Saturday, April 24, 2010



I ran across Ruth and Boomer at a nursing home one day and I was confused as to who was whose master/mistress. It certainly appeared that Boomer had the upper hand and was training Ruth for a higher calling in life.

Boomer teaching Ruth to give proper commands

Boomer acquired Ruth when Ruth retired from the Department of Defense where she supervised material for the Department of Logistic Agency in the storage section at Pearl Harbor. Her primary mission was to support the War Fighters to make sure that their material needs were met. When she retired after 28 years, her husband acquired Boomer, a wire hair Jack Russell from Australia for her.

Boomer, at 8 weeks old, set his sight on training Ruth to do his bidding so he could provide pet therapy for patients at care homes and hospitals. Boomer has been providing pet therapy at Pearl City Nursing Home for 2 1/2 years and at Straub clinic for 1 /2 years. Boomer is now a very young 3 1/2 years old so he has a very bright career to look forward to.

Ruth's mom was a patient at Pearl City Nursing Home and that's where Boomer decided to begin his career. He was impressed with the staff and saw that they took very good care of Ruth's mom so he insisted that he begin his career there. The Kaneohe resident's mom passed on about 6 months ago but Boomer insisted on continuing his therapy work there in gratitude for the work that the staff there did. I have personally observed the same gratitude expressed by other family members of patients at P.C. Nursing Home.

Boomer has fun teaching Ruth new tricks because he sees her as very bright and it only takes her a couple of days to learn things. He somehow knows when someone isn't bright enough to learn tricks because while he doesn't show outright disdain for me, he politely ignores me when he sees me. Probably because he plays the piano better than I do. It helps that he loves and admires Ruth.

Next up is teaching Ruth how to give commands so he can show off his agility skills.

Saturday, April 17, 2010



Some of you couldn't pass the entrance test for Farrington High School so had to go to Punahou or Iolani. I can tell from the comments you've made.

Mostly, many are concerned about costs to care for the elderly. Some financial planners, social workers, lawyers and other professionals regularly urge clients to transfer their wealth to their children so that they can then qualify for Medicaid. Medicaid is welfare. This is fraudulent practice. And if someone recommends these types of actions, you should turn them in to the authorities and have them prosecuted to the full extent of the law.

Sparky, an 85 year old, visits his wife daily at the nursing home. He's unable to care for her at home but is able to spend time with her every day and makes sure that her needs are met. He also helps with other patients.

There is a difference, however, if someone transfers assets or control over assets to family members or to a charity to lower estate tax obligations. That is a legitimate planning move. The estate owner still has sizable amounts left to pay for his/her own long-term care so is not making such transfers in order to fraudulently qualify for welfare.

When a person transfers all of his assets to the children, other problems surface besides the fraud issue. The first, is that the person making the transfer loses his/her dignity because he/she becomes an instant pauper. They say that the difference between an elderly gent and an old man is money. That's because the elderly suddenly becomes a dependent and loses his position of respect and leverage in the family and societal structure. I'm aware of parents who are forced to live in, and take their meals in a single small room and not be allowed to eat with the rest of the family after giving their house to their children. Parental abuse like this is rarely reported because parents don't like to sue their children. And, children are often seen as being saints for "allowing the parents to live with them".

Then, problems between siblings often arise when one sibling has to take on the responsibility of caring for the elderly parents. That sibling/caregiver quits working and often has to pay for the elderly's medical needs and drugs out of his/her pocket. Suppose a person makes $50,000 a year. Becoming a fulltime caregiver means that the person loses that income. Further, drugs and out-of-pocket medical needs may cost another $12,000 or more a year. That caregiver should be entitled to take some of the assets and income the parent has, to compensate for the losses.

That's when greed surfaces. Siblings may not understand that the previously well-to-do caregiver/sibling is losing money and assets. Or don't care to understand that, because they have their eye on the potential inheritance from their parents. Or, siblings may have spouses who resent that their future "inheritance" is being spent by the caregiver. Sometimes lawsuits are filed. And, if it doesn't get to that stage, lawsuits are filed after the death of the elderly parent(s) causing financial and emotional grief that continue for years after the passing.

It is common for the caregiver to have to hire someone to cover for respite periods to allow the caregiver time to rest and take care of other chores required for daily living. If one hires a person for $10 an hour, 10 hours a day for 7 days a week, that comes up to $36,400 a year. The caregiver is now an employer and must also pay for workers comp insurance, unemployment insurance, Temporary Disability insurance, Social Security Taxes, Medicare taxes, provide medical insurance, etc. on top of the $36,400. Failure to do so exposes the caregiver to prosecution for tax fraud and breaking employment laws. Further, the "employee" may sue the caregiver for unemployment, worker comp claims, etc. after legal counsel advises of these entitlement possibilities. We can assume the actual cost to hire respite help to be about $65,000 annually if done legally and properly.

The caregiver is also exposed to lawsuits by siblings or other family members because accidents happen and often, the elderly falls regardless of how careful the caregiver is. The caregiver must spend money defending against such lawsuits and if proven to be negligent, must pay the judgment as well as the legal fees. Homeowners insurance generally won't cover such lawsuits, especially if it can be proven that some money is paid to the caregiver even if the money is used for the benefit of the elderly parent. The money exchange may constitute a business transaction.

Sometimes the elderly parent may not wish to release money to the caregiver because parents want to treat each child fairly and if money is given to one, then, in all "fairness", the same amount must be given to all the children. Sometimes, they even want to keep their assets intact so it can be a legacy for themselves and want all assets to be given to the grandchildren so they would be remembered fondly. The elderly often loses perspective and logic.

