Lawmakers and advocates for the elderly gathered yesterday to talk about how to minimize the harm to seniors when they are transferred to new care homes.

They hope to prevent cases such as that of a man on the Big Island who died recently from a "broken heart" after he could no longer live in the same care home with his wife of 50 years.

People familiar with the case say the man got depressed and refused to eat after being moved to a different community care foster home because of state regulations that limit who can stay in such facilities.

There are about 900 community care foster homes statewide, which serve a maximum of three seniors each. The homes were intended to serve mostly seniors who rely on Medicaid. The state allows only one "private pay" senior, or those who pay out of their own pocket, per home. At least two of the three beds per home must be reserved for Medicaid recipients.

The separation of married couples becomes a problem in cases where both the husband and wife are "private pay."

Officials at the state Department of Human Services say the Big Island couple never should have been in the home together to begin with, since both were private pay. The couple, whose identities were not released, were separated in February or March after two years of living in the same Hilo care home, said state House Human Services Committee Chairman John Mizuno, D-30th, (Kamehameha Heights-Kalihi Valley-Fort Shafter).

The Big Island man died a week after being transferred to a care home in Honoka'a, Mizuno said.

"It's my understanding that this person was begging to be back with his wife," he said, adding that with Hawai'i's aging population such cases involving couples will come up again and he wants to ensure the state can deal with them properly.

Mizuno stressed that details of the Big Island case are still coming out, but he said the information so far raises questions about how such cases are handled. He said "transfer trauma" is a real concern for not only elderly couples, but those who are living in care homes with relatives or even good friends.

"Transfer trauma occurs when a patient is moved," Mizuno said. "The most severe outcome ... is death."

NEW LAW SIGNED BY LINGLE

The Big Island man died as lawmakers were considering changes to regulations for community care foster homes to address the separation of another Hilo couple, Terry and Sidney Kaide. Those changes were approved by the Legislature and signed into law by Gov. Linda Lingle, allowing the Kaides to live under the same roof.

Under the new law, a private pay couple can live together in a community care foster home if a member of the couple has lived in the home for five years. The foster care home must also have had a vacancy of one of its Medicaid beds for the previous six months.

Mizuno pointed out yesterday that even if the measure had become law before the Big Island man died, he would not have been eligible for an exception. That, Mizuno said, could mean the law needs further adjustment to allow for exceptions. He also said the state needs to gather more information on just how big an issue such transfers are.

The state Department of Human Services declined to discuss the case because of confidentiality requirements, but officials at the legislative hearing yesterday said they are studying the issue. State Deputy Attorney General Cori Woo, who also declined to discuss specifics, said that there are long-term-care options for private pay seniors other than community care foster homes.

Community care foster homes are intended for those who can't live independently, but aren't yet in need of constant care. The state law governing the homes was designed to give priority to low-income patients who qualify for Medicaid. DHS spokeswoman Toni Schwartz said the new law on the care homes gives DHS some discretionary authority.

Under the old law, no waivers to the rules could be issued.

'HE BEGGED AND BEGGED'

Schwartz said it appears foster care homes were breaking the rules (including, apparently, in the case of the Big Island man), when they admitted more than one private pay client. But she said the department is watching the homes more closely in the wake of the new law. Schwartz added that the rules for the homes were made to help Medicaid patients, who were being turned away from adult residential care homes and other facilities in favor of private pay clients.

Schwartz said the only waiver for private pay patients issued so far under the new law has been to the Kaides, whose efforts to live together in their final days spurred the restrictions changes. Terry Kaide, 87, spent about two years pushing for a change to the law to be able to live with her husband in a Hilo care home.

The law was signed April 22.

At the hearing yesterday, two women close to the case of the Big Island man who died talked to lawmakers via phone, calling for more action to prevent harm to seniors when they're transferred. The women spoke on condition of anonymity. One of the women told legislators that the Big Island man "begged to be reunited with his wife."

He called her daily after his move, and eventually fell into a depression and stopped eating, she said.

"This man died from a broken heart," the woman said, "or in your terms, transfer trauma."

Mizuno asked the other woman to clarify when the Big Island man fell ill.

"When he was transferred, that's when his health deteriorated?" Mizuno asked. "Yes, tremendously," she replied.

The woman said the couple had been married for more than 50 years and had never been separated.

"He begged and begged and begged" to be reunited with his wife, the woman said by phone at the hearing.

Lou Erteschik, staff attorney at the Hawai'i Disability Rights Center, said he understands the concerns about separating patients in care homes but is also sympathetic to worries that too many exceptions will give Medicaid patients a disadvantage — going against the original intent of the law. He said some of the problems could be avoided with more study of individual cases.