As Hawaii’s population ages and long-term care costs continue to rise, two measures aimed at addressing elder care and dementia support are headed to Gov. Josh Green for signature, but critics say much more help is needed.
House Bills 1804 and 1853, both approved by the Legislature this session, seek to lay the groundwork for future long-term care financing and expand dementia care coordination statewide.
Advocates who have pushed for comprehensive elder care reform for decades say the measures fall far short of addressing what they describe as Hawaii’s looming long-term care funding crisis.
HB 1804 would require the state Executive Office on Aging to develop a framework and scope of work for a future study examining public and private financing options for long-term care services and supports. The bill appropriates $100,000 for the effort and allows the office to contract with the University of Hawaii.
Lawmakers cited mounting pressures on families caring for aging relatives. According to the bill, annual long-term support service costs range from roughly $45,500 in adult foster care homes to more than $200,000 in skilled nursing facilities.
The measure also points to Hawaii’s rapidly growing senior population and the need for a “comprehensive, data-driven evaluation” of sustainable financing models for long-term care.
Under the bill, the Executive Office on Aging must submit a report to the Legislature before the 2027 session outlining the study framework, estimated costs and recommendations for future action, including potential legislation.
Longtime kupuna care advocate Melvin Sakurai said the original proposal was significantly weakened during the legislative process.
“What really happened there was several really critical things,” Sakurai said. “First of all, it was a commission that provided for broad stakeholder involvement and engagement and ownership.”
Sakurai said removing the commission structure and placing responsibility solely within the Executive Office on Aging narrowed public participation in what he described as a multibillion-dollar issue affecting much of Hawaii’s population.
“Any initiative that comes out of this thing is going to be multibillions of dollars,” he said. “You need to have community ownership and consensus building and involvement in that.”
Sakurai also questioned whether the Executive Office on Aging has the expertise and capacity to oversee such a complex effort, pointing to delays in producing a state master plan for long-term care previously assigned to the office.
“They haven’t shown leadership, they haven’t produced, they have no experience or expertise, despite what the bill says, in the area of public financing,” he said.
Still, Sakurai said the bill retains “a modicum, a tiny fragment of functionality” because it begins a formal process that eventually could lead to outside actuarial studies and financing proposals.
“If everything goes perfectly with no delays,” he said, “it will take 12 years before the first dollar can be paid out.”
Former Hawaii first lady and kupuna care advocate Vicky Cayetano said supporters were disappointed by amendments made to the bill late in the session.
“The concern is that to an extent it was modified so that we are questioning how efficient this whole outcome will be,” Cayetano said. “They just wanted to say we got this bill done to address long-term care, even if it’s not going to result in anything.”
Cayetano said policymakers may be reluctant to pursue large-scale financing proposals because of the significant costs involved and concerns about maintaining dedicated funding over time.
“This issue impacts more people than any other issue,” she said. “Other than the multimillionaires and billionaires, everyone else is going to be impacted by this subject.”
The second measure, HB 1853, would establish a statewide Hanai Memory Network Program within the Executive Office on Aging to improve dementia screening, care coordination and caregiver support.
The bill appropriates $3 million for fiscal year 2026-2027 to support dementia care specialists, memory clinics, referral systems, provider training and a public-facing resource website.
Lawmakers cited projections showing Alzheimer’s disease could affect more than 62,000 Hawaii residents by 2050. Medicaid spending tied to Alzheimer’s care in Hawaii rose from $240 million in 2020 to $309 million in 2025, according to the bill, and could approach $1 billion annually by 2050 without intervention.
The legislation also notes that memory care can cost families more than $15,000 per month.
The bill references the planned Hanai Memory Network initiative supported by the Alzheimer’s Association, which aims to improve early diagnosis and reduce crisis- driven care.
Sakurai criticized the measure as another example of fragmented programming that does not address the larger financing problem.
“While the issue of dementia care and the need for coordination certainly merit attention, this kind of initiative is exactly the kind of incremental programmatic deflection that fundamentally and detrimentally ignores the foundational issue of paying for (long-term services and supports),” he said. “We don’t need more program ideas — we need money.”
Both bills would take effect July 1, if signed by Green.
