globalag.igc.org/health/us/2006/Hawaii.htm -
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Published on: 1/17/2006
Last Visited: 3/9/2007
"If you look at the lack of resources we have, we're barely able to keep up with the frail elderly now," said Tony Krieg, chief executive officer of Hale Makua, which operates nursing facilities and other programs for seniors on Maui.
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All states are in trouble because an increasing number of people are turning to the government's Medicaid program as the answer for long-term care, said Krieg, also chairwoman of the Long Term Care Division of the Health Care Association of Hawaii and of the Maui Long Term Care Partnership."It's going to bankrupt the country ... if we don't develop more innovative ways, at different price points, to take care of frail and vulnerable people," Krieg said.
Proposals have been made to extend the three-year waiting period for people to apply for Medicaid after transferring assets to heirs or others, he said.Hawaii and other states also are looking for ways to manage Medicaid dollars more efficiently, Krieg said."The state response will be to limit eligibility and turn it (the system) over to the private sector to make it cost less."The next two or three years, I think, will be somewhat revolutionary," Krieg said, explaining that privatization of the system can be beneficial if incentives are created to develop more home and community-based services."People need to be able to make choices at different price levels, and they're not available."
In 2000 the state population over age 85 was 17,983.By 2020 it will number 38,867, Krieg said.The population over age 70 will jump to 185,000 in 2020 from 119,000 in 2000.Yet, rural Hawaii has fewer than 18 beds per 1,000 population over age 65, compared with an average of 62 beds in rural areas across the mainland, he said.Urban Hawaii has 23 beds per 1,000 senior population, while the U.S. urban average is 47 beds.
As a result, hospitals have patients they are no longer getting paid for, Krieg said.
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Krieg said more than 80 percent of nursing home costs, on neighbor islands especially, are from Medicaid reimbursements.Free-standing nursing homes are losing $9.25 per patient a day, and hospital-based nursing homes are losing $24 per patient a day, he said.He said managed care can be good if nursing homes are paid based on the care required, rather than one payment per average client, and if more home and community-based services result from privatizing the system."The state needs to establish a floor," he said."What we're concerned about is private companies will get a contract with the state and be free to negotiate whatever they can, how low they can go, with nursing homes.Many of us are already in trouble."
Nursing homes are also worried about where they are going to get labor, especially on the neighbor islands, where they are competing with industry, Krieg said."As baby boomers approach old age, the pool of women providing care in homes is going to be substantially smaller."He said 70 percent of the cost of nursing home care is for labor because highly skilled professional nurses and social workers are required.Requirements are not as stringent at care homes and assisted-living facilities, he said.
Some nursing homes were converted to other settings in states where Medicaid was privatized, Krieg said."I think we're going to be forced to consider it."Krieg said long-term care facilities should "take a lesson from the disabled community" and find ways to use technology to help provide care.Regulators and payers are going to have to work with providers to look at technology because of the labor shortage, he said.For instance, he said, home health nurses travel 45 miles from Kahului to Lahaina on Maui to visit someone discharged from a hospital.Reimbursement needs to recognize that with technology, nurses can take vital signs and visit places remotely without traveling there, he said.
Krieg heads Hale Makua, a 60-year-old care program that started during World War II.The plantation hospital in Wailuku was converted to a modern 124-bed nursing home in the early 1960s.Another 120-bed facility was developed in Kahului in 1978, and 118 beds were added to it in 1996, thinking it would take 10 years to fill them, Krieg said.They were full in three years, mostly with Medicaid patients, he said.
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