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.

Fifty-one kilometres of open ocean, with no land in sight for the first hour: that is the reality of the Kaiwi Solo, a 51km (32-mile) outrigger canoe race across Hawaii’s Kaiwi Channel, widely regarded as one of the most demanding open-water crossings in the sport.

“You cannot see a thing – you have no point of reference,” said Alex Hunter. “It is extremely disorienting and unnerving setting off. It’s not until about an hour into the race that you can start to visualise where you are heading.”

Earlier this month, Ekaterina Lukyanets, a 39-year-old software engineer, and Hunter, 38, water sports manager at Victoria Recreation Club, became Hong Kong’s only female and only male participants in the annual event, each paddling the full 51 km alone.

For Hunter, the race had long held a near-mythical status. “It is not a race everyone can enter, and it is not a race everyone can finish,” he said. “That highly coveted nature is what drew me to it.”

After seven years in the sport, including local competitions and a 128km team race in Tahiti, he decided last year that the time had come.

What followed was six months of disciplined preparation: four to five sessions a week, often starting at 6am, with monthly mileage exceeding 400km.

The Hawaii County Council voted 6-3 on Wednesday in favor of passing a long-term public planning document that has garnered significant public outcry, at times described by council members as “personal attacks,” “vilifying comments,” “conspiracy theories” and “AI psychosis.”

Council members Dennis “Fresh” Onishi, Ashley Kierkiewicz and Holeka Inaba all cast “no” votes.

These accusations have eclipsed discussions about Bill 66, which adopts the Hawaii County General Plan 2045. The plan is a 20-year comprehensive policy document guiding land use, growth, public services and transportation on the island. The current edition on the books was adopted in 2005 and has come to the end of its functional lifespan, prompting Planning Department officials to submit a 310-page revision to the County Council in March of last year.

This exhaustive update — referred to informally as the “2045 Plan” — is the byproduct of years of public hearings and comment periods, formed with the input from dozens of meetings and thousands of comments submitted by the public.

The 2045 Plan calls for climate change adaptation, sets goals for net-zero carbon emissions, and restricts growth to urban areas in order to protect rural, agricultural land. It calls for stricter land use rules, provisions for mass transit expansion, and mandates for adopting renewable energy technology.

Available for public review for over a year, the plan was making steady progress until it was sidelined in early March when Kierkiewicz sent her fellow council members a 71-page proposal amending the significantly longer and more detailed plan penned by the Planning Department.

Kierkiewicz submitted a letter to the council two weeks later on March 19 trying to justify the changes, where she claimed the objectives of her “2026 Plan” were the same as the document it essentially replaces.

County officials, including past and present planning directors, pushed back on the alteration. Former Planning Director Chris Yuen criticized the 2026 Plan’s removal of language relating to climate change — among other issues — and testified at Wednesday’s meeting via Zoom in defense of the 2045 Plan in an attempt to set the record straight.

“I’d like to talk about some of the positive features of this plan, and in particular, two aspects that have unfortunately been a little bit controversial, and that is sustainability and climate change,” Yuen said. “Neither one should be controversial. Sustainability is just a word to describe practices that enable us to live in harmony with the environment that sustains us. It’s another word for the Hawaiian term, (which) would be malama aina.”

Arguing that climate change provisions would be indispensable to a planning document governing growth on the island for the next two decades, he reiterated that policymakers should be listening to scientists who’ve been sounding the climate alarm for decades.

“(There) has already been a scientific consensus that man-made climate change is happening,” Yuen said. “These predictions about increasing global temperatures, sea level rise, and extreme weather events have proven very accurate.”

Even so, some testifiers at Wednesday’s meeting voiced stern opposition to the 2045 Plan’s climate provisions. One of whom was Kailua-Kona resident Eugene Elmer, who echoed a common misconception among the plan’s opponents that the document sought to abolish fossil fuels and reduce private property rights.

Elmer directed his animosity toward the five council members who voted May 4 to approve Bill 66 during the Policy Committee on Planning, Land Use and Economic Development meeting.

“To the five council members who voted aye: Do you really think there won’t be repercussions when you start turning people’s land into conservation and telling them what they can and can’t do with their property?” he asked. “Wait till the local braddahs find out you guys like take their diesel work trucks. We will make sure they all find out, and your names will definitely be put on blast.”

Elmer then appeared to make thinly veiled threats against council members considering voting in favor of the 2045 Plan.

“Forcing this bill through will create a level of resentment and hostility in this community that we haven’t seen in a long time,” he said. “I am a peaceful person. But I know this island, and this will push some people past their breaking point. For the sake of peace and unity, please do not create that kind of division.”

South Kona resident Juhl Rayne had similarly hostile words for the five council members who helped pass the bill out of committee earlier this month.

“I don’t know how you’re going to sleep at night knowing that you’re selling out to the elite 2021 UN agenda,” Rayne said. “The only thing that I can figure … (about) how this could be is either you’re being paid off by some corporation or entity, or you’ve been completely brainwashed … or you’re just completely innocent to the idea that that people can be bad.”

Ka‘u Councilwoman Michelle Galimba attempted to address Elmer’s claim that the 2045 Plan would ban diesel trucks.

“There is a strong desire expressed and goals established towards getting away from fossil fuels,” Galimba said about the plan. “I drive a diesel truck, and I’m happy to drive a diesel truck because I need it for certain jobs on the ranch, but I also understand that electrifying our public fleet would be a good thing.”

She said that as a rancher, she’s not concerned that any of the plan’s provisions would threaten her livelihood.

“I’m not afraid that this general plan is going to affect my ability to do what I need to do with my big … fossil-fuel-burning diesel truck,” she said. “I think a lot of people have gotten sort of hung up on particular words, particular policies, and see them as threatening.”

At its core, she said, the general plan would not endanger civil rights or restrict personal choice.

“It is not a coercive document,” she said. “It is a plan for all of us to go in a direction that I think the majority of people on this island want to go in, and I respect those who don’t want to go in that direction, and I don’t think that there is anything in here that will change or not allow you to burn all the fossil fuel that you want in your personal life.”

Kona Councilwoman Rebecca Villegas expressed sympathy for some of public comments, but reiterated that there was nothing sinister about what the council was attempting to do.

“Honestly my heart breaks for some of the testifiers because I see and hear the concern and the fear and the belief systems that this is some kind of a conspiracy document related to a global world order and whatnot,” Villegas said. “Our intention sitting here as imperfect, humble public servants is not a grand scheme for global takeover, smart cities, weather change patterns, all those things.”

Bill 66 will now head back to the full council for a second and final vote.

Email Stefan Verbano at stefan.verbano@hawaiitribune-herald.com.