Overall, Hawaii’s health care system ranks among the best in the nation. That’s reflected in the state’s statistically long and relatively healthy lifespans, access to quality care and outcomes from treatment.

Concerns persist, however, over a worsening shortage of doctors, nurses and certified nursing aides, especially in rural areas. And while state officials have expressed high concern over the issue, more needs to be done — particularly along the spectrum of nursing care.

One of the worst examples of the price paid for inadequate staffing has occurred at the Yukio Okutsu State Veterans Home in Hilo. Sadly, the Veterans Home also presented the worst-case scenario for Hawaii during the pandemic, when COVID-19 infected more than 80% of residents and killed 27, giving the facility Hawaii’s worst health record of the pandemic.

The state took over the care home, placing it under management by the East Hawaii Region of the Hawaii Health Systems Corp. But just two years later, an annual inspection by the Department of Health (DOH) to assess quality of care found the home was not providing appropriate care to treat and prevent bedsores, failed to provide appropriate pain management and sometimes left bedridden residents waiting hours for assistance from a nurse, resulting in a further degradation of their health.

Nursing home administrators at the Veterans Home reported that they struggle to hire enough staff. The facility, in particular, is short of certified nursing assistants (CNAs), despite recruiting and training efforts.

State support for CNA training programs at the high school and community college level is expected to help with this facet of health care. But the Hawaii Education Association (HEA), which advocates for both public K-12 and higher education programs, has raised concern that funding for the University of Hawaii nursing school this year failed to materialize.

HEA points to the value of Hawaii Promise scholarships, which support workforce training for thousands of students annually, but only at the community college level. HEA rightly urges the Legislature to enlarge the program, funding high-quality, four-year-level education opportunities.

With such need, and so much at stake, it’s disappointing that the Legislature did not find a path forward to approve House Bill 1635 in 2022, which would have established a Rural Health Task Force within the Center for Nursing at UH-Manoa. This task force would have been charged with recommending solutions to recruit registered nurses on Maui, Molokai and Lanai, where shortages are most acute. While the focus of the study was rural, the information could have served as a template for building nursing staff at institutions statewide.

The need for focused legislative support and funding for four-year college and graduate-level training continues.

There are signs of hope. In 2022, Chaminade University initiated a fast-track program for training as a registered nurse, in the school’s Accelerated Bachelor of Science and Nursing program.

And thanks to a $1.75 million state infusion of funds last year to UH four-year and two-year programs, 39 nursing instructor positions were created statewide, allowing the university to double its intake of nursing students, adding 230. That reversed a lamentable situation that saw UH denying about 65% of applicants because of the lack of instructors.

Also beneficial: Legislature-approved increