RIP, Extended Care Facility?

Administrators of East Hawaii’s hospital system began last week to publicly build a case for the possibility of shutting down the Extended Care Facility at Hilo Medical Center.

Members of the East Hawaii Regional Board of Hawaii Health Systems Corp. agreed at their regularly scheduled meeting Saturday that they weren’t ready to shutter the 50-year-old facility yet. Rather, they intend to maintain its current admissions policy until they have a better idea of the region’s needs.

However, at a public forum later in the day, HHSC East Hawaii Regional CEO Dan Brinkman provided attendees with data collected in the past year showing that the newer, more spacious Hale Ho‘ola Hamakua long-term care facility in Honokaa could likely absorb all of the region’s “safety net” extended care patients currently served in Hilo while providing them with better quality care.

“One of the most important parts of our mission in East Hawaii is to care for our kupuna, and we really, strongly believe that they should have quality care and housing — the best that’s available in our region. We don’t take that lightly,” he said. “… This wonderful facility (Hale Ho‘ola Hamakua), we believe, could serve as the region’s primary long-term care facility. It’s attractive, it’s modern, it has a long tradition of great care, it has high resident satisfaction. And ultimately, using this facility means that it will help ensure the viability of the community, because we are the largest employer (in the area). It would be a waste to not use this great asset.”

In July, Hilo Medical Center’s Extended Care Facility began working to place new patients, when possible, with alternative private care providers — such as Hale Anuenue, Life Care Center or dozens of community foster homes — or with East Hawaii’s two other public system facilities at Hale Ho‘ola and at Ka‘u Hospital. The move was part of an effort to cut costs to meet a predicted $7 million budget shortfall for the current fiscal year.

Since that time, the average monthly number of patients at HMC’s Extended Care Facility has steadily dropped, from an average of 70 in July to 50 in December. As of Jan. 31, the total number of long-term nursing residents at the hospital stood at 41.

Of those patients, 21 could potentially transfer to private facilities because they have dual insurance, meaning that they are covered by both Medicaid and a second insurer, Brinkman said. The remaining 20 are “safety net” residents who have no other options apart from the public health system.

Of those 20, only three receive regular family visits of two or more times per week, he explained, meaning that, should they be moved to the Honokaa facility, family members of the majority would not have to deal with the burden of making the one-hour trip from Hilo.

Last month, state Rep. Richard Onishi, D-Hilo, questioned Brinkman about travel to Honokaa, saying that he had heard from families in his district who were concerned by the movement of long-term care residents out of HMC.

During a question-and-answer portion of Saturday’s forum, former Hale Ho‘ola administrator Romel Dela Cruz said he was mystified by those concerns.

“What was that all about?” he asked of Onishi’s grilling of Brinkman at a legislative committee hearing. “The extended care unit at Hilo Medical Center is in no position to compete. … For many years when I was there, there was talk of shutting it down. The only facility in the system right now that can compete … is (Hale Ho‘ola). I don’t understand why all the residents of Hilo and you board members don’t stand up and say, ‘You know, it’s not too bad to go to Honokaa. After all, for the past 60 years we’ve been coming the other way.’ … “When you have an aging plant that can’t compete, why not?”

Of the 50-or-so attendees at Saturday’s public forum, no one spoke out directly against the idea of transferring residents to Honokaa. However, former Mayor Harry Kim said he had grave reservations about the direction of East Hawaii’s health care system in general, saying that legislators and hospital system administrators appeared to be letting the community down.

“I feel that there is no commitment of anyone with responsibilities to HHSC, including the members of the Legislature, including the governor’s office and the Department of Health … to that commitment. This board here … was created to get away from the bureaucracy of government, to simplify things,” he said. “… I feel because of political pressure, without exception, all of your decisions the past couple of years, and not only you, the rest of the state, have been based on fiscal matters. None of it based on program needs or community needs.”

In response, HHSC East Hawaii Regional Board Chairman Kurt Corbin echoed Kim’s point, while calling on the public to help secure funding for the hospital system to provide the services East Hawaii residents require.

“It’s one thing for the hospital management and, frankly, even the hospital board to say to our legislators, ‘You have this obligation. Health care is a priority. How can you not honor that priority?’” he said. “But, frankly, in politics, unless the grassroots voters say to their legislator, ‘This is a priority, and if you don’t support it, we will not return you to office.’ You need both the leadership of this board, from management, and from you as individual citizens to talk to your legislators.

“It’s unfortunate they (East Hawaii legislators) weren’t here today to hear, because they need to hear that. They need to know that these issues are of the highest priority.”

Email Colin M. Stewart at cstewart@hawaiitribune -herald.com.