When I first met the elderly gentleman at an Oahu retirement facility, he sat quietly by himself, paying no attention to the dining room’s chatter or the lunchtime musical entertainment.

That’s probably why the facility’s administrator sat me next to him when I paid a visit to do some research.

The first thing the man said to me was, “I don’t like it here. People sit with the same people all the time.”

photograph Cory Lum/Civil Beat

In the U.S. two out of every three seniors will live in a nursing home at some point.

Cory Lum/Civil Beat

He was still handsome and vigorous-looking, but he had serious memory issues and had trouble tracking our conversation. He was not sure of his age.

After a number of successful years in Hawaii’s entertainment industry, his life began to go downhill financially and emotionally. He ended up living with one of his ex-wives prior to moving into the retirement community.

I asked him why he lived there if he disliked it so much.

“Where else could I go?” he said.

Sad? Sure. But considering what it is like to grow old in Hawaii, he is also lucky. After all, he had enough money to avoid aging in place.

The Only Choice For Some

Avoid aging in place? Really?

Generally we consider aging in place as the ideal, the best way to maintain an older person’s autonomy while giving her the help she needs.

It’s equated with keeping your sense of place in Hawaii, where sense of place is such a powerful force.

This man could not age in place. He really had no place and could not have survived on his own.

But overall, isn’t aging in place the best choice?

Yes, in theory. But we shouldn’t deceive ourselves about how aging in place typically works in Hawaii where theory butts up against a harsh economic reality.

The term “aging in place” has special cultural resonance in Hawaii, where the ideals of ohana and respect for kupuna are so appealing.

But like other issues involving extended families here — child care, for instance — aging in place involves combinations of respect for family and the hard realities of economic survival in the most expensive state to grow old.

Housing for the elderly here is scarce, and what’s available costs so much, particularly as the need for custodial care increases.

In the U.S. two out of every three seniors will enter a nursing home sometime during their lives. Forty percent of people with long-term care needs live near or below the poverty line.

No surprise, the situation is more formidable in Hawaii. The average annual cost of a nursing home room in Hawaii is about 50 percent higher than the national average of about $78,000, and the average person in a Hawaii nursing home pays $26,000 out of pocket.

According to an index that measures elderly needs in Hawaii, an average Hawaii couple over 65 needs from $32,000 to $52,000 a year to stay above the poverty line. That’s far more than the average social security check.

The costs of less-custodial elderly housing facilities are also higher than elsewhere.

These are expensive facilities and there’s not enough of them, creating a housing squeeze. And according to one assessment, Hawaii’s “complicated and confusing” system of care facilities adds to the problem.

Grandchildren Often ‘Unsung Heroes’

So most elderly people in Hawaii have few choices. They may end up aging in place even if it would be better for them to live somewhere else.

They live frugally, rely on their families, and hope that when they become too fragile or incapacitated to remain at home, they find some accommodations, like a small care home that may or may not be licensed.

It’s not really about making the best choice.  It’s “we gotta do what we gotta do.”

At its heart, as it does everywhere, aging in place depends on unpaid caregivers.

Grandchildren all too often have to skip school in order to get their kupuna to the places they need to go. Two working parents, a couple of children with drivers’ licenses — someone has to do it.

Nationally, close to 90 percent of long-term care hours are provided by unpaid caregivers, likely family members. Considering Hawaii’s severe economics and elderly housing shortages, that enormous percentage is likely even higher here.

These caregivers are most likely to be children and grandchildren, most of whom still work or are still going to school. Most of us are aware of how hard that is. That’s why the Legislature passed the Kupuna Care bill that gives some relief to these caregivers.

But that only scratches the surface.

Consider the role that school-age grandchildren play. John McDermott, the state ombudsman for the elderly, told me that they are “unsung heroes” of the elderly care process, particularly on the Waianae Coast.

These grandchildren all too often have to skip school in order to get their kupuna to the places they need to go. Two working parents, a couple of children with drivers’ licenses — someone has to do it.

It is possible to purchase services like home health aides or adult day care, but that’s expensive. And it is hard to get solid, dependable help because it’s hard work with low pay.

When Leaving Isn’t An Option

I still think aging in place is the best alternative. That is what I am doing as I write this, and it’s what I would like to do until, well, until who knows what?

And I can afford to purchase services, including the awesomely expensive high-end senior housing. This makes up for the fact, at least economically if not emotionally, that my wife and I don’t have family living here.

And I can leave Hawaii.

But my situation is so different from the “we gotta do what we gotta do” aging in place process that so many families here face.

“We gotta do …” sounds a lot like the general approach people here have toward surviving in Hawaii.

Keep that in mind, and don’t let those ideas about Hawaii’s respect for kupuna and strong sense of ohana and place conceal this real deal.

In my next column I’ll look at some surprising choices older people from Hawaii make to deal with this problem. It involves a small, isolated Oregon town and a retirement place there where Hawaii folks make up a large proportion of the residents.

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