refers to older persons who are in both greatest social and greatest
74
economic need. (This group of persons is commonly referred to as the most vulnerable.)
C. Methods for Assuring Service Preference
1. Each area plan submitted by an Area Agency on Aging for approval by the State agency will
provide assurances that preference will be given to providing services to older individuals
with the greatest economic or social needs, with special emphasis on meeting the service
needs of the most vulnerable older adults. Such plans will also include proposed methods
for implementing the preference requirements which are consistent with methods
contained herein.
2. Each Area Agency on Aging will develop and publish methods by which priority of services
is determined. Such methods will include factors and weights which affirmatively provide
service preference to meeting service needs of individuals with greatest economic or social
needs and the most vulnerable older adults.
3. Area Agencies on Aging will divide their respective geographic area into distinct sub-areas
considering among others the following: the distribution of older individuals having
greatest economic need; the distribution of older individuals having physical or mental
disabilities; the incidence of need for supportive and nutrition services; the location of
resources available to meet service needs; and the adequacy and effectiveness of the
existing resources in meeting service needs.
4. Area Agencies on Aging, upon review and analysis of information described in item C.3
above, will determine which locations within the area will need service assistance under
area plans due to high concentration or high proportion of older individuals with greatest
economic or social need, and specialize in the types of services most needed by these
preference groups.
5. The State’s intrastate funding formula for allocating Title III funds will include factors and
appropriate weights which reflect the proportion among the planning and service areas of
older individuals in greatest economic or social need.
6. Area Agencies on Aging will establish working relationships with appropriate public and
private agencies and organizations, toward attaining or maintaining referral linkages for
casework management, problem assessment and counseling, and for mutual assistance in
identification of vulnerable older individuals in need of community or home-based support
services.
7. Area Agencies on Aging will establish working relationships with appropriate public and
private agencies and organizations, toward attaining or maintaining referral linkages
necessary for assessing in-home health services needed by
older individuals and such other services which may be deemed needed through the
provision of such services.
8. Area Agencies on Aging will establish working relationships with other public and private
agencies and organizations working on behalf of vulnerable older persons, such as Easter
Seals, rehabilitation units, boarding homes, sheltered workshops, post office, police
department, utilities, etc., toward gaining their assistance in identifying problems, and
inform such agencies and organizations of the availability of service under area plans.
9. Area Agencies on Aging will use outreach efforts that will identify individuals eligible for
assistance under area plans, with special emphasis on rural seniors, and inform such
individuals of the availability of such assistance.
10. Area Agencies on Aging will maintain, as reasonably feasible, elderly minority participation
rates in Title III funded programs at or above the %age distribution of older minorities in
their planning and service areas, as determined by the most reliable and satisfactory data
available.
II. Method for Assuring Service Preference to Older Individuals from Rural Areas
A. Declaration of Compliance
With respect to older individuals residing in rural areas, the Executive Office on Aging, the State agency
for the State of Hawaii, through all designated Area Agencies on Aging, will conduct the Title III
program under the Older Americans Act of 1965, as amended Through P.L. 116-131, Enacted March 25,
2020, in such a manner so as to ensure that this target group will be served.
The Hawaii Revised Statutes Section 349-1 – Declaration of purpose, support, duties – in part enables
75
our older people to secure equal opportunity to the full and free enjoyment of the following, which
apply to rural older adults:
1. The best possible physical and mental health which science can make available, without
regard to economic status.
2. Pursuit of meaningful activity within the widest range of civic, cultural and recreational
opportunities.
3. Efficient community services which provide social assistance in coordinated manner which
are readily available when needed.
4. Freedom, independence and the free exercise of individual initiative in planning and
managing their own lives.
5. Make available comprehensive programs which include a full range of health, education
and social services to our older residents who need them.
B. Definitions
Rural seniors are persons age 60+ residing in any area that is not defined as urban. Urban areas
comprise (1) urbanized areas (a central place and its adjacent densely settled territories with a
combined minimum population of 50,000) and (2) an incorporated place or a census designated place
with 20,000 or more inhabitants. For PSA IV, Hilo is the only census designated place that would
qualify as urban.
C. Methods for Assuring Service Preferences
1. Each area plan submitted by the Area Agencies on Aging for approval by the State agency
will provide assurances that preference will be given to providing services to older
individuals living in rural areas.
2. Area Agencies on Aging will use outreach efforts (such as intake and referral, newsletters,
community forums and public hearings) to identify individuals eligible for assistance as well
as to inform the rural seniors of the availability of services.
3. Area Agencies on Aging will provide a variety of services for the rural area such as:
comprehensive services, case management, information and referral, personal care, senior
identification, and transportation.
4. Area Agencies will inform the isolated rural older adults about the services and programs
available by using a variety of means available and feasible which may include brochures,
newsletters, radio programs and/or television programs.
5. The Area Agencies will work with community council representatives in an effort to inform
them of programs and services existing in the rural community.
6. Federal funds awarded to Area Agencies on Aging will take into consideration the numbers
of older individuals residing in rural areas.
III. Method for Assuring Service Preference to Low-Income Minority Older Individuals
A. Declaration of Compliance
With respect to low-income minority older individuals service needs, the Executive Office on Aging, the
State agency for the State of Hawaii, through all designated Area Agencies on Aging, will conduct the
Title III program under the Older Americans Act of 1965, as amended Through P.L. 116-131, Enacted
March 25, 2020, in such a manner as to ensure that this target group will be met.
The Hawaii Revised Statutes Section 349-1 – Declaration of purpose, support, duties – in part enable
our older adults to secure equal opportunity to the full and free enjoyment of the following, which
apply to low-income minority older individuals:
1. The best possible physical and mental health which science can make available, without
regard to economic status.
2. Suitable housing, independently selected, designed and located with reference to special
needs and available at costs which older citizens can afford.
3. Opportunity for employment with no discriminatory personnel practices because of age.
4. Efficient community services which provide social assistance in a coordinated manner and
which are readily available when needed.
76
5. Freedom, independence, and the free exercise of individual initiative in planning and
managing their own lives.
6. Make available comprehensive programs which include a full range of health, education
and social services to our older residents who need them.
7. Give full and special consideration to older residents with special needs in planning such
programs and, pending the availability of such programs for all older residents, give priority
to the seniors with the greatest economic and social needs.
8. Provide comprehensive programs which will assure the coordinated delivery of a full range
of essential services to our older residents and, where applicable, also furnish meaningful
employment opportunities for individuals, including older persons from the community.
9. Ensure that the planning and operation of such programs will be undertaken as a
partnership of older residents, the at-large community and the State and its counties with
appropriate assistance from the federal government.
B. Definitions
1. Low Income means having an income at or below the federal poverty level. It is the same
as “greatest economic need.”
2. Minority seniors are persons age 60+ who are either: American Indian/Alaskan Native;
Asian/Pacific Islander; Black, not of Hispanic origin; or Hispanic.
3. Low-Income Minority seniors are persons age 60+ who are either: American
Indian/Alaskan Native; Asian/Pacific Islander; Black, not of Hispanic origin; or Hispanic, with
an annual income at or below the established poverty level.
C. Methods for Assuring Service Preferences
1. The Area Agencies on Aging will provide assurance that preference will be given to
providing services to low-income older individuals with special emphasis on meeting the
service needs of the most vulnerable seniors. The Area Plan will include proposed
methods for implementing the preference requirements which are consistent with
methods contained herein.
2. The Area Agencies on Aging will include a condition in all contracts with its service
providers that:
a. If there is a wait list, the provider will give preference to low-income and/or minority
older adults.
b. Service providers will attempt to serve low-income minority elderly individuals in at
least the same proportion as the population of low-income minority older
individuals’ bear to the population of older individuals of the area served by such
providers.
3. The Area Agencies on Aging will develop and publish methods by which priority services
are determined. Such methods will include factors which affirmatively provide service
preference to meeting service needs of individuals with greatest economic or social need
and the most vulnerable seniors.
4. The Area Agencies on Aging will divide the County into distinct sub-areas considering,
among others, the following: the distribution of low income; the distribution of older
individuals having physical or mental disabilities; the incidence of need for supportive and
nutrition services; the location of resources available to meet service needs; and the
adequacy and effectiveness of the existing resources in meeting service needs.
5. The Area Agencies on Aging, upon review and analysis of information described in item 4
above, will determine which locations within the area will need service assistance under its
Area Plan due to high concentration or high proportion of low-income minority older
individuals, and specialize in the type of services most needed by this group.
6. The Area Agencies on Aging will establish working relationships with appropriate public
and private agencies and organizations, toward attaining or maintaining referral linkages
for casework management, problem assessment and counseling, and for mutual assistance
in identification of vulnerable older low-income individuals in need of community or home-
based support services.
7. The Area Agencies on Aging will establish working relationships with appropriate public
77
and private agencies and organizations, toward attaining or maintaining referral linkages
necessary for assessing in-home health services needed by older individuals and such other
services which may be deemed needed through the provisions of such services. Similar
relationships will be developed with private entities.
8. The Area Agencies on Aging will establish working relationships with other public and
private agencies and organizations working on behalf of low-income minorities older
persons. The Area Agencies will seek their assistance in identifying problems, and inform
such agencies and organizations of the availability of service under its Area Plan.
9. The Area Agencies on Aging will use information and referral, and outreach efforts will
identify individuals eligible for assistance under its Area Plan, with special emphasis on
rural seniors, and inform such individuals of the availability of such assistance.
10. The Area Agencies on Aging will encourage service providers to make efforts to hire and
recruit bilingual staff who are able to communicate with elderly immigrants and other
minority elderly. Lastly, the Area Agencies on Aging and its service providers will make
efforts whenever possible, to translate information of its services in ethnic languages for
distribution to service providers and in residential areas of high numbers of low-income
and minority older adults.
