David Chong walks six miles each way to see his mother at Leahi Hospital in Kaimuki, where she’s lived for the past five years.

After her arthritis and gout worsened, she was no longer able to live independently, and staying at the state-run long-term care facility has been a necessity, and a lifesaver. Neither David nor his sister were able to stop working and become full-time caregivers, and so they are grateful for the care that the staff has provided for their mom. They feel like the folks who work there are family.

That’s why the recent news of employee cuts, and closing down of the fourth floor of the facility hurt so deeply.

At a meeting at Leahi on July 10, David, fresh from his six-mile journey, met with several other distressed families about the upcoming layoffs, and how they might affect the lives of the people who worked there for decades, not to mention the hardship on those who stay to carry on the extra work. All of the families were worried about the care of their loved ones.

Leahi Hospital

Leahi Hospital, a state-run long-term care facility in Kaimuki, is going to be downsizing.

“I don’t get it,” David told me. “They want to spend over $200 million for a new stadium, but the care of those who were part of the greatest generation, the ones that helped the U.S. win World War II, these are the people that are going to suffer? It just doesn’t make sense. We need more funding for the care of our elderly, not a new place to play sports!”

Leahi Hospital and Maluhia, another long-term care facility in Honolulu, have plans to lay off 64 employees, with notices expected to go out Aug. 1. Some residents may have to be moved to other facilities, others might have their rooms moved to accommodate staffing changes.

In addition, a whole wing of long-term care beds will be shuttered, and new admissions will be halted. The administrative staff is trying to minimize any disruption to patients, but no one can guarantee that more changes won’t be necessary if the financial situation gets worse.

Both facilities are part of the Hawaii Health Systems Corp. They accept Medicaid and Medicare patients for long-term care and will be closing off 76 formerly available beds to patients in need. What will happen when these beds are no longer available?

“Things would be a lot easier if (the Legislature) acted now, not wait for the downstream effects to make it even worse.” — David Chong, son of a resident at a state-run long-term care facility

Ultimately, it may be the reason why mainstream hospitals in the very near future are full and someone you love is sent home because there are no beds left.

When patients are admitted to the acute care hospital, like Queen’s Medical Center, Straub Hospital, Pali Momi, Kuakini, etc., they are treated for their illness, and once medically stable enough, discharged home.

However, in some cases, doctors and social workers find out that the person can’t go home and live by themselves any more. If no family members can take them in and provide the care they need, then the hospital case managers look for facilities to take the patient for long-term care.

It’s not that easy to find care homes that accept patients who can’t pay themselves, and are on Medicaid or Medicare. After all, the reimbursement rates are set by the federal government, and patients can’t be charged any more, even if the costs are higher than what the facility receives. With no way to control how much they get paid, many facilities are facing a never-ending shortfall when it comes to covering their costs.

So, if the hospitals can’t discharge someone to a long-term care facility because there are no available beds, then the hospitals have to keep patients even longer, and yet they are only paid the rate of a long-term care facility.

The average cost of a hospital bed is $2,000 a day.

Long-term care rates are much lower at about $300 a day.

It doesn’t take an expert in math to realize that the dollars just don’t add up. Any one of our hospitals could end up on the brink of bankruptcy if the reimbursement doesn’t cover costs. Then it’s not just an issue with Leahi and Maluhia closing wings and laying off staff, it’s all of our major care facilities suffering the same fate.

At that point, perhaps, the Legislature will take notice. Or maybe not. Based on its appropriations, the Hawaii Health Systems Corp. is expected to lose $50 million dollars this fiscal year. That’s after receiving $117 million already. But the amount of money the facilities have been given is just not enough to care for all of those who need it, and statistically, the numbers of seniors needing help is only going to rise.

Other state-run hospitals have already made significant cuts or plan to do so in the very near future. Kona Community Hospital has already closed its skilled care wing and eliminated 34 positions as of Aug. 1. Hilo Medical Center is looking at doing the same, and also cutting psychiatric and home care services. The consequences may worsen the shortage of long-term care beds even more, by increasing demand if those who previously had home services may need to be admitted to a care home as a result.

Maui Memorial Hospital is in talks to privatize, already approved by the Legislature, in an effort to limit the inevitable service cuts to the community as it is looking at a deficit of $28 million this fiscal year.

None of this makes sense to David or his mother. She is facing the loss of some of the few people left in her life who help to take care of her needs. He’s worried that the staff won’t be able to keep up with so many people leaving, and that it will take someone getting hurt and filing a lawsuit to force the state to intervene.

He hopes the Legislature will make more funds available to care for the neediest in our society.

“Things would be a lot easier if they acted now, not wait for the downstream effects to make it even worse,” he said.

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