COURTESY PHOTO Dentists Dr. Chris Igawa and Dr. Patsy Fujimoto provided free oral screens last September for the participants at the Early Signs Health Fair at Life Care Center of Hilo. Fujimoto has provided this service for five years and Igawa for the past two years.

Patients wait to get long-term care

The four Life Care Centers in Hawaii are trying to change the image of a nursing home as a place to go to die, says Fred Horwitz, regional director of Life Care operations within the state.

"We are taking a lot of pride in bringing folks in for skilled or rehabilitative services and sending them back into the community," said Horwitz, also executive director of Life Care Center of Hilo.

"Old-fashioned aloha with modern rehabilitation is our motto."

Hawaii's 50 licensed nursing homes last week celebrated National Nursing Home Week.

"It provides the opportunity to showcase the lives of the residents in a nursing facility setting," said Coral Andrews, Healthcare Association of Hawaii vice president for long-term care. "Culture change within the industry has encouraged nursing facilities to evolve to a more home like environment of care."

The facilities have 4,186 licensed beds and average 94 percent occupancy, Andrews said.

Many long-term care patients are in acute hospitals ready for discharge and stuck there waiting for an appropriate community placement. Legislation to deal with the waiting list problem didn't clear the legislative session because of the state's shrinking economy, Horwitz said.

Two Life Care Centers are located in Hilo, one in Kona and one on Oahu in Kapolei. "We've seen occupancy rates climb and more demand for inpatient services," Horwitz said. Patients are more frail and require more nursing care, he said.

Horwitz said he and other baby boomers are concerned about how government is going to meet their needs for long-term care. He advocates long-term care insurance, saying nursing homes cost from $85,000 per year to more than $100,000 for private pay.

The saddest thing he sees, he said, are elderly folks who worked hard all their lives to stay off welfare and suddenly have to give up all their assets and go on Medicaid in the last years of their lives to pay for long-term care.

Lanai Community Hospital, which just celebrated its 40th anniversary, is a different example of long-term care in Hawaii. It has Lanai's only long-term care beds -- 10 out of 14 the hospital's private inpatient rooms.

With plantation workers aging, the hospital could use 10 more long-term care beds within the next few years, said Mary Catiel, who has been at the hospital 34 years and is nursing director. "Now, we're having wait-list patients. ... and on this island there are no care homes and no other nursing homes."

Some patients stay more than two years -- one 10 years -- but the average is about 1.5 years, Catiel said.

She said the hospital, built in 1968 and staffed by six full-time nurses, is the smallest in Hawaii, "or, as my boss likes to say, the 32nd largest."

It doesn't have a rehabilitation program but has "very good nursing restorative care," she said. "We're not very progressive, but we're very good."

The hospital doesn't have surgery capabilities, a CAT scan or MRI (magnetic resonance imaging), and it doesn't do special laboratory tests or deliver babies unless it's an emergency, she said. The neighboring Straub Clinic provides physicians under contract,

She said the hospital needs to expand its emergency room, which has 70 to 100 patients per month. With no freeways and a 45 mph speed limit, "Thank God we don't have a lot of that (accidents)," she said. "But we have two five-star hotels. People get hurt every day."