11. The Area Agencies on Aging will maintain, as reasonably feasible, low-income minority
older adult participation rates in Title III funded programs at or above the percentage
distribution of elderly minorities in the State as determined by the most reliable and
satisfactory data available.
12. The Area Agencies on Aging will give preference to the promotion and publicity of programs
and services with a high indication for the low-income and/or the minority seniors.
13. The Area Agencies on Aging will continue to advocate for expansion and implementation of
services with a high indication for the low-income and/or minority seniors.
14. The Area Agencies on Aging will encourage service clubs and private enterprises to conduct
service projects and/or funding to the low-income, minority, or frail older individual
whenever the opportunity arises.
15. The Area Agencies on Aging will encourage service providers to plan ethnic activities as a
means of attracting minority elderly to participate or utilize the services and programs in
the County.
IV. Method for Assuring Activities to Increase Access to Title III Services by Native Americans (American
Indians, Alaskan Natives, and Native Hawaiians)
A. Declaration of Compliance
With respect to Native Older Americans, the Executive Office on Aging, the State agency for the State
of Hawaii, through all designated Area Agencies on Aging, will conduct the Title III program under the
Older Americans Act of 1965, as amended Through P.L. 116-131, Enacted March 25, 2020, in such a
manner so as to ensure that this group will be served.
The Hawaii Revised Statutes Section 349-1 – Declaration of purpose, support, duties – in part enable
our older adults to secure equal opportunity to the full and free enjoyment of the following which
apply to older individuals of native ancestry:
1. The best possible physical and mental health which science can make available, without
regard to economic status.
2. Suitable housing, independently selected, designed and located with reference to special
needs and available at costs which older citizens can afford.
3. Opportunity for employment with no discriminatory personnel practices because of age.
4. Efficient community services which provide social assistance in a coordinated manner and
which are readily available when needed.
5. Freedom, independence, and the free exercise of individual initiative in planning and
managing their own lives.
6. Make available comprehensive programs which include a full range of health, education
and social services to our older residents who need them.
7. Give full and special consideration to older residents with special needs in planning such
78
programs and, pending the availability of such programs for all older residents, give priority
to the seniors with the greatest economic and social needs.
8. Provide comprehensive programs which will assure the coordinated delivery of a full range
of essential services to our older residents and, where applicable, also furnish meaningful
employment opportunities for individuals, including older persons from the community.
9. Insure that the planning and operation of such programs will be undertaken as a
partnership of older residents, the at-large community and the State and its counties with
appropriate assistance from the federal government.
B. Definitions
Native Americans - Title VI of the Older Americans Act, as amended Through P.L. 116-131, Enacted
March 25, 2020, Grants for Native Americans Sec. 601 states: It is the purpose of this title to promote
the delivery of supportive services, including nutrition services to American Indians, Alaskan Natives,
and Native Hawaiians that are comparable to services provided under Title III.
C. Methods for Assuring Service Preferences
1. The Area Agencies on Aging will establish working relationships with appropriate public and
private agencies and organizations, toward attaining or maintaining referral linkages for
casework management, problem assessment and counseling, and for mutual assistance in
identification of older Native American individuals in need of community or home-based
support services.
2. The Area Agencies on Aging will establish working relationships with appropriate public and
private agencies and organizations, toward attaining or maintaining referral linkages
necessary for assessing in-home health services needed by older Native American individuals
and such other services which may be deemed needed through the provisions of such
services. Similar relationships will be developed with private entities.
3. The Area Agencies on Aging will establish working relationships with other public and private
agencies and organizations working on behalf of Native Americans. The Area Agencies will
seek their assistance in identifying problems, and inform such agencies and organizations of
the availability of service under its Area Plan.
V. Methods for Assuring Service Preference to Older Individuals at Risk for Institutional Placement
A. Declaration of Compliance
With respect to older individuals at risk for institutional placement, the Executive Office on Aging, the
State agency for the State of Hawaii, through all designated Area Agencies on Aging, will conduct the
Title III program under the Older Americans Act of 1965, as amended, in such a manner as to ensure
that this target group will be given service preference. A means test normally used by other programs
will not be imposed by this program. Services under the Act are provided through a comprehensive
and coordinated service system under area plans, towards attainment of the following statutory goals
for such individuals and families:
1. To secure and maintain maximum independence and dignity in a home environment for
older individuals capable of self-care with appropriate supportive services;
2. To remove individual and social barriers to economic and personal independence for older
individuals; and
3. To provide a continuum of care for the vulnerable elderly.
B. Definition
At risk for Institutional Placement means, with respect to an older individual, that such individual is
unable to perform at least two activities of daily living without substantial assistance (including verbal
reminding, physical cuing, or supervision) and is determined by the State involved to be in need of
placement in a long-term care facility. \[OAA, Sec. 101(45)\]
79
C. Methods for Assuring Service Preference
1. Each area plan submitted by an Area Agency on Aging for approval by the State agency will
provide assurances that preference will be given to providing services to older individuals
at risk for institutional placement, with special emphasis on meeting the service needs of
the most vulnerable older adults.
2. The State’s intrastate funding formula for allocating Title III funds will include factors and
appropriate weights which reflect the proportion among the planning and service areas of
older individuals at risk for institutional placement.
3. Area Agencies on Aging will establish working relationships with appropriate public and
private agencies and organizations, toward attaining or maintaining referral linkages for
casework management, problem assessment and counseling, and for mutual assistance in
identification of vulnerable older individuals in need of community or home-based support
services.
VI. Methods for Assuring Service Preference to Older Individuals with Limited English Proficiency
A. Declaration of Compliance
With respect to older individuals at risk for institutional placement, the Executive Office on Aging, the
State agency for the State of Hawaii, through all designated Area Agencies on Aging, will conduct the
Title III program under the Older Americans Act of 1965, as amended, in such a manner as to ensure
that this target group will be given service preference. A means test normally used by other programs
will not be imposed by this program. Services under the Act are provided through a comprehensive
and coordinated service system under area plans, towards attainment of the following statutory goals
for such individuals and families:
1. To secure and maintain maximum independence and dignity in a home environment for
older individuals capable of self-care with appropriate supportive services;
2. To remove individual and social barriers to economic and personal independence for older
individuals; and
3. To provide a continuum of care for the vulnerable elderly.
B. Definition
Limited English Proficiency – individuals who do not speak English as their primary language
and/or have a limited ability to read, write, speak, or understand English \[Executive Order
13166: Improving Access to Services for Persons with Limited English Proficiency\].
C. Methods for Assuring Service Preferences
1. The Area Agencies on Aging will continue working relationships with appropriate public
and private agencies and organizations, toward attaining or maintaining referral linkages
for casework management, problem assessment and counseling, and for mutual assistance
in identification of older individuals with limited English proficiency in need of community
or home-based support services.
2. The Area Agencies on Aging will continue working relationships with appropriate public
and private agencies and organizations, toward attaining or maintaining referral linkages
necessary for assessing in-home health services needed by older individuals and such other
services which may be deemed needed through the provisions of such services. Similar
relationships will be developed with private entities.
3. The Area Agencies on Aging will continue working relationships with other public and
private agencies and organizations working on behalf of limited English proficient older
persons. The Area Agencies will seek their assistance in identifying problems, and inform
such agencies and organizations of the availability of service under its Area Plan.
4. The Area Agencies on Aging will use information and referral, and outreach efforts to
identify limited English proficient older individuals.
5. The Area Agencies on Aging will encourage service providers to make efforts to hire and
recruit bilingual staff who are able to communicate with elderly immigrants and other
minority elderly.
80
6. The Area Agencies on Aging will utilize tools and resources, as needed and allowed by fiscal
resources, offered through the Federal Interagency Working Group on Limited English
Proficiency, comprised of representatives from over 35 federal agencies. This group
created the Web site LEP.gov, which supports implementation of Executive Order 13166
(defined above), Title VI and Title VI regulations regarding language access. It is a
clearinghouse, providing and linking to information, tools and technical assistance
regarding Limited English Proficiency and language services for federal agencies, recipients
of federal funds, users of federal programs and federally assisted programs, and other
stakeholders.
7. The Area Agencies on Aging will utilize resources, as needed and allowed by fiscal
resources, training, technical assistance, translation and interpretation services by
organizations such as the Hawaii Interpreters and Translators Association, the National
Council on Interpreting in Health Care, the Society of Medical Interpreters, Diversity RX,
and the Cross Cultural Health Care Program.
8. The Area Agencies on Aging and its service providers will make efforts whenever possible,
to translate information of its services in ethnic languages for distribution to service
providers and in residential areas of high numbers of low-income and minority older
adults.
81
Targeting Services – The Previous Year, 2022
Table 2. Previous Year’s Targeting Outputs (FFY 2022: Oct. 2021-Sept. 2022)
At Risk for
Program & Total Fund FFY 22 Greatest Rural Limited Native Resource
Greatest Low
Services Budgeted Expenditures Economic English Institution- American Allocation
Social Income
Need Proficient alization
Need Minority
Access Number of Persons Served
Transportation $ 336,842 $ 225,794 403 526 312 934 105 85 245 NB
I & A $ 0 $ 0 ** ** ** ** ** ** **
Outreach $ 21,262 $ 14,430 130 17 98 696 5 31 125 NB
Case Mgt $ 600,000 $ 511,979 75 464 46 266 23 351 68 A
Asst Trans $ 42,000 $ 84,511 12 44 8 27 3 52 4 A, NE
In-Home Number of Persons Served
Personal
Vendor Pool
Care $ 600,000 $ 283,990 25 102 17 137 6 85 17 A
Homemaker VP $ 331,695 34 130 19 92 9 123 25 A
Chore VP $ 14,865 4 0 2 13 1 5 2 A
Home Del.
