At the age of 80, Enriqueta Yacas spent 165 days at The Queen’s Medical Center until Monday, when she became the center’s first patient discharged to a new long-term skilled nursing facility where she is undergoing treatment for a trifecta of medical needs that otherwise would have forced her to the West Coast or to live out the rest of her life at Queen’s.

Yacas’ discharge from Queen’s follows more than a dozen previous patients who also relied on a ventilator while needing dialysis for kidney failure and treatment for a tracheostomy, which until Monday could not otherwise be found in Hawaii, according to Alex Wroe, vice president of patient care at Queen’s.

The other patients either died in the hospital or were sent to the mainland for long-term rehabilitative treatment, creating financial and emotional pressure on their families.

Yacas, Wroe told the Hono­lulu Star-Advertiser before Yacas’ discharge, “is the first patient under a new program that keeps them here. It’s a very exciting day. This has been a long time coming. … We have other patients that fit that profile, a handful.”

The new chapter in Yacas’ treatment, rehabilitation and desired return to her home in Waipahu is the result of a confluence of events: her son’s persistent reluctance to send his mother into long-term care somewhere on the West Coast, and the creation of a new long-term, skilled nursing facility called Islands Skilled Nursing and Rehabilitation that began working with Queen’s in 2020 to take in some of its early COVID-19 patients who relied on ventilators in the intensive care unit, which helped clear bed space at Queen’s.

Yacas has 13 children, 25 grandchildren and a 2-year-old great-granddaughter who is her spitting image, said Yacas’ oldest son, Gedeon, who is 57.

Except for one son, all of Yacas’ family live on Oahu and it would have been impossible for everyone to move to the mainland to be close to the family matriarch, Gedeon said.

He told Queen’s officials, “’You’re sending my mom to the mainland to die on her own.’ It’s a graphic description, but it’s true. My siblings are tied into Hawaii with employment, the jobs, it’s uprooting the whole ohana … to a foreign land, so to speak.

“I just pushed and pushed and I said, ‘There are other families in the same boat, the same predicament,’” Gedeon recalled. “I really emphasized that here in Hawaii, Hawaii is a different culture than the mainland. We’re family dependent. My mom depends on her kids being there and having family around her. When you send her to the mainland she’s by herself.”

Wroe said family support is critical for patients in long-term care with critical medical needs.

“With somebody with these high-care needs they really need their family support,” Wroe said. “It’s a major change in the quality of family, so it’s nice to have the option of Islands.”

Gedeon said he appreciates the care that his mother received at Queen’s, but the staff was unable to provide the rehabilitative care she needs, such as getting assistance to walk around the hospital, “instead of sitting all day.”

At Islands Skilled Nursing and Rehabilitation, Gedeon said the medical costs are less and the facility is better equipped to provide rehabilitation with the goal of getting his mother weaned off of a ventilator and tracheo­tomy maintenance while receiving off-site dialysis.

“She will get the rehab that she needs,” Gedeon said.

Working with Queen’s, Islands Skilled Nursing and Rehabilitation overhauled its health care model to treat and rehabilitate patients needing ventilators and tracheostomy care, while transporting them to off-site dialysis treatment, said Gary Wong, Islands’ director for respiratory services, who is also president of the Hawaii Society for Respiratory Care.

“Queen’s said, ‘They stay here for the rest of their lives and they end up dying here,’” Wong said. “I said, ‘Wow. We need to figure this out.’”

Islands has 42 beds but only enough respiratory therapists to currently care for 21 patients, he said.

Wong plans to reach out to Kaiser Permanente and Hawaii Pacific Health to see if they have patients needing care similar to Yacas who could be discharged to Islands.

“Mrs. Yacas was the first one,” he said, “the first one of many.”

Gedeon Yacas said he told his mother, “‘Hey mom, you’re setting the standard for this. What you’re going through will not only benefit you, but benefit future or present families. It opens the door. You’re keeping families together here in Hawaii.’”