One goal of long-term care policy is to keep the disruption of daily routines short-term, whenever that’s possible. In Hawaii, where nearly 1 in 5 residents are 65 or older, this focus needs a greater emphasis in the health-care sector.
It’s this need that Islands Skilled Nursing and Rehabilitation, in association with The Queen’s Medical Center, hopes to address with its 42-bed facility in Honolulu. What’s called “short-term rehabilitation” is a capacity that the Alexander Street center has developed over the course of the pandemic, though the demand does exist independently of COVID-19.
The problem is one of scale: Specialized care of this type, outside the hospital setting, is hard to deliver in a market as small and isolated as Hawaii is, in a sustainable way.
But Queen’s this week discharged the first patient needing short-term rehabilitation to this facility, freeing up space at the hospital that, as the tide of virus infections once again begins to mount, will be needed for more acute cases.
Otherwise, this inaugural patient — Enriqueta Yacas, 80 — would have to stay in the hospital or go for short-term rehabilitation far from home, such as in San Francisco, Los Angeles or Seattle. That is not an outcome loved ones or anyone who cares for the aging population would want.
This niche has been part of the skilled-nursing sector on the mainland for some time: Providers have seen short-term rehabilitation centers as a pathway to claim a larger share of the Medicare pool. As a therapy course prescribed by a physician, short-term rehabilitation is covered by Medicare.
Further, officials navigating the early pandemic nationally leaned on these facilities to open additional beds so hospitals could discharge more patients.
In some states in the Midwest and Southwest, the rush has led to overbuilding, according to the 2019 Healthcare & Senior Housing Commercial Real Estate Trends Report, a publication of Integra Realty Resources.
Hawaii is facing the opposite reality. People such as Yacas are consigned either to stay in an acute-care setting or relocate entirely to a place that can deliver the more involved care they require.
In her case, the requirement was for dialysis, treatment for a tracheostomy and a ventilator, a grouping of services not generally available outside the hospital setting.
When COVID-19 first began straining the health system here in March 2020, Queen’s was casting about for alternative sites delivering respirator care. Islands Skilled Nursing and Rehabilitation, which did have that service, took on some patients. And in the discussions with Queen’s in the months that followed, the expansion to short-term rehabilitation was accomplished.
According to its website, the center can assemble a program that also can include physical, speech and other kinds of therapies, social work, nutritional counseling and the basic critical-care nursing. Although some patients do require a longer-term stay, the aim is to help patients transition “to as normal a life as possible.”
Should this trend continue to build across this state as is needed, the imperative would be to train patients and their families fully for proper care in the home environment.
AARP Hawaii’s position has been one of concern about how patients are discharged from hospital, ill-trained to adapt to a new normal, said spokesman Craig Gima. But if short-term rehabilitation can be conducted successfully, the results would be something to endorse.
“We encourage efforts trying to bring people back home, where they want to be,” Gima said.
So do we all. In the continuum of care, anything that lights the way back to recovery in familiar settings deserves support.