Meals $ 466,499 $ 470,597 121 141 93 319 53 290 87 A, NC-2
Legal $ 131,700 $ 131,700 119 129 75 285 6 80 73 NB, A
Community Based Services Number of Persons Served
Adult Day
Care VP $ 65,074 2 20 2 12 0 16 3 A
Caregiver
Support $ 200,000 $ 192,611 18 3 9 67 2 2 12 NE
Cong. Meals $ 343,125 $ 222,625 181 196 140 515 65 148 147 NC-1
Title III & KC
Funding Total $2,741,428 $ 2,549,871
** No data to support field.
NB = Federal Funds (Title III-Part B)
NC-1 = Federal Funds (Title III-Part C-1)
NC-2 = Federal Funds (Title III-Part C-2)
ND = Federal Funds (Title III-Part D)
NE = Federal Funds (Title III-Part E)
NO = Federal Funds (Other)
A = State General Funds (General Funds)
S = County Funds (Cash only)
PI = Includes all income generated by the program including client voluntary contributions money raised by
the program through fund raising activities (such as bake sales, etc.) proceeds from the sale of tangible
property, royalties, etc.
O = Other funds used directly by the program including but not limited to trust funds, private donations, etc.
(cash only)
XS = County In-kind
XO = Other In-kind
82
Figure 25. Hawai‘i County Targeting Performance
Indicators
County of Hawaii
Population Distribution by District FFY22
WellSky database run 3/21/23
Total Older Individuals Served (Unduplicated) – 3,514
N = 120 (3%)
POV = 31%
N = 157 (5%)
RURAL = 100%
POV = 20%
N = 52 (1%)
LIM = 24%
RURAL = 100%
POV = 29%
FRAIL = 23%
LIM = 14%
RURAL = 100%
LEP = 15%
FRAIL = 13%
LIM = 29%
LEP = 6%
FRAIL = 10%
LEP = 4%
N = 219 (6%)
POV = 11%
N = 1,246 (36%)
RURAL = 100%
POV = 20%
LIM = 8%
RURAL = 13%
FRAIL = 22%
LIM = 17%
LEP = 4%
FRAIL = 28%
LEP = 5%
N = 539 (15%)
N = 542 (16%)
POV = 23%
POV = 21%
RURAL = 100%
RURAL = 98%
LIM = 16%
LIM = 15%
FRAIL = 21%
FRAIL = 20%
L OWER
U PPER
LEP = 4%
LEP = 3%
P UNA
P UNA
N = 193 (6%)
N = 149 (4%)
POV = 21%
POV = 26%
RURAL = 100%
RURAL= 100%
LIM = 17%
LIM = 19%
FRAIL = 22%
FRAIL = 21%
LEP = 5%
LEP = 3%
N = 267 (8%)
POV = 28%
RURAL= 100%
LIM = 17%
FRAIL = 13%
LEP = 9%
LEGEND
N Older individuals served = 3,514
POV Poverty
RURAL Rural Residence
LIM Low income minority
Prepared by
Hawaii County Office of Aging
FRAIL Unable to perform 2 ADLs or more
LEP Limited English Proficiency
83
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84
PART IV Funding Plan
A. Previous Year Expenditures for Priority Services (FFY22)
Table 3. Title III Part B Federal Funds Only
In accordance with the Older Americans Act \[Section 306 (a) (2)\] the Area Agency is disclosing the amount of
funds expended for each category of services during the fiscal year most recently concluded.
Service Budgeted Compliance FFY 22 Actual % for Title III B
Amount (Dollars) Expenditures Categories
Access
Info & Assistance 0 0
Outreach 21,262 14,430
Transportation 336,842 225,794
Sub-total 363,994 240,224 62%
In-Home
Home Modification 15,000 13,456
Sub-total 15,000 13,456 4%
Legal
LASH 131,700 131,700
Sub-total 131,700 131,700 34%
Other
Title III Part B Total 504,804 385,380 100%
85
B. Table 4: Projected Service Outputs & Resources Allocation Plan
Programs, Services, and
Source
Unduplicated Persons Units of Service Unit Total Amount (Projected)
Code
Activities 2024 2025 2026 2027 2024 2025 2026 2027 2024 2025 2026 2027
ACCESS
I/A, Referral, O/C
1,000 1,000 1,000 1,000 7,000 7,000 7,000 7,000 Contact $0 $0 $0 $0
A2
Outreach
1,134 1,134 1,134 1,134 1,134 1,134 1,134 1,134 Person $ 17,010 $ 17,010 $ 17,010 $ 17,010
NB
Public Education
3,100 3,100 3,100 3,100 3,100 3,100 3,100 3,100 Issue $ 25,000 $ 25,000 $ 25,000 $ 25,000
NB
Transportation
1,000 1,250 1,500 1,750 68,500 71,500 74,500 79,200 Trip $ 278,000 $ 297,625 $ 317,250 $ 346,225
NB
SUPPORTIVE IN-HOME
Case Management
550 550 550 550 9,000 9,000 9,000 9,000 Hour $ 600,000 $ 600,000 $ 600,000 $ 600,000
A1
Vendor Pool
Chore (Heavy)
15 17 18 20 468 515 566 623 Hour $ 15,912 $ 17,503 $ 19,254 $ 21,179
A1
Homemaker
177 195 214 236 12,143 13,357 14,693 16,162 Hour $ 388,576 $ 427,434 $ 470,177 $ 517,195
A1
Personal Care
102 112 123 136 9,533 10,486 11,535 12,688 Hour $ 333,655 $ 367,021 $ 403,723 $ 444,095
A1
Adult Day Care
20 22 24 27 4,338 4,772 5,249 5,774 Day $ 520,560 $ 572,616 $ 629,878 $ 692,865
A1
Assisted Transportation
43 47 52 57 2,354 2,589 2,848 3,133 Trip $ 96,514 $ 106,165 $ 116,782 $ 128,460
A1
Home Modification 137 151 166 182 744 818 900 990 $ 13,456 $ 14,802 $ 16,282 $ 17,910
Request
A1
NUTRITION
Congregate Meals 650 700 800 900 42,250 45,500 52,000 58,500 Meal $ 276,738 $ 298,025 $ 340,600 $ 383,175
NC-1
Congregate Meals (PI exp.)
85 85 85 85 5,551 5,551 5,551 5,551 $ 36,359 $ 36,359 $ 36,359 $ 36,359
PI
Home Delivered Meals
550 600 650 700 85,800 93,600 101,400 109,200 Meal $ 592,878 $ 655,200 $ 719,940 $ 786,240
NC-2
Home D Meals (fed)
550 600 650 700 80,752 80,752 80,752 80,752 $ 556,750 $ 556,750 $ 556,750 $ 556,750
NO
Home D Meals (state)
34 90 147 207 5,228 14,064 22,985 32,323 $ 36,128 $ 98,450 $ 163,190 $ 229,490
A1
Home D Meals (PI exp.)
54 54 54 54 8,470 8,470 8,470 8,470 $ 55,478 $ 55,478 $ 55,478 $ 55,478
PI
Nutrition Education
900 900 900 900 12,000 12,000 12,000 12,000 $ 15,000 $ 15,000 $ 15,000 $ 15,000
Session
NC-1
CAREGIVER SUPPORT
ACCESS
Case Management
Hour
INFORMATION SERVICES
Information Services
560 560 560 560 13 13 13 13 Activity $ 3,500 $ 3,500 $ 3,500 $ 3,500
NE, A
Information CG Conf.
Activity
NE
Counseling
10 10 10 10 180 180 180 180 $ 20,700 $ 20,700 $ 20,700 $ 20,700
Session
NE
Training
50 50 50 50 300 300 300 300 $ 21,000 $ 21,000 $ 21,000 $ 21,000
Session
R. Adult Day Care
21 23 25 28 3,864 4,250 4,675 5,143 Day $ 463,680 $ 510,048 $ 561,053 $ 617,158
NE
R. Personal Care
31 34 38 41 1,572 1,729 1,902 2,092 Hour $ 55,020 $ 60,522 $ 66,574 $ 73,232
NE
R. Homemaker
45 50 54 60 2,816 3,098 3,407 3,748 Hour $ 90,112 $ 99,123 $ 109,036 $ 119,939
NE
R. Chore
1 1 1 1 24 26 29 32 Hour $ 816 $ 898 $ 987 $ 1,086
NE
86
Sour
Programs, Services and
Unduplicated Persons Units of Service Unit Total Amount
ce
Code
Activities 2024 2025 2026 2027 2024 2025 2026 2027 2024 2025 2026 2027
CG Supplemental Services
R. Assisted Trans
7 8 8 9 269 296 325 358 Trips $ 11,029 $ 12,132 $ 13,345 $ 14,680
NE
R. Home Modification
13 14 16 17 75 83 91 100 $ 1,477 $ 1,625 $ 1,787 $ 1,966
Request
NE
R. GRG
25 25 25 25 25 25 25 25 $ 8,000 $ 8,000 $ 8,000 $ 8,000
Hour
NE
LEGAL SERVICES
Legal
290 298 307 316 2,474 2,548 2,625 2,703 Hour $ 127,000 $ 127,000 $ 127,000 $ 127,000
NB
SUPPORTIVE SERVICES
COMMUNITY-BASED
Better Choices (Federal)
48 48 48 48 4 4 4 4 Class $ 21,000 $ 21,000 $ 21,000 $ 21,000
ND
---(State)
A3
Source Codes:
N: Federal Funds (Title III)
NB: Federal Funds (Title III-Part B)
NC-1: Federal Funds (Title III-Part C-1)
NC-2: Federal Funds (Title III-Part C-2)
ND: Federal Funds (Title III-Part D)
NE: Federal Funds (Title III-Part E)
NO: Federal Funds (Other)
A: State General Funds (General Funds): A1-Kupuna Care; A2-ADRC; A3-Healthy Aging.
