AVAILABILITY OF LONGTERM CARE SERVICES IN HAWAII: PERCEPTIONS OF SENIORS AND CASE MANAGERS

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AVAILABILITY OF LONG-TERM CARE SERVICES IN
HAWAII PERCEPTIONS OF SENIORS AND CASE MANAGERS

• Charon A. Pierson, RN, PhD, GNP-BC, FAANP
• Assistant Professor, Department of Geriatric
  Medicine, John A. Burns School of Medicine,
  University of Hawaii

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Acknowledgements

• Funding Support
• This pilot study was funded through a National
  Institute of Nursing Research P20 grant,
  NR008360-02, Center for Health Disparities
  Research.
• This research was partially done during a
  Post-doctoral Fellowship (2001-2003) from the
  John A. Hartford Building Academic Geriatric
  Nursing Capacity program

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Reflexive Statement

• I approached this research from both a strong
  clinical background as a GNP and a strong
  philosophical bent towards ethnomethodology and
  conversation analysis. Although the methodology
  was not in the EM/CA tradition, my bias is always
  towards how people make sense of what is
  happening and what it looks like doing-being an
  older person in need of services or doing-being
  a case manager.

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Purpose

• Gather descriptive data on perceived needs,
  access to, and utilization of the variety of
  long-term care services (both community-based and
  institutional) for a multiethnic group of elderly
  in Hawaii
• Determine which groups experience difficulty
  accessing services
• Explore possibilities of how best to monitor the
  ongoing needs of this growing population

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Conceptual Framework
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Methods

• Focus groups of seniors
• 11 groups
• 76 seniors
• 5 islands

• Individual interviews
• 4 discharge planners
• 5 case managers
• 1 director of Area Agency on Aging for Kauai

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Methods contd

• Questions were developed with guidance of mentors
  based on conceptual model
• IRB consents approval (exempt status)
• Participants solicited through sites for Senior
  Centers, Meals-on-Wheels programs, Area Agencies
  on Aging, hospitals, word-of-mouth
• Specific attempts made to recruit seniors from
  variety of ethnic groups
• Interviews/groups recorded and transcribed
  verbatim

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Findings

• Focus Groups Seniors concerns
• Cost of services is major concern
• Little knowledge of the range of services
  available
• Little or no planning for future care needs
• Most used medical services and did not see the
  value of social services for themselves
• Most saw their children as resources for their
  future needs
• Wanted more assistance with staying healthy and
  less of focus on traditional care programs

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Findings contd

• Interviews with planners/managers
• Saw seniors finances as less of a real problem
  and more of a perception issue
• Saw regulation and institutional policies as
  major barriers
• Found greatest difficulty in suitable
  placements
• Believed there was a great need for case
  management

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Implications

• Hawaii needs more coordination to provide the
  range of services that seniors perceive they need
• Information about advanced care planning is
  urgently needed

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Implications contd

• Options for community-based care are needed to
  deal with the shortage of LTC beds
• Communities need to be involved in the planning
  process
• Support services are need-ed to facilitate
  placement of difficult patients