The solution is for thorough and complete communication among all interested family members and regular meetings should be conducted with each party receiving complete minutes of such meetings and that all financial matters be disclosed.

Some will still sue, but at least the documentation is there for the caregiver's defense. And, in most cases, there is a lifetime resentment that develops among the siblings because everyone can only see things from his/her perspective. The caregiver usually loses. As does the kupuna who has to witness the family greed.

Saturday, April 10, 2010


O.K. I'll be a pinhead. But only this once... or twice.

I've received a bunch of emails on the series that the Advertiser ran on the elderly. Seems like readers believe that I'm advocating for more regulations by the state because I've posted the link on my personal profile. That is far from the truth. So I'll explain.

Don Having fun with patient in nursing home

I'm a proud Graduate of Farrington High School so I know lots of things. I was on full scholarship because I don't recall paying any tuition. Whatever I don't know, I readily make up. So I'll give you the real scoop.

The more government involvement, the more long-term-care costs will be. And the fewer choices will be available to those in need of the services.

Here's the Advertiser series:

Currently, charges run from $50 a day for adult day care (must be ambulatory) to $300 a day or more for acute nursing care. In between are facilities with charges based upon the amount of care the patient requires.

Let's examine some of the factors that go into the cost of running a care facility. A certified nurse's aide (CNA) gets paid about $10 an hour. We'll use this figure because I'm not very bright and it'll be easier for me to do the calculations.

The facility needs to generate revenue equal to twice that amount in order to break even. That's because they have to pay for worker compensation insurance, Temporary Disability insurance (TDI), Unemployment insurance, medical insurance, Social Security and Medicare premiums. There is also the cost of professional liability insurance in addition to the comprehensive general liability insurance premiums on the operation and premises.

The facility also must pay for support services, including supervisory costs, rent or facilities costs, etc. If the State increases the regulatory requirements, then those reporting and administrative costs must also be added to the cost of operations. Labor to fill and maintain file cabinets costs money.

Generally, regulatory costs are included in the licensing fees by the state and that is charged to care operators. I'm not sure it includes the costs to operate both the licensing board and the Regulated Industries Complaints Office (RICO). But increased rules and regulations also increases the State's cost to inspect, examine complaints and to issue judgments.

Once a report goes to a state agency, the state has culpability and must examine every report in detail. Many want more regulation because the State is considered to have "deep pockets". So if a State employee is paid $15 an hour to examine paperwork, they need to increase tax/fees revenues by 250% of that amount because of the generous employee benefits programs that the state offers. The amounts paid out to settle lawsuits are charged to taxpayers.

And these additional costs are passed on to the consumer by the facility or the facility goes belly up.

Here's a solution if anyone cares.

Require each facility to completely disclose everything to each entering resident/patient. If they do not carry professional liability insurance, or if they have very low limits, then that should be a part of the disclosure and written agreement. You can even be named as "additional insured" on the liability policy so if the policy lapses, you would be notified.

A clearing house could also be set up to register the number of complaints (not anonymously) each facility receives. This could be set up by the professional association and be available online. The data gives a prospective patient relevant facts to make an informed decision.

The result is that each person (or appropriate family members) entering a facility, having received such complete disclosure takes responsibility for the choice made. If they decide to choose a low-cost facility by selecting a facility that shaves costs, then they are entering into the agreement with their eyes wide open. This gives people a wide range of choices on the already shrinking supply of care facilities.

Lawsuits are also remedies open to patients and families of patients. If the care home operator doesn't carry professional liability insurance, you may want to ask them to provide you with a financial statement prepared by a CPA to determine if assets are available should a lawsuit is necessary. Or not. Your choice. Everyone has choices and is responsible for his decisions.

If the Advertiser article still bothers you because you believe that it advocates for more regulations instead of being fair journalism, then you may want to stop buying the newspaper.

Freedom with individual responsibility is wonderful.

Sunday, April 4, 2010



I ran into a very skillful harmonica player the other week, Don Nakama. It turns out that Don, at the young age of 79 has been playing this instrument for over 50 years. It wasn’t until about 10 years ago, though, that he got serious about this instrument and learned from Hoshi Sensei, how to also play by reading music. This stepped Don up into another level as a musician.

Shiro Matsuo, Tony Kawasaki (hidden), Don Nakama and faithful wife Kay in background

Don has been entertaining at senior citizen groups, nursing homes, and adult day care centers for over 10 years. As part of his show, he also sings, tells jokes (he tells me nobody laughs) and even does magic in addition to his great harmonica playing. The day I caught up with him at Pearl City Nursing Home, he even had a celebrity guest playing the ukulele and singing. The dapper Shiro Matsuo, the saimin king. Both were having a ball entertaining the patients there.

Don also brings his wife Kay along, I suspect, to impress her of his skills and sometimes brings his own sound man, Tony Kawasaki to mix his sound. He regularly entertains at Pearl City Nursing Home, Pearl City Hongwanji adult day care, Waipahu Day Care and Wahiawa Hongwanji.

Don is a farmer and still operates his farm every day, Don Nakama Farms, where he grows papayas, bananas and avocados. In fact, he makes his rounds every week at the Leeward Farmer’s markets in Wahiawa, Waipahu, Waiau and Waikele. If you don’t see him there, he likely has sold out his inventory for the day and went home.

If you do see him, ask him to play a few tunes or show you some of his magic tricks. I’ll bet he accommodates you.