Margaret, 88, is a patient of mine, who used to live with her 92-year-old sister-in-law in an apartment not far from my office.

She would take the bus to come see me, and always bring a carry-on suitcase with her instead of a purse. I asked her about it, and she claimed it was easier than carrying a bag, and it also helped her to stay steady with her walking.

That was until she fell down while crossing Beretania Street. After a brief hospital stay, she insisted on going home to her apartment, and didn’t want to go to a nursing home for therapy or anywhere else. She was stubborn, but was of sound mind, and so there was nothing I or any of the other members of her health care team could do about it at that time.

The options available for our seniors in Hawaii are limited, and often not affordable to the average person. Senior rentals have long waiting lists, and usually require a certain level of independence.

Hokulaki Senior Living LLC walkers and wheel chairs. care home elderly. 14 aug 2015. photograph Cory Lum/Civil Beat

Walkers and wheel chairs at a senior living facility on Oahu. More options are essential to meet the various needs and desires of our aging population.

Cory Lum/Civil Beat

Assisted living facilities have popped up in several places, like The Plaza at Punchbowl, and in Waikiki. These locations offer on-site nurses aides and can help with things like bathing and medication. However, the services are costly, and not covered by insurance.

Nursing homes cost even more, and are usually reserved for those who need the most skilled nursing services.

Hawaii offers some unique solutions with the foster home concept, allowing certified caregivers to provide full-time care in locations recognized by the Department of Health and subject to inspection and licensure in order to serve the Medicaid population along with those who have the funds to privately pay for the care. Average costs vary but can exceed $4,000 a month.


A controversial new model of care is emerging in the islands, called “aging in place.” It may skirt the legal definition of a care facility, and in doing so, avoid some of the state’s inspection rules, but it’s a creative option for senior care and deserves a closer look.

We have limited options for seniors in our state and need more creative approaches to providing assistance for those who need it most.

These facilities rent rooms to residents, and services can be provided by other certified agencies. Physical therapy and home health needs can be met by outside providers, but the operators of the home provide care as well. The main issue is the absence of official licensure.

We have limited options for seniors in our state and need more creative approaches to providing assistance for those who need it most.

All across the mainland, there are communities struggling with the same issues. The American Association of Retired Persons has highlighted several of the more innovative options, including the concept of the Village Home.

In this model, members pay a fee to be part of a community that works to create a network of paid staff and volunteers to assist with activities such as food shopping, transportation, technology training and home repairs.

The St. Francis Healthcare System is pioneering this type of care model at its Liliha Campus, and is in the process of creating a senior living facility that will help to centralize services and provide options for everyone of any age to participate.

Keeping seniors engaged with younger generations is essential to avoid the concerns of isolation and loneliness that have proven to be among the greatest risk factors for premature death in the aging population, eclipsing diabetes, obesity and smoking.

All of these care models are helpful, and it’s time to create more alternatives that decrease the burden of documentation and credentialing, along with the years-long wait for approval.

Studies have shown that Hawaii caregivers already provide more than $2.1 billion dollars of unpaid care for their loved ones.

This is done most often by relatives trying to maintain full-time jobs and meet other family commitments like child-rearing. The percentage of old people is increasing, so the number of younger folks able to provide this care will decline.

Margaret and her sister-in-law were providing care for one another, trying their best to retain their independence, but it got progressively harder. After her third hospital stay, Margaret was placed in a foster care home and her sister-in-law was placed nearby.

I still see her periodically and although she’s not living on her own anymore, she has people who are looking after her, and admits that it’s a lot easier than when she had to do her own cooking, cleaning and laundry. She doesn’t need to bring the carry-on for balance anymore and she’s enjoying spending time with the other residents of the house — and with her sister-in-law when she’s able to come by.

It’s not easy to give up living on our own terms, but those of us lucky enough to reach our golden years may all need help in some form or another. Providing more options to our seniors now can only help increase what will be available when it’s our turn.

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