S: County Funds (Cash Only)
PI: Includes all income generated by the program including client voluntary contributions, money raised by the program through fundraising
activities (such as bake sales, etc.), proceeds from the sale of tangible property, royalties, etc.
O: Other funds used directly by the program including, but not limited to, trust funds, private donations, etc., (Cash Only)
XS: County In-Kind
XO: Other In-Kind
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C. Minimum Percentages for Title III Part B Categories of Services
For the duration of the Area Plan, the Area Agency on Aging assures that the following minimum
percentages of funds received for Title III-B will be expended to provide each of the following
categories of services, as specified in OAA Section 306(a):
Categories of Services %____
Access* 0.2720
In Home 0.0240
Legal 0.1040
Total % 0.4000
*Includes transportation, outreach, information and assistance services.
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Appendix A: Waivers
Note: Not Applicable but shown here as a reference.
A.1 Waiver to Provide Direct Service
The State of Hawai‘i Executive Office on Aging will be issuing a statement that will allow all AAA’s in Hawai‘i
to provide direct services without requiring Waivers to Provide Service.
(Area Agency)
JUSTIFICATION FOR AREA AGENCY’S DIRECT PROVISION OF SERVICE
For the period beginning __________ through __________
Service
Title III Reference
Funding Source
Title III
State
County
Other
Total
Justification
This Exhibit must be renewed annually for each year the Area Agency wishes to provide any service directly.
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A.2 Waiver of Priority Categories of Services
(Area Agency)
JUSTIFICATION FOR WAIVER PRIORITY CATEGORIES OF SERVICES
For the duration of the Area Plan (2023-2027)
The Area Agency on Aging is required to spend at least 40 % of its Title III-B allotment in the priority categories of
services, with some expenditures occurring in each category. If the Area Agency on Aging wishes to waive this
requirement, it must identify the category of service which will be affected and provide a justification and documentation
as required by Section 306(b). If the waiver is granted, the Area Agency on Aging certifies that it shall continue to
expend at least 40 % of its Title III-B annual allocation for the remaining priority categories of services.
Priority Service Check Category Affected
Access (Transportation, Outreach, and _____
Information and Assistance, and Case
Management Services)
In Home Services (including supportive _____
Services for Families of Older Individuals who are
victims of Alzheimer’s disease and
related disorders with neurological
and organic brain dysfunction).
Legal Assistance _____
Justification
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Appendix B: Assurances
B1: Assurance of compliance with the Department of Health and Human Services Regulation
under Title VI of the Civil Rights Act of 1964
B2: Department of Health and Human Services Assurance of Compliance with Section 504 of the
Rehabilitation Act of 1973, as Amended
B3: General and Program Specific Provisions and Assurances
a. General Assurances
b. Program Specific Assurances
c. Other Assurances as Related to the Code of Federal Regulation 1321.17(F) 1 to 15
d. Certification Regarding Lobbying
e. Declaration of Compliance
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Appendix B3: General and Program Specific Provisions and Assurances
B3a. General Assurances
The Area Agency will maintain documentation to substantiate all the following assurance items. Such
documentation will be subject to State and/or federal review for adequacy and completeness.
1. General Administration
a. Compliance with Requirements
The Area Agency agrees to administer the program in accordance with the Older Americans
Act of 1965, as amended, the Area Plan, and all applicable rules and regulations and policies
and procedures established by the Commissioner or the Secretary and by the Director of the
Executive Office on Aging.
b. Efficient Administration
The Area Agency utilizes such methods of administration as are necessary for the proper and
efficient administration of the Plan.
c. General Administrative and Fiscal Requirements
The Area Agency’s uniform administrative requirements and cost principles are in
compliance with the relevant provisions of 45 CFR Part 92 and 45 CFR 16 except where these
provisions are superseded by statute and with the State Policies and Procedures Manual for
Title III of the Older Americans Act, as amended Through P.L. 116-131, Enacted March 25,
2020.
d. Training of Staff
The Area Agency provides a program of appropriate training for all classes of positions and
volunteers, if applicable.
e. Management of Funds
The Area Agency maintains sufficient fiscal control and accounting procedures to assure
proper disbursement of and account for all funds under this Plan.
f. Safeguarding Confidential Information
The Area Agency has implemented such regulations, standards, and procedures as are
necessary to meet the requirements on safeguarding confidential information under relevant
program regulations.
g. Reporting Requirements
The Area Agency agrees to furnish such reports and evaluations to the Director of the
Executive Office on Aging as may be specified.
h. Standards for Service Providers
All providers of service under this Plan operate fully in conformance with all applicable
Federal, State, and local fire, health, safety and sanitation, and other standards prescribed in
law or regulations. The Area Agency provides that where the State or local public
jurisdictions require licensure for the provision of services, agencies providing such services
shall be licensed.
i. Amendments to Area Plan
Area Plan amendments will be made in conformance with applicable program regulations.
j. Intergovernmental Review of Services and Programs
The Area Agency will assure that 45 CFR 100 covering Intergovernmental Review of
Department of Human Services Programs and Activities be maintained. The regulation is
intended to foster an intergovernmental partnership and a strengthened Federalism by
relying on State processes and on State, area wide, regional, and local coordination for
review of proposed Federal financial assistance and direct Federal development.
97
k. Standards for a Merit System of Personnel Administration
The Area Agency will assure that there are Standards for a Merit System of Personnel
Administration as stated in 5 CFR Part 900, Subpart F.
2. Equal Opportunity and Civil Rights
a. Equal Employment Opportunity
The Area Agency has an equal employment opportunity policy, implemented through an
affirmative action plan for all aspects of personnel administration as specified in 45 CFR Part
70.4.
b. Non-Discrimination on the Basis of Handicap
All recipients of funds from the Area Agency are required to operate each program activity so
that, when viewed in its entirety, the program or activity is readily accessible to and useable
by handicapped persons, as specified in 45 CFR 84.
c. Non-Discrimination on the Basis of Age
The Area Agency will assure compliance with 45 CFR 91 which is the regulation for The Age
Discrimination Act of 1975 as amended and is designed to prohibit discrimination on the
basis of age.
d. Civil Rights Compliance
The Area Agency has developed and is implementing a system to ensure that benefits and
services available under the Area Plan are provided in a non-discriminatory manner as
required by Title VI of the Civil Rights Act of 1964 as amended.
3. Provision of Services
a. Needs Assessment
The Area Agency has a reasonable and objective method for determining the needs of all
eligible residents of all geographic areas in the PSA for allocating resources to meet those
needs.
b. Priorities
The Area Agency has a reasonable and objective method for establishing priorities for service
and such methods are in compliance with the applicable statute.
c. Eligibility
The activities covered by this Area Plan serve only those individuals and groups eligible under
the provisions of the applicable statute.
d. Residency
No requirements as to duration of residence or citizenship will be imposed as a condition of
participation in the Area Agency’s program for the provision of services.
e. Coordination and Maximum Utilization of Services
The Area Agency to the maximum extent coordinates and utilizes the services and resources
of other appropriate public and private agencies and organizations.
4. Non-Construction Programs
a. Legal Authority
The Area Agency has the legal authority to apply for Federal assistance, and the institutional,
managerial and financial capability (including funds sufficient to pay the non-Federal share of
project costs) to ensure proper planning, management, and completion of the project
described in non-construction program application.
b. Hatch Act
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The Area Agency will comply with the provisions of the Hatch Act (5 U.S.C. SS 1501-1508 and
73224-7328) which limit the political activities of employees whose principal employment
activities are funded in whole or in part with Federal funds.
c. Single Audit Act of 1984
The Area Agency will cause to be performed the required financial and compliance audits in
accordance with the Single Audit Act of 1984.
d. Other Laws
The Area Agency will comply with all applicable requirements of all other Federal laws,
executive orders, regulations, and policies governing this program.
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B3b. Program Specific Provisions and Assurances
Program specific assurances will follow the intent of the area plans as stated in section 306 of the Older
Americans Act, as amended Through P.L. 116-131, Enacted March 25, 2020.
Sec. 306(a), AREA PLANS
(2) Each area agency on aging shall provide assurances that an adequate proportion, as required under
section 307(a)(2), of the amount allotted for part B to the planning and service area will be expended for the
delivery of each of the following categories of services-
(A) services associated with access to services (transportation, health services (including mental
health services), outreach, information and assistance (which may include information and assistance
to consumers on availability of services under part B and how to receive benefits under and
participate in publicly supported programs for which the consumer may be eligible), and case
management services);
(B) in-home services, including supportive services for families of older individuals who are
victims of Alzheimer's disease and related disorders with neurological and organic brain
dysfunction; and
(C) legal assistance;
and assurances that the area agency on aging will report annually to the State agency in detail the
amount of funds expended for each such category during the fiscal year most recently concluded.
(4)(A)(i)(I) provide assurances that the area agency on aging will—
(aa) set specific objectives, consistent with State policy, for providing services to older
individuals with greatest economic need, older individuals with greatest social need, and
older individuals at risk for institutional placement;
(bb) include specific objectives for providing services to low-income minority older
individuals, older individuals with limited English proficiency, and older individuals
residing in rural areas; and
(II) include proposed methods to achieve the objectives described in items (aa) and (bb) of
subclause (I);
(4)(A)(ii) provide assurances that the area agency on aging will include in each agreement made with a
provider of any service under this title, a requirement that such provider will—
(I) specify how the provider intends to satisfy the service needs of low-income minority
individuals, older individuals with limited English proficiency, and older individuals residing in rural
areas in the area served by the provider;
(II) to the maximum extent feasible, provide services to low-income minority individuals, older
individuals with limited English proficiency, and older individuals residing in rural areas in accordance
with their need for such services; and
(III) meet specific objectives established by the area agency on aging, for providing services to low-
income minority individuals, older individuals with limited English proficiency, and older individuals
residing in rural areas within the planning and service area; and
(4)(A)(iii) With respect to the fiscal year preceding the fiscal year for which such plan is prepared, each area
agency on aging shall--
(I) identify the number of low-income minority older individuals and older individuals residing in rural
areas in the planning and service area;
(II) describe the methods used to satisfy the service needs of such minority older individuals;
and
(III) provide information on the extent to which the area agency on aging met the objectives
described in clause (a)(4)(A)(i).
