Hawaii faces a severe shortage of nurses aides, and that is having a ripple effect throughout nursing homes, long-term care facilities and hospitals. It’s causing patients to stay in hospital beds longer, at greater expense, as it prevents nursing homes and care facilities from accepting hospital transfers and filling their beds.

The problem has reached crisis proportions, exacerbated by the COVID-19 pandemic’s effect on staffing: Some hospital patients can wait for weeks or months for a long-term care placement, according to the Healthcare Association of Hawaii (HAH), a trade group representing hospitals and long-term care facilities.

In November, HAH reported that more than 700 positions for certified nursing assistants and nurse aides were open across the state. And on any given day, about 200 patients in Hawaii hospitals face delay in transfer to long-term care facilities because there are no available beds.

This crisis, precipitated by the nursing aide shortage, is lamentable, but it’s also predictable. To draw loyal employees requires a living wage, but nurses aides have typically been paid very low wages, which are no longer adequate to meet the cost of living in this state.

Solving the problem requires coordinated effort between private-sector health care providers and public leaders, if the industry is to find a sustainable solution.

More and better educational options are part of the recipe, as is an industrywide pivot to higher wages. A revamp of Medicaid funding for health-care facilities that treat low-income patients is also essential, if these facilities are expected to raise wages. New, creative solutions to attract and retain local workers must also be considered.

Legislators and educators have made admirable progress in supporting beefed-up training programs to bring new workers into the system — for instance, a pilot “glidepath” program paying certified nurse aides at long-term facilities to attend community college, training as a licensed practical nurse while continuing to work.

As employees advance, however, nurses aides will continuously be needed. And health-care providers report that workers are leaving the field, changing careers, retiring early or leaving the state. Meanwhile, wages have been rising for other entry-level jobs, such as fast-food service, and that’s increased competition for good employees.

The Hawaii Nurses Association has called for certified nurse aides to be paid a minimum of $20 an hour. Fair enough, but many facilities, particularly long-term care facilities, are financially challenged because their clients are primarily served by Medicaid, and Medicaid reimbursements for services, typically much lower than private-pay insurance benefits, fall short of covering costs.

With the support of Gov. Josh Green, who has called for Hawaii to become a health-care hub for the Pacific, hospitals are in discussion with Med-QUEST, Hawaii’s Medicaid managed care program, to “re-base” rates for long-term care facilities.

Green has said he plans to increase state Medicaid payments by $30 million over the next two years. He also expects to reduce the burden on hospitals and care homes by providing housing and preventative care for the chronically homeless, improving health outcomes.

Still, more changes will be required to recruit adequate numbers of ambitious, capable and caring nurses aides. It’s time to think out of the box. Could there be a focused drive to supply housing for health-care workers, on or near health-care facilities, as is being explored for teachers at public schools? Could expanded student-loan forgiveness or tax credits work?

Finding new ways to reduce the cost of living for Hawaii’s health-care workers can be another avenue for addressing the problem. And the state has no time to waste.