More than two dozen elderly care facilities in Hawaii have been affected by COVID-19, according to data released earlier this week, prompting calls from kupuna advocates for a more concerted effort to prevent infections at care homes.

As of July 31, there were 23 cases associated with six different elderly care homes and four deaths. On Tuesday, less than a month later, the case count had quadrupled to 94 cases across 28 different facilities as new cases continued to emerge in the islands, especially on Oahu. Those cases have resulted in 27 hospitalizations and six deaths.

“The cases are much worse than we had imagined at these long term care facilities,” said Keali‘i Lopez, director of Hawaii AARP.

The Department of Health made public for the first time Tuesday more details about COVID-19 in long term care facilities and community care homes. It’s unclear how regularly they will provide this information. 

Nearly half of cases associated with care homes have been workers at the facilities. The health department still refuses to publish the names of the care homes affected.

Health officials told Civil Beat last month that in many of the cases, caregivers have unwittingly introduced the virus to smaller care home households after contracting it in the community.

Lopez said the information released Tuesday highlights the need for more heightened attention to caretakers and kupuna, especially if the state wants to avoid running out of hospital beds and intensive care units.

“We’d like to see the state do more to be proactive and maybe overreact a little and scale back rather than continue to play catch up,” she said.

Hawaii Democratic Convention Chair Kealii Lopez2.
Hawaii AARP Director Keali‘i Lopez says the state needs to do more to prevent COVID-19 in long term care settings, especially smaller residential care homes. Cory Lum/Civil Beat

In Hawaii to date, slightly more than 5% of all people diagnosed with COVID-19 have required hospitalization. By comparison, the new DOH figures show nearly 30% of people who contracted COVID-19 in long term care settings were hospitalized.

The new figures do not specify if the people hospitalized were patients or staff, but generally hospitalizations have been among the elderly, according to Lt. Gov. Josh Green, an emergency medicine physician and the state’s COVID-19 medical liaison.

More cases among kupuna could easily inundate Hawaii’s limited hospital capacity, Green and Lopez said.

The number of people hospitalized in Hawaii has nearly doubled in two weeks, from 105 to 201 people hospitalized as of Thursday, according to Green.

Wahiawa General Hospital could become a dedicated spot for long term care facility patients with COVID-19. Hospital CEO Brian Cunningham confirmed Thursday that the hospital is in the process of expanding its COVID-19 dedicated unit. Approximately six patients are already under care there. The hospital has already received transfers of non-critical COVID-19 patients from other hospitals on Oahu such as the Queen’s Health Systems.

“We’re trying to stay as flexible as possible,” Cunningham said, noting that the hospital is willing to take kupuna from care homes, nursing facilities and other COVID-19 patients if needed, but will be limited to about 36 patients at maximum capacity.

Facilities Unable To Meet Federal Testing Mandate

At the end of July, officials with the federal Centers for Medicare and Medicaid Services said they would begin requiring all federally regulated nursing homes in states with high positivity rates — more than 5% of COVID-19 tests are coming back positive — to start testing all of their staff members weekly.

The new testing requirement will enhance efforts to keep the virus from spreading through nursing homes by identifying asymptomatic carriers, CMMS said in a release.

At the time, Hawaii’s positivity rate didn’t reach that threshold, but the weekly average of positive tests has been more than 5% throughout August.

The new mandate is supposed to come with support for equipment and supplies, but the state is still waiting on federal help and doesn’t have the capacity locally to assist long term care facilities with regular staff COVID-19 testing.

Wahiawa General Hospital Trauma Emergency Room.
Wahiawa General Hospital may be making room for elderly COVID-19 patients. Cory Lum/Civil Beat/2019

“They prioritized sending devices to so-called hot spots, and while our infection rate has been going up, in terms of our nursing facilities, we’re still doing very well overall,” said Hilton Raethel, president and CEO of the Healthcare Association of Hawaii.

The U.S. Department of Health and Human Services indicated this week it will send Hawaii facilities point of care testing and equipment by the end of September, according to Gov. David Ige.

The federal department indicated about $170,000 could be distributed per facility, according to Raethel, but that would be insufficient to cover repeated rounds of weekly testing of all staff, not to mention testing of all patients or residents.

“That sounds like a lot of money but the reality is that if you’re talking about testing everyone in a facility, depending on the size, each round of testing could be in the range of $100,000,” Raethel said. “That’s probably a little less than two rounds of testing per facility.”

It remains unclear if smaller operations such as community care foster family homes, which are under state oversight, will also be eligible for such grant funding. Throughout the pandemic so far, smaller care home operations have been left out of much of the federal COVID-19 relief funding.

Hale Makua Health Services CEO Wesley Lo is dealing with COVID-19 cases firsthand.

Hale Makua staff are currently monitoring two elderly COVID-19 patients who initially tested negative for COVID-19 when discharged from Maui Memorial Medical Center. It took additional testing of the newly admitted residents to find the infections. The kupuna are stable and don’t have symptoms, according to Lo.

Lo, who chairs the Healthcare Association of Hawaii’s long term care committee, said testing supply chains have been unreliable and severe outbreaks on the mainland have affected testing turnaround times in the islands.

In prior months, other nursing facilities have tested all staff and patients as a precaution. Most have not conducted that sort of mass testing of staff regularly because it’s too expensive, he said.

Hale Makua is screening people for symptoms regularly and testing people who have been in contact with someone with the virus. The facility doesn’t have the resources to conduct such regular surveillance testing, he said.

Facility administrators would love to test regularly, but simply can’t afford it, Lo said. As a result, the new mandate poses a further burden on the survivability of smaller care homes, he said.

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