(4)(B)(i) Each area agency on aging shall provide assurances that the area agency on aging will use
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outreach efforts that will identify individuals eligible for assistance under this Act, with special
emphasis on--
(I) older individuals residing in rural areas;
(II) older individuals with greatest economic need (with particular attention to low-income
minority individuals and older individuals residing in rural areas);
(III) older individuals with greatest social need (with particular attention to low-income
minority individuals, older individuals residing in rural areas, and those who identify as
LGBTQ+);
(IV) older individuals with severe disabilities;
(V) older individuals with limited English proficiency;
(VI) older individuals with Alzheimer’s disease and related disorders with neurological and
organic brain dysfunction (and the caretakers of such individuals); and
(VII) older individuals at risk for institutional placement; and
(4)(C) Each area agency on agency shall provide assurance that the area agency on aging will ensure
that each activity undertaken by the agency, including planning, advocacy, and systems
development, will include a focus on the needs of low-income minority older individuals and older
individuals residing in rural areas.
(5) Each area agency on aging shall provide assurances that the area agency on aging will coordinate
planning, identification, assessment of needs, and provision of services for older individuals with
disabilities, with particular attention to individuals with severe disabilities, and individuals at risk for
institutional placement, with agencies that develop or provide services for individuals with
disabilities.
(6)(F) Each area agency will:
in coordination with the State agency and with the State agency responsible for mental health
services, increase public awareness of mental health disorders, remove barriers to diagnosis and
treatment, and coordinate mental health services (including mental health screenings) provided with
funds expended by the area agency on aging with mental health services provided by community
health centers and by other public agencies and nonprofit private organizations;
(9) Each area agency on aging shall provide assurances that the area agency on aging, in carrying out
the State Long-Term Care Ombudsman program under section 307(a)(9), will expend not less than
the total amount of funds appropriated under this Act and expended by the agency in fiscal year
2000 in carrying out such a program under this title.
(11) Each area agency on aging shall provide information and assurances concerning services to older
individuals who are Native Americans (referred to in this paragraph as "older Native Americans"),
including-
(A) information concerning whether there is a significant population of older Native
Americans in the planning and service area and if so, an assurance that the area agency on
aging will pursue activities, including outreach, to increase access of those older Native
Americans to programs and benefits provided under this title;
(B) an assurance that the area agency on aging will, to the maximum extent practicable,
coordinate the services the agency provides under this title with services provided under title
VI; and
(C) an assurance that the area agency on aging will make services under the area plan
available, to the same extent as such services are available to older individuals within the
planning and service area, to older Native Americans.
13)(A) Each area agency on aging shall provide assurances that the area agency on aging will
maintain the integrity and public purpose of services provided, and service providers, under this title
in all contractual and commercial relationships.
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(13)(B) Each area agency on aging shall provide assurances that the area agency on aging will disclose to the
Assistant Secretary and the State agency--
(i) the identity of each nongovernmental entity with which such agency has a contract or
commercial relationship relating to providing any service to older individuals; and
(ii) the nature of such contract or such relationship.
(13)(C) Each area agency on aging shall provide assurances that the area agency will demonstrate that a loss
or diminution in the quantity or quality of the services provided, or to be provided, under this title by such
agency has not resulted and will not result from such non-governmental contracts or such commercial
relationships.
(13)(D) Each area agency on aging shall provide assurances that the area agency will demonstrate that the
quantity or quality of the services to be provided under this title by such agency will be enhanced as a result
of such non-governmental contracts or commercial relationships.
(13)(E) Each area agency on aging shall provide assurances that the area agency will, on the request of the
Assistant Secretary or the State, for the purpose of monitoring compliance with this Act (including conducting
an audit), disclose all sources and expenditures of funds such agency receives or expends to provide services
to older individuals.
(14) Each area agency on aging shall provide assurances that funds received under this title will not be used
to pay any part of a cost (including an administrative cost) incurred by the area agency on aging to carry out a
contract or commercial relationship that is not carried out to implement this title.
(15) provide assurances that funds received under this title will be used-
(A) to provide benefits and services to older individuals, giving priority to older individuals
identified in paragraph (4)(A)(i); and
(B) in compliance with the assurances specified in paragraph (13) and the limitations specified in
section 212;
In addition, the Area Agency on Aging agrees to comply with the requirements of the Older
Americans Act, as amended Through P.L. 116-131, Enacted March 25, 2020, including sections: 305,
307, 373, and 705 and all applicable Federal Rules and Regulations.
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B3c. Assurances As Related to the Code of Federal Register §1321.17(f) 1 to 15:
The Area Agency on Aging will meet all assurances as required under CFR §1321.17(f) 1 – 15
outlined below:
(1) Each area agency engages only in activities which are consistent with its statutory mission as
prescribed in the Act and as specified in State policies under § 1321.11;
(2) Preference is given to older persons in greatest social or economic need in the provision of
services under the plan;
(3) Procedures exist to ensure that all services under this part are provided without use of any
means tests;
(4) All services provided under title III meet any existing State and local licensing, health and
safety requirements for the provision of those services;
(5) Older persons are provided opportunities to voluntarily contribute to the cost of services;
(6) Area plans shall specify as submitted, or be amended annually to include, details of the
amount of funds expended for each priority service during the past fiscal year;
(7) The State agency on aging shall develop policies governing all aspects of programs operated
under this part, including the manner in which the ombudsman program operates at the State
level and the relation of the ombudsman program to area agencies where area agencies have
been designated;
(8) The State agency will require area agencies on aging to arrange for outreach at the
community level that identifies individuals eligible for assistance under this Act and other
programs, both public and private, and informs them of the availability of assistance. The
outreach efforts shall place special emphasis on reaching older individuals with the greatest
economic or social needs with particular attention to low income minority individuals, including
outreach to identify older Indians in the planning and service area and inform such older Indians
of the availability of assistance under the Act.
(9) The State agency shall have and employ appropriate procedures for data collection from
area agencies on aging to permit the State to compile and transmit to the Commissioner
accurate and timely statewide data requested by the Commissioner in such form as the
Commissioner directs; and
(10) If the State agency proposes to use funds received under section 303(f) of the Act for
services other than those for preventive health specified in section 361, the State plan shall
demonstrate the unmet need for the services and explain how the services are appropriate to
improve the quality of life of older individuals, particularly those with the greatest economic or
social need, with special attention to low-income minorities.
(11) Area agencies shall compile available information, with necessary supplementation, on
courses of postsecondary education offered to older individuals with little or no tuition. The
assurance shall include a commitment by the area agencies to make a summary of the
information available to older individuals at multipurpose senior centers, congregate nutrition
sites, and in other appropriate places.
(12) Individuals with disabilities who reside in a non-institutional household with and
accompany a person eligible for congregate meals under this part shall be provided a meal on
the same basis that meals are provided to volunteers pursuant to section 307(a)(13)(I) of the
Act.
(13) The services provided under this part will be coordinated, where appropriate, with the
services provided under title VI of the Act.
(14) (i) The State agency will not fund program development and coordinated activities as a
cost of supportive services for the administration of area plans until it has first spent 10
percent of the total of its combined allotments under Title III on the administration of
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INSERT SIGNED B3d Assurances page HERE
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Appendix C: HCOA Chart of Existing Services
Current HCOA Contracted Services (2022)
Programs and Services Provider Agency Area Served
Access
Assisted Transportation Hawaiʻi Island Adult Care, Inc. East Hawaiʻi
Hawaii Care Solutions – KC Trans Island-wide
Maxi-Care Link Island-wide
Metrocare East Hawaiʻi
Ultimacare Island-wide
Caregiver Access Services Services for Seniors Island-wide
HI Economic Opportunity Council
Caregiver Counseling Alzheimer’s Association Island-wide
Hawaiʻi Island Adult Care, Inc.
