In Privatization


My brother Chris spends most of his waking time in a wheelchair. He is unable to do basic things for himself. The water he drinks has to be thickened to molasses consistency so he won’t choke. Every word, when he can get the word out, is unintelligible. But look at his eyes. The stroke that devastated his motor skills left his thinking mind intact. His eyes are alive and he is acutely aware of everything around him.

He just can’t tell you about it.

He is the reason my mother, a sister and another brother and I were in the jam-packed community meeting at Leahi Hospital a few nights ago. Chris was parked in his wheelchair in the front row. He couldn’t contribute to the discussions, but he wanted to be there. He wants to be kept in the loop.

So do we all.

I don’t speak in the column as a reporter. This happens to be personal.

The news organizations already have reported that one skilled nursing unit from Leahi Hospital and one from Maluhia will be shut down because of $3.7-million budget shortfall.

The reasons are complicated, but it boils down to money – declining revenue, including inadequate Medicare, Medicaid and state funding.

According to the handout given to us by Hawaii Health Systems Corporation, which oversees the hospitals, this year’s legislative session “closed without funding – none available per State.”

At the same time, costs are increasing, including “unfunded collective bargaining raises.”

And so, 64 employees are either losing their jobs or will transfer within the system, while 76 patients will be moving to different units in the hospitals.

The patients are so fragile – most of them are elderly, many with Alzheimer’s. And all of them, like my brother the stroke patient, need skilled nursing care 24 hours a day, seven days a week.

That’s daunting and expensive. So the emotions in that filled-to-capacity room were overwhelming – concern, fear, anger, confusion, sadness. It’s safe to say everyone felt blindsided.

To their credit, the members of HHSC who were there were quick to reassure patients and families the no one is being kicked out. And there are no plans (“at this time” is the unspoken here) to shut down Leahi or Maluhia. They’ll just take on fewer patients.

Wow. Think about that. They’ll admit fewer patients.

Never mind that Hawaii’s elderly population is growing at a faster rate than the nation’s, or that projections from U.S. Census data shows that by 2030, one out of every five individuals in Hawaii will be age 65 or older.

And never mind that Hawaii’s long-term care bed rate of 22 beds per 1,000 residents age 65 and older is almost half that of the U.S. rate!

So reduce the number of long-term beds in the state? That seems crazy.

Dr. Gary Okamoto is a board member for Leahi and a member of HHSC-Oahu region. He’s also a physician who has spent many years in the field of medical rehabilitation, treating patients with the most severe physical disabilities. He sees Hawaii’s current situation as a crisis in the making.

“When we start reducing bed capacity for long-term care facilities, we really are being very short-sighted,” he says. “If we don’t do a good job in coordinating all of this, what will happen (and actually is happening now) is that the long-term care facilities will begin to cap their admissions because they cannot afford to operate.”

It means a decreasing number of beds for this critical and growing population and that, he says, “will point toward a dangerous situation in this state.

More patients in acute-care hospitals who need this type of 24/7 care will have to be wait-listed until one of the diminishing numbers of long-term care beds becomes available.

So, Catch 22. These severely incapacitated patients end up in hospitals. Then they can’t be moved out because there’s no room at current skilled nursing facilities. The hospitals end up eating the costs. Everyone loses.

And we haven’t even talked about patients who aren’t in hospitals and are still at home with families that can no longer handle them. What do these families do if they can’t afford a private nursing home and can’t find an appropriate government-funded facility?

This is going to put tremendous strains on them.

Cutting bed space at Leahi and Maluhia, says Okamoto, may be necessary in the short term, but, “it’s not even an effective mandate, in my opinion. The community will pay for it in other ways.

I know a lot of you reading this will file it into the “news that affects other people and not me” category.

But I looked around that room at Leahi and saw a bunch of people grappling with some of the scariest questions imaginable – what happens to us when we get old or disabled?

How do we find a safe place for loved ones when we can’t take care of them at home?

And, I thought, this is the tip of the iceberg.

So, yes, it’s personal. But it’s way bigger than my brother’s plight. The crisis is here. It won’t go away just because we slap a Band-Aid on it.

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