long-term care - Legislative Reference Bureau

Chapter 1
INTRODUCTION
Senate Concurrent Resolution No. 33 and Senate Resolution No. 27: Senate
Concurrent Resolution No. 33 (Appendix A) directs the Bureau to study "the merits of
establishing a single entry point for long term care services used by elderly adults and
families of disabled children and disabled younger adults in Hawaii." The Bureau "may use
models of systems from other states in exploring a system appropriate for Hawaii's
environment and population."
The two Resolutions state that:
[A] "single point of entry" for long-term care services is a method which may
simplify access to long-term care services because it provides a local or regional
access point where consumers receive information and assistance, assessment of
needs, care planning, and authorization of services.
The Resolutions further elaborate that a single entry point ("SEP") also involves
"helpring] individuals become aware of the services available." The focus of the Resolutions
appears to be improving access to the system. From the perspective of potential consumers,
this means an easier, simpler, and faster way to get at long-term care services. From the
State's point of view, it may also mean a more efficient way to deliver services.
Limitations and Focus of Study: Both Resolutions specifically recognize that an SEP is
"only one component of a comprehensive long-term care system." This is a vel}' important
point. The focus of the Resolutions, and therefore of this study, is a single entry point system
and does not encompass the entire panoply of issues of interest in the long-term care field.
Any long-term care system, even if targeted to just one discrete population such as the
elderly, is hugely complex and multi-faceted. These complexities are compounded by the
addition of two other categorical populations: disabled children and the disabled non-elderly.
The many components, precisely because they form part of a system, are necessarily interrelated
and inter-dependent. Therefore, it is only natural, upon examining one component, to
want to look at the next related component. However, the Resolutions clearly did not intend
for an all-encompassing exegesis of a comprehensive long-term care system to be done and,
thus, none is attempted.
Although this study focuses on access to a care system which happens to be longterm
in nature, interesting long-term care issues abound, however tangentially related to the
concept of an SEP. Worthy though they may be, many issues, including those listed here,
are examined onfy if and to the extent that they shed light on a single entry point system:
• The philosophical differences between long-term institutional care and
community- and home-based long-term care support services; and differences
within the community- and home-based model itself, for example, the merits
of using support services in congregate housing vs. group homes vs. ownhome
situations.
• Long-term care reform: the merits of private vs. public strategies, including
the use of private continuing care retirement communities, capitated,
managed care, sociallhealth maintenance organizations, individual medical
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