The Hawaii Department of Health is revamping how it provides services to COVID-19 patients who are trapped at home and in need of food or another place to stay.
Local service providers and community leaders have been overwhelmed with calls from patients who can’t leave their house because they tested positive but don’t have access to food and medicine, and are infecting their family members because they can’t isolate within their own homes.
“What I see is that there’s people getting infected and then there’s no place to go so you just have to stay with your family,” said Tina Tauasosi-Posiulai. Like many Pacific Islander community advocates, she has been spending her evenings delivering food to people within her community who are sick.
She heard from one Pacific Islander family where the father slept in his car to try to keep his five children from getting sick. They waited days to hear back from the state for help and finally got a call Thursday.
“If there’s $50 million, why is it a problem to get a hotel room for quarantine?” she asked, referring to the federal money flowing into the state to help manage the pandemic. “Where’s the $50 million? Why aren’t we using this to help these people?”
Edward Mersereau, deputy director of the behavioral health services administration, said the delays thus far haven’t been due to a lack of hotel rooms but rather how the state manages providing support services amidst a sharp rise in cases. He wants to turn things around.
The state is trying to avoid situations like Tauasosi-Posiulai described by shifting the responsibility for the response to Mersereau’s behavioral health services branch that normally works with people who are disabled, mentally ill or struggling with substance abuse. Two weeks ago, the division started taking responsibility for providing services to COVID-19 patients in need, a role that previously was split among other Department of Health branches.
It’s a work in progress.
“We are building the response system kind of as we speak,” Mersereau said.
He said the state is averaging at least 250 calls per day from people who need some kind of COVID-19 support services and placing 10 patients per day on average into hotel rooms to isolate.
In many ways, Mersereau’s division is a natural fit for this job. Staff there regularly work with case management agencies and nonprofits that provide meal services. Earlier in the pandemic, they were focused on housing homeless people and others with behavioral health challenges.
The behavioral health division is still coordinating with neighbor island health offices and the City and County of Honolulu, which is in the process of contracting with a 130-room hotel to house COVID-19 patients.
Mersereau said his goal is to provide services to coronavirus patients in need within hours, not days.
“I keep telling my team that rapid response is the key,” he said. “We take care of people first and we figure out the details later.”
The shifting of responsibilities comes as Hawaii coronavirus cases top 6,000, most of which are on Oahu. Patients get tested in hospitals, at community health centers or drive-thru testing sites, and sometimes return home to crowded households anxious about infecting their loved ones.
After their test results come back, the Department of Health is supposed to reach out to them to offer support. But that hasn’t been working well this summer.
Mersereau said up until two weeks ago, the health department’s Disease Outbreak Control Division was trying to investigate cases before offering support services to COVID-19 patients. But as cases climbed and investigators became increasingly overwhelmed, delays grew. According to service providers, the delays led to more people getting sick within the same household, compounding the problem.
Mersereau said investigating cases before providing services worked when cases were low but as they started to spike, some patients were waiting as long as a week to hear whether they could be separated from their families.
He said it was also confusing that the responsibility for providing services on Oahu was split between the health department’s Public Health Preparedness Office and Disease Outbreak Control Division, both of which have been overwhelmed.
The Disease Outbreak Control Division has been focused on posting daily case counts and tracking the virus, while the Public Health Preparedness Office is also trying to work with hospitals on their surge planning and managing the distribution of personal preparedness equipment.
Conversations about shifting responsibilities to his division started in July, Mersereau said.
As the department figured out what to do, community leaders and community health centers were stepping up to address the needs. At Kokua Kalihi Valley Comprehensive Health Services, a community health center in Kalihi, staffers have been working to help COVID-19 patients and elderly people who can’t easily leave their homes. Every week they deliver hundreds of meals and other necessities: cleaning supplies, hand sanitizer, masks, diapers, medication and water.
But service providers say they started noticing improvements last week. On Thursday, KKV staffers called the state about a COVID-19 patient and her child who didn’t have anywhere to stay. The state responded within an hour and provided them with a room.
That’s encouraging but it’s still not the norm, says Megan Inada, a research coordinator at the clinic who now spends her days delivering food to families.
“We still hear painful stories of patients saying ‘I never got contacted and now the rest of my family is sick,’” she said.
Ideally, Mersereau wants his team to respond to COVID-19 patients within three to four hours.
Mersereau says patients who are tested for COVID-19 should tell their health providers immediately what their home circumstances are, such as if they share a bedroom or bathroom with other people, and health providers should contact the Department of Health.
“Physicians I think can and should be taking more of a role of identifying when a person should quarantine and isolate,” he said. “I think the Department of Health definitely encourages physicians to try to be part of that conversation with the Department of Health. Ultimately it’s the physician’s patient.”
The DOH can help arrange isolation for “anybody who cannot for whatever reason isolate and quarantine on their own for their own safety and the safety of those in their household,” and can help provide food and other support for “anybody who doesn’t have support systems on their own to get food delivered to them,” Mersereau said.
Mersereau says he’s still working on ensuring that people who don’t speak English fluently will be able to have access to interpreters when they call. The state has struggled to provide interpreters for people calling the unemployment office.
He also plans to meet with leaders in the Native Hawaiian and Pacific Islander communities Monday. State data shows non-Hawaiian Pacific Islanders are disproportionately sick from coronavirus, and so far, leaders were disappointed after meeting recently with Sarah Park, the head of the Disease Outbreak Control Division.
Mersereau says the whole response is a work in progress.
“If we seek perfection in this response we’re never going to find it,” he said. “There’s going to be mistakes, there’s going to be balls dropped. You drop a ball you figure out how to pick it up. That’s progress.”
• People who are sick at home with COVID-19 and need assistance can call 211, an Aloha United Way number that connects people with a range of support services.
• The City and County of Honolulu has an information hotline 768-CITY and an email address: firstname.lastname@example.org. The Disease Outbreak Control Division can also be reached at 586-4586. After hours, people can call 600-3625 for general information.
• COVID-19 patients who need support or their service providers can also call 832-3100 to reach Department of Health staffers.
This story was produced with support from the USC Annenberg Center for Health Journalism National Fellowship and its Dennis A. Hunt Fund for Health Journalism.
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