Case Management Services for Seniors Island-wide
HI Economic Opportunity Council
Outreach EAD – Coordinated Services Island-wide
Transportation EAD - Coordinated Services Island-wide
EAD - Nutrition Program Island-wide
HI Economic Opportunity Council Island-wide
In-Home
Chore Hawaii Care Solutions Island-wide
Maxi-Care Link Island-wide
Metrocare Hawaiʻi Island-wide
Ultimacare Island-wide
Home Delivered Meals EAD – Nutrition Program Island-wide
HI Economic Opportunity Council Island-wide
111
Programs and Services Provider Agency Area Served
In-Home con’t
Homemaker Hawaii Care Solutions Island-wide
Mastercare Island-wide
Maxi-Care Link Island-wide
Metrocare Hawaiʻi Island-wide
Ultimacare Island-wide
Personal Care Hawaii Care Solutions Island-wide
Mastercare Island-wide
Maxi-Care Link Island-wide
Metrocare Hawaiʻi Island-wide
Ultimacare Island-wide
Community Based
Adult Day Care Hawaii Island Adult Care Inc. East Hawaii
Legal Legal Aid Society of Hawaiʻi Island-wide
Nutrition – Congregate EAD – Nutrition Program Island-wide
Nutrition Education EAD – Nutrition Program Island-wide
Respite Hawaii Care Solutions Island-wide
Mastercare Island-wide
Maxi-Care Link Island-wide
Metrocare Hawaiʻi Island-wide
Ultimacare Island-wide
112
Community Public, Private, & Non-Profit Programs and Services
Programs and Services Provider Agency Area Served
Adult Foster Care DHS – Adult and Community Services East Hawai‘i
Section, Adult Protective Services West Hawaiʻi
Assisted Transportation Alu Like, Inc. Island-wide
EAD – Coordinated Services Island-wide
HI Economic Opportunity Council Island-wide
DHS – Adult & Community Care Services Island-wide
Caregiver Information Aging & Disability Resource Center Island-wide
Alu Like, Inc. Island-wide
Alzheimer’s Association Island-wide
Hawaiʻi Community Caregiver Network West Hawaiʻi
PHN Case Management Coordination
Case Management Island-wide
Project
DHS Adult Protective Services Island-wide
Chore & Homemaker DHS – Adult & Community Care Services Island-wide
EAD – Coordinated Services Island-wide
Community Health Centers Bay Clinic Mobile Dental Van Pahoa & Ka’u
Hamakua Health Center Island-wide
Hilo Family Health Center East Hawaiʻi
Hilo Family Dental Center East Hawaiʻi
Ka’u Family Health Center Ka’u
Kea’au Family Health Center Puna
Kohala Family Health Center Island-wide
Pahoa Family Health Center Pahoa
West Hawaiʻi Community Health Center West Hawaiʻi
West Hawaiʻi Community Health Center West Hawaiʻi
- Kealakekua
Elder Abuse and Neglect DHS – Adult Protective Services Island-wide
113
Programs and Services Provider Agency Area Served
Employment Alu Like Inc. Island-wide
State Workforce Development Division Island-wide
Home Health Care Resource Hawaii Island-wide
Department of Human Services Island-wide
Health Resources Island-wide
Kohala Home Health N/S Kohala
North Hawaiʻi Hospital Hamakua
Hawaii Care Solutions Kokua Nurses East Hawaiʻi
Mastercare Island-wide
Metrocare Hawaiʻi Plus Island-wide
Ultimacare Island-wide
Hospice Hawaiʻi Care Choices East Hawaiʻi
Hospice of Kona N/S Kona
North Hawaiʻi Hospice N/S Kohala
East Hawaiʻi
Housing Big Island Housing Foundation & Waimea
Bob Tanaka Realty West Hawaiʻi
Cambridge Management East Hawaiʻi
Day Lum Property Management Island-wide
Hale Hoaloha East Hawaii
Hawaiʻi Affordable Proper?es Island-wide
Hawaiʻi Island Community Development Island-wide
Corporation
Hawaiʻi Public Housing Authority Island-wide
Office of Housing and Community Island-wide
Development
The Michaels Development Corporation West Hawaii
114
Programs and Services Provider Agency Area Served
Congregate Meals Alu Like, Inc. Island-wide
Home Delivered Meals Alu Like, Inc. Island-wide
Nutrition Education Alu Like Inc. Island-wide
Recreation Adult Day Care Hilo
Alu Like Inc. Island-wide
EAD – Elderly Recreation Services Island-wide
EAD – Congregate Nutrition Program Island-wide
Shopping Assistance Alu Like, Inc. East Hawaiʻi
EAD – Coordinated Services Island-wide
Hawaiʻi County Economic Opportunity Island-wide
Council
EAD – Congregate Nutrition Program Island-wide
Transportation Hui Malama Ola Na’Oiwi Island-wide
Alu Like, Inc. Island-wide
Mass Transit, County of Hawaii Island-wide
Volunteer Services Alu Like, Inc. Island-wide
Foster Grandparent Program East Hawaii
Retired Senior & Volunteer Program Island-wide
Senior Companion Program Island-wide
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Appendix D: Contact Information for Focal Points, Congregate Sites, Home Delivered
Meals Providers, And Adult Day Centers
Community Focal Points and Multi-Purpose Centers Location
Aging and Disability Resource Center 1055 Kinoʻole St., Suite 101, Hilo, HI. 96720
Honokaʻa Senior Center 45-540 Koniaka Place, Honokaʻa, HI. 96727
Kamana Senior Center 127 Kamana Street, Hilo, HI. 96720
Kohala Court House 54-3900 Akoni-Pule Hwy., Kapaau, HI. 96755
Lily Yoshimatsu Center 67-1199 Mamalahoa Hwy. Kamuela, HI. 96743
Na’alehu Community Center 95-5635 Mamalahoa Hwy. Naʻalehu, HI. 96772
Pāhala Senior Center 96-1169 Holei Street, Pāhala, HI. 96777
Pāhoa Community Center 3016 Kauhala Road, Pāhoa, HI. 96778
West Hawaiʻi Civic Center 75-5044 Ane Keohokalole Hwy., Bldg. B
Kailua-Kona, HI. 96740
Congregate Nutrition Site Area Served Congregate Schedule
Units FY22
Aunty Sally’s Luau Hale South Hilo 20,407 M -F 8:00a – 12:00p
799 Pi‘ilani St., Hilo, HI 96720
Pomaikai Senior Center South Hilo 0 M -Th 8:30a – 12:30p
929 Ululani St., Hilo, HI. 96720
Kula‘imano Elderly Housing South Hilo 2,450 M -F 8:30a – 12:30p
28-2947 Kumula St., Pepe‘ekeō, HI 96783
Pāpa‘aloa Gym Annex North Hilo 0 M -Th 8:00a-12:00p
35-1994 Govt. Main Rd., Pāpa’aloa, HI 96780
Hale Ho`okipa Elderly Housing South Kona 0 M -F 8:30a – 12:30p
81-1038 Nani Kupuna St., Kealakekua, HI 96750
Yano Hall Senior Center South Kona 586 T 8:30-12:30
82-6145 Mamalahoa Hwy., Captain Cook, HI. 96704
Hōlualoa Imin Center North Kona 821 M WF 8:00a-12:00p
76-5877 N. Kona Belt Rd., Keauhou, HI 96739
Ocean View Estates (HOVE) Ka’ū 557 MWF 8:0 0a-12:00p
799 Pi`ilani St., Ocean View, HI 96737
Pa‘auilo Community Center Hamakua 0 M -F 8:00a-12:00p
43-977 Gym Rd., Pa’auilo, HI 96776
Hale Haouli Elderly Housing Hamakua 1,078 M -F 8:30a – 12:30p
45-540 Konaika Place, Honoka`a, HI 96720
Kea‘au Elderly Housing Puna 0 M -F 8:00a-12:00p
16-189 Pilimuai St., Keaau, HI 96749
Pāhoa Neighborhood Center Puna 1,644 M -F 8:00a-12:00p
15-2910 Puna Road, Pahoa, HI 96778
Lily Yoshimatsu Senior Center South 1,851 M -F 8:00a-12:00p
67-1199 Māmalahoa Hwy., Kamuela, HI 96743 Kohala
Kohala Senior Center North 2,825 M -F 8:00a-12:00p
54-3900 Akoni-Pule Place, Kapaau, HI 96755 Kohala
Nā`ālehu Community Center Ka’ū 630 M -F 8:00a – 12:00p
95-5635 Mamalahoa Hwy., Na`alehu, HI 96772
Pāhala Elderly Housing Ka’ū 3,104 M -F 8:30a – 12:30p
96-1183 Holei St., Pahala, HI 96777
Home Delivered Meal Distribution Centers
Meals on Wheels – Hilo South Hilo 60,055 M -F 9:00a-12:00p
Meals on Wheels - Kona North Kona 15,155 M -F 9:00a-12:00p
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Adult Day Centers
Hawaiʻi Island Adult Day Care East Hawaii M -F 7:00a – 5:00p
47 Rainbow Drive, Hilo, HI. 96720 Sat 8:00a – 4:00p
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Appendix E: HCOA Staffing and Organizational Chart
Staffing of the Area Agency
The Hawaiʻi County Office of Aging has a staff of 19 professional and para-professional positions
including:
Executive on Aging
Aging Program Planners
Administrative Services Assistant
Information Systems Analyst
ADRC Management
ADRC Specialists
Case Manager
Administrative Support
(Chart 3)
Advisory Councils
The Mayor of Hawai‘i County and HCOA have established two advisory councils, the Committee on
Aging and the Committee on People with Disabilities. The Committee on Aging serves as an
advisory council to advise HCOA on the development and administration of the area plan, conduct
public hearings, represent the interests of older persons, and receive and comment on all
community policies, programs, and actions which affect older persons of Hawai‘i County. The
Committee on Aging is a mandated function by the Older Americans Act and a requirement for this
plan to be approved and funding to be released. (See Chart 3) HCOA also spearheads the Mayors’
Committee on People with Disabilities which advises the Mayor on all matters related to persons
with disabilities. As its’ primary goal, the committee reviews and recommends actions and provides
guidelines to improve the quality of life for all people with disabilities. (Chart E1)
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Chart E1. Office of Aging – Organizational Chart – 2023
Mayor
Managing Director
Committee
Committee
on
on Aging
Disability
Executive on Aging
Administration Services Planning and Program
Access Division
Division Development Division
Aging & Disability
Information
Aging & Disability
Service Manager
Admin. Services
Aging Program
System Analyst
Service Manager
Assistant I
Planner III
IV
Case Management
ADRC
Information and
Computer
Assistant Clerks
Operator I
Hilo – 2
Aging Program
Aging Program
Planner II
Planner II
Kona – 1
Clerk III
Hilo – 1
*Aging &
*Aging &
Aging & Disability Aging & Disability
Aging &
Aging &
Disability
Disability
Specialist II Specialist I
Disability Disability
Specialist I
Specialist I
Specialist I
Specialist I
ADRC-1/2 East HI
ADRC-1/2 West HI
ADRC ADRC
ADRC-East HI ADRC-West HI
Vacant
Vacant
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Appendix F: Public Hearings, Evaluations
Public Hearings
PROTOCOL
HCOA shall conduct a public hearing(s) (in accordance with Section 5-5-.08) for the purpose of
providing the opportunity for older persons, the general public, officials of general purpose
local government, and other interested parties to comment on the area plan. Two Public
Hearings are scheduled for review of the 2023-2027 PSA-4 Area Plan on Aging, one in East
Hawaiʻi and one in West Hawaiʻi.
STANDARDS FOR CONDUCTING PUBLIC HEARINGS FOR REVIEW OF AREA PLANS AND
AMENDMENTS OF THE PLAN:
(1) At least two weeks before submitting an area plan, or significant amendments, to the State
Agency, an AAA must hold at least one public hearing on the area plan or the significant
amendments to the area plan. Public hearing(s) must be held within the geographical
boundaries of the planning and service area (PSA) for which the area plan is developed.
(2) The AAA must give adequate notice to older persons and adults with disabilities, public
officials and other interested parties of the time(s), date(s), and location(s) of the public
hearing(s).
(3) The AAA must hold the public hearing(s) at a time and location that permits older persons
and adults with disabilities, public officials, and other interested persons reasonable
opportunity to participate.
(4) The AAA will develop procedures to assure effective participation of actual or potential
consumers of services under the area plan at the local level through public hearings.
(5) The AAA must submit the area plan and amendments for review and comment, to the AAA
advisory council prior to submission to the State Agency. The advisory council shall review the
area plan before the AAA conducts public hearings on the plan. If comments made at the public
hearing result in changes to the area plan, the advisory council shall make provisions for a final
review of the area plan prior to the AAA’s submission of the area plan to the State Agency.
(6) The AAA must apply the following standards in the conduct of its public hearing(s):
(a) The public hearing(s) must be scheduled to allow sufficient time for review of the
area plan by the advisory council at least one week prior to the date of the public
hearing(s).
(b) Public hearings should be conducted at easily accessible public locations, such as
community centers, public auditoriums, public schools or community colleges, senior
centers, or county courthouses.
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(c) Available transportation resources should be used to insure that as many older
persons and adults with disabilities as possible are able to attend the public hearing(s).
(d) Notice of time and place of the public hearing(s) must be given at least two weeks in
advance of the hearing(s), for example, by paid advertisement or news release in the
major county/district newspaper, radio, or television station(s). Wherever possible,
notice should be given to possible participants through senior centers, nutrition sites,
county courthouses, and post offices.
(e) Participants in the public hearing should be asked to register by county.
(f) Members of the AAA advisory council should be in attendance, introduced, and
assist in the conduct of the hearing(s). Also, a list of the names of the AAA advisory
council members, their addresses, and the counties they represent should be provided
at the hearing.
(g) The director, or program leader, should present each program objective and allow
for discussion or questions on each. All questions or comments from participants
should be recorded either by tape recording or by secretary.
(h) As a minimum, the hearing(s) must include the following:
(i) an explanation of the OAA and a description of services funded under the
Act;
(ii) an explanation of the function and responsibilities of an AAA, what an area
plan represents, the period of time it covers, and why a public hearing is
required;
(iii) an explanation of the differences between national, state, and locally
developed objectives;
(iv) an explanation of all terms and phrases used in presenting the objectives
which may not be easily understood by participants; and
(v) details and explanations of proposals to pay for program development and
coordination as a cost of supportive services.
(i) Complete copies of the area plan must be made available for public inspection at
least in each county of the PSA and provision should be made for receiving comments
and questions outside of the public hearing(s).
(j) Documentation of the methods used to distribute aging and disability funds, within
State Agency guidelines, among service providers must be available at the public
hearing(s).
(k) The AAA must obtain review and comment from the general public, including older
persons, government, and the aging and disability service network prior to using
additional amounts of direct supportive service funds for program development and
coordination.
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(l) Procedures for review and analysis of comments received at the public hearing(s)
must be established and described in writing.
(7) The results of the public hearing must be reported in the area plan in the appropriate
exhibit. Significant comments made during the hearing and the response by the AAA toward
incorporation of these comments into the area plan must be included.
(8) Summaries of the comments made at the public hearing(s) must be available at the office of
the AAA after the public hearing(s).
(9) All records of the public hearing(s) must be on file at the AAA as a part of the official area
plan file.
Public Notice
The Hawaiʻi County Office of Aging will be conduc?ng Public Hearings on the proposed Area
Plan on Aging for the period October 1, 2023 through September 30, 2027. The Area Plan on
aging sets forth in detail the development of a service system designed to meet the needs of
older persons in Hawaiʻi County. The Office of Aging utilizes Older Americans Act funds through
the State Executive Office on Aging to implement the Area Plan.
Draft copies of the proposed plan will be available for public review at the Hawaiʻi County
Office of Aging, 1055 Kinoʻole Street, Suite 101, Hilo, HI. and at the Office of Aging Kona
Satellite Office at the West Hawaiʻi Civic Center, 74-5044 Ane Keohokālole Hwy., Kailua Kona.
The meetings were scheduled as follows:
April 21, 2023
11:00 a.m. – 12:00 p.m.
Hawaiʻi County Office of Aging
Aging and Disability Resource Center, Training Room
1055 Kino’ole Street, Hilo, HI. 96720
April 26, 2023
11:00 a.m. – 12:00 p.m.
West Hawaiʻi Civic Center
Community Hale, Building G
74-5044 Ane Keohokālole Hwy. Kailua Kona, HI. 96740
If you require an accommodation or auxiliary aid and/or services to participate in this meeting
please contact Hawaiʻi County Office of Aging at 961-8600 or 323-4390 by April 14, 2023.
123
HAWAIʻI COUNTY OFFICE OF AGING
AREA PLAN ON AGING PUBLIC HEARINGS
County of Hawai‘ì
Office of Aging
Public Informational Hearing
4 Year Area Plan on Aging
Plan Period: October 1, 2023 – September 30, 2027
April 21, 2023, 11:00 A.M., Aging and Disability Resource Center, Hilo
April 26, 2023, 11:00 A.M., West Hawaiʻi Civic Center, Kona
AGENDA
I. WELCOME/OPENING REMARKS
II. PURPOSE OF THE PUBLIC MEETING
III. REVIEW OF AREA PLAN
POWERPOINT PRESENTATION
IV. OPPORTUNITY FOR PUBLIC INPUT
V. CLOSING REMARKS
VI. ADJOURNMENT
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Public Hearing Minutes
HAWAI’I COUNTY OFFICE OF AGING
AREA PLAN ON AGING
Minutes of Hearing – East Hawaii
April 21, 2023
The Hawai’i County Office of Aging held a public hearing on the 2023 – 2027
Draft Area Plan on Aging, on Friday, April 21, 2023, 11:00 a.m., at the Hawaii
County Office of Aging, 1055 Kino’ole Street, Hilo, Hawai’i 96720.
STAFF MEMBERS PRESENT:
William Horace Farr, Executive on Aging; Deborah Wills, Aging Program
Planner II West Hawai’i; Clayton Honma, Aging Program Planner III East
Hawai’i, Mary Kenoi, Aging Program Planner II East Hawai’i, Charmaine Felipe,
Administrative Services Assistant I; Lori Enomoto, Information & Assistance
Clerk
OTHERS PRESENT:
Lance Takai, Laenette Longakit, Pam Bruce, Toby S. Hazel, Jasmine Powell,
Momi Kawai, Salena Espejo, Jennifer Abiley, Marsha Okajima, Pam Nehts,
Shannen Matson, Kari Sochor, Berdena Flesher, and Lurlyne Paleka-Kama
WELCOME/OPENING REMARKS:
The hearing was called to order at 11:01 a.m.
William Horace Farr, Executive on Aging; Clayton Honma, Aging Program
Planner III East Hawai’i; Deborah Wills, Aging Program Planner II West Hawai’i;
and Mary Kenoi, Aging Program Planner II East Hawai’i, were introduced. William
Horace Farr welcomed the attendees and staff, and opened the public hearing on
the Area Plan.
REVIEW OF AREA PLAN POWERPOINT PRESENTATION:
Deborah Wills gave an overview of the Office of Aging’s roles and responsibilities
as an Area Agency on Aging and the development of the 2023 – 2027 Draft Area
Plan on Aging.
’
Attendees included representatives from the following agencies: Hawaii County
Committee on Aging; AARP; MTM Transit; Hilo Medical Center; Kau Hospital;
Hawai’i Community College; Legal Assistant and Intern for Jenn Kagiwada;
RSVP; and senior residents of East Hawai'i. The attendees of the meeting were
given an opportunity to ask questions, provide comments, and give feedback on
the proposed plan. See Comments, Power Point Presentation, and Sign-ln
Sheet below.
125
OPPORTUNITY FOR PUBLIC INPUT:
Toby Hazel, wanted to know why clients aren’t informed of the end date of home
care services, and why that by the time that services are received, that half the
time is used so services have to be combined in a short amount of time.
Berdena Flesher, who is a Case Manager, was able to explain the entire
process, and answer Toby’s question.
Deborah Wills, thanked Toby for her comments and informed her that her
comments were noted.
Toby Hazel, stated that clients should be informed of how many days it takes to
receive services.
Berdena Flesher, explained that the County cannot be responsible for giving
immediate Emergency Services. If the party is in need of immediate Emergency
Services, their doctor can be the one to recommend, and get that individual
immediate in-home services.
Deborah Wills, thanked Toby for her comments and informed her that her
comments were noted.
Shannen Matson, asked about the Aging and Disability Resource Center, as
well as the lack of staffing regarding the Committee on Aging, and the Mayor’s
Committee on People with Disabilities.
William Horace Farr, explained that the Aging and Disability Resource Center is
a part of Office of Aging, and that we do not provide disability services, but can
provide resources such as Aloha Independent Living. The Committee on Aging
is a requirement from The Older Americans Act, and we must have that
Committee in place. The Mayor’s Committee on People with Disabilities is
strictly at the discretion of the Mayor. It is not that the committee cannot function
because a lack of staffing, because the Mayor can decide to institute that
committee. If the Mayor decides to institute the Mayor’s Committee on People
with Disabilities, we will only assist. It is not a committee that we will run, as how
we run the Committee on Aging.
Shannen Matson, asked if the Committee on Aging is filled.
WilliamHorace Farr, explained that the number of members have to be
balanced, and they currently have enough members to function, but may have
space for 2 to 3 more people.
Shannen Matson, asked about the Kakoo Paratransit Services.
William Horace Farr, explained that Paratransit is a part of the Mass Transit
Agency, and they handle the Paratransit Service. He also explained that the
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function of the Aging and Disability Resource Center is to gather all the
information on the Aging network, and then refer to the appropriate County
agency, or even to an agency outside of the County system. The ADRC is
essentially a one-stop shop, so the caller is not bouncing from agency to
agency.
Toby Hazel, asked if the Mayor’s office has an EA who understands all these
bits and pieces that are scattered all over the place.
Charmaine Felipe, explained that the Mayor’s Office would have to be the one to
answer that question.
Pam Bruce, asked if anyone has a database that has information of who installs
lifts, renovates bathrooms, or other items in the home, so the senior doesn’t
have to look in a phone book for different numbers.
Clayton Honma, stated that the ADRC has a list.
William Horace Farr, explained that the Office of Aging cannot recommend any
companies or individuals on the list, but can provide a list of individuals who
have indicated to the Office of Aging that they would like to be on the list.
CLOSING REMARKS:
William Horace Farr, Deborah Wills, and Clayton Honma, thanked everyone who
attended the Area Plan on Aging Public Information Hearing.
ADJOURNMENT:
Meeting Adjourned at 11:43 a.m.
127
128
HAWAI’I COUNTY OFFICE OF AGING
AREA PLAN ON AGING
Minutes of Hearing – West Hawaii
April 26, 2023
The Hawai’i County Office of Aging held a public hearing on the 2023 – 2027
Draft Area Plan on Aging, on Friday, April 26, 2023, 11:00 a.m., at the West
Hawai’i Civic Center, Community Hale, Building G, 74-5044 Ane Keohokalole
Hwy, Kailua Kona, Hawaii, 96740
STAFF MEMBERS PRESENT:
William Horace Farr, Executive on Aging; Deborah Wills, Aging Program
Planner II West Hawai’i; Lori Enomoto, Information & Assistance Clerk
OTHERS PRESENT:
Adele Enomoto, Judy Bell, Roberta Murray, Deborah Wills, Joy Foster, Eileen
Mena, Susan Olson, Lupua Mora, Betty Clark, and Michael Lam
WELCOME/OPENING REMARKS:
The hearing was called to order at 11:05 a.m.
William Horace Farr, Executive on Aging; and Deborah Wills, Aging Program
Planner II West Hawai’i, were introduced. William Horace Farr welcomed the
attendees and staff, and opened the public hearing on the Area Plan.
REVIEW OF AREA PLAN POWERPOINT PRESENTATION:
Deborah Wills gave an overview of the Office of Aging’s roles and responsibilities
as an Area Agency on Aging and the development of the 2023 – 2027 Draft Area
Plan on Aging.
’
Attendees included representatives from the following agencies: Hawaii County
Committee on Aging; AARP; PABEA; HCCN; Hawai’i Fire Department; RSVP;
and senior residents of West Hawai'i. The attendees of the meeting were given
an opportunity to ask questions, provide comments, and give feedback on the
proposed plan. See Comments, Power Point Presentation, and Sign-ln Sheet
below.
OPPORTUNITY FOR PUBLIC INPUT:
Roberta Murray asked, how the EOA older adult’s survey was conducted, and
over what period of time it was taken.
Deborah Wills explained, that the State EOA was an online survey was sent
through email last summer. Out of all the surveys that were sent out, 214
responses were collected for Hawaiʻi County.
William Horace Farr explained, that a physical copy, of the 16 page, back and
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front survey, was sent to individuals that were not able to go online. Once the
surveys were mailed back to the Office of Aging, they were then entered into the
system.
Betty Clark asked, how many seniors live on Hawaii Island.
Deborah Wills answered, 61,000.
Susan Olson asked, if Office of Aging can use the Driver’s License database to
get seniors addresses to send out more surveys.
William Horace Farr explained, that with outreach, we have a consolidated
database where the seniors are registered. There are many different avenues of
outreach, and it is also important to be registered in this consolidated database,
to be able to contact seniors in the event of a natural disaster.
Deborah Wills, thanked everyone for their comments.
Deborah Wills explained, that due to Covid, the Office of Aging door in Kona has
been and is still currently closed, but there is a door bell in front of the office
which the public can ring for assistance.
William Horace Farr explained, that as an Area Agency on Aging, we are mainly
a planning office. Per the Older Americans Act, we cannot do direct service
because we receive the funding. Once a year the Area Agency on Aging, is able
th
to organize the event for Older Americans Month. This year it will be on May 12
at the Hilton Waikoloa Village, where we will be honoring and recognizing our
Kupuna.
Joy Foster stated, that she is a volunteer at the County of Hawaii, Retired Senior
Volunteer Program at the Parks and Recreation Office, and gave information on
how someone would be able to receive a Kupuna ID Card.
Betty Clark stated, that she doesn’t know anybody in Kona, and has never
participated in anything, but would like to.
Michael Lam explained, that he is with the Hawaii County Fire Department EMS
Office, where they support ambulance operations. Through the Community
Paramedicine Program, they work with the Office of Aging as well as other
agencies to assist Kupuna in need.
Susan Olson asked, if a patient can choose which hospital they would like to go
to when being transported to the hospital.
Michael Lam explained, that the patient will go to the closest hospital from the
location they are picked up from.
Eileen Mena explained, that she is a volunteer with AARP and the Hawaii
Caregivers Network, and was informed that the senior club meets at 10:00am on
Wednesday for game day at Hale Halawai.
Roberta Wong Murray explained, that she is a volunteer with AARP Hawaii, and
is also on the Policies Advisory Board for Elder Affairs, which advises the Area
Offices on Aging and the Executive Office on Aging.
Judy Bell explained, that she usually represents the Hawaii Community
Caregiver Network, but today she is representing the Committee on Aging, with
is the advisory committee to the Office of Aging.
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CLOSING REMARKS:
William Horace Farr and Deborah Wills thanked everyone who attended the
Area Plan on Aging Public Information Hearing.
ADJOURNMENT:
Meeting Adjourned at 12:05 p.m.
131
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Evaluations
Evaluation and Data Collection
As part of an on-going effort to ensure quality assurance, HCOA performs monthly, quarterly,
biannual, and annual evaluations of program effectiveness in meeting the needs of older adults
and their caregivers in PSA-4. Evaluation methods include but not limited to:
a. desktop monitoring,
b. analysis of reports and service data,
c. on-site monitoring,
d. client surveys,
e. review of provider and community input.
Data collection is conducted throughout the program service year for the following key
indicators of program success:
Progress in meeting goals and objectives
Number of individuals served
Number of units of service provided
Targeting Performance
Goals and Objectives will be assessed each year to ensure HCOA is on track in meeting its
objectives.
Moreover, it’s important to note that as new initiatives or funding streams become available,
goal and objectives might change.
Appendix F, Table 1, below shows service outputs for the previous year (FFY22). Each year,
HCOA tracks its’ service outputs to analyze how services are being utilized and how they
compare to HCOA’s service goals and objectives.
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Appendix F Table 1. SERVICE OUTPUTS: HCOA FFY22
Programs, Services, and
Unduplicated Persons Units of Service Unit
Activities
FY22 Actual Percent FY22 Actual Percent
FFY 2022
Contracts Served Achieved Contracts Served Achieved
Case Management (SFY22) 550 521 95% 10,000 9,524 95% Hour
Adult Day Care VP 20 - VP 4,338 - Day
Assisted Transportation VP 43 - VP 2,354 - Trip
Heavy Chore VP 15 - VP 468 - Hour
Homemaker VP 177 - VP 12,142 - Hour
Personal Care VP 102 - VP 9,533 - Hour
Transportation - CSE 1,150 938 82% 36,800 29,905 81% Trip
Transportation - HCEOC 190 199 105% 23,805 9,235 39% Trip
Transportation - HCNP 322 331 103% 16,666 7,835 47% Trip
Congregate Meals 931 651 70% 54,750 36,567 67% Meal
Home Delivered Meals 426 543 127% 74,318 75,210 101% Meal
KC Home Delivered Meals Meal
Nutrition Education 966 1,077 111% 10,500 6,195 59% Session
Public Education 2,500 4 Issue
Outreach 1,134 960 85% 1,134 962 85% Person
Home Modification PTA 137 - PTA 744 - Request
Legal 400 440 110% 2,195 2,195 100% Hour
Caregiver Prog – Counseling 50 16 32% 60 38 63% Hour
VP 65 - VP 8,276 - Hour
Caregiver Program - Respite
Hour
Caregiver Program - Training
Var 20 - Var 344 - Request
Caregiver Program - Suppl
600 513 86% 12 12 100% Activity
Caregiver Program - Info
Legend
VP: Vendor Pool
PTA: Price Term Agreement
Var: Variable
134
Appendix G: Disaster Preparedness Plan
G.1 West Hawaiʻi Civic Center Emergency Action/Evacuation Plan
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G.1 West Hawaiʻi Civic Center Emergency Action/Evacuation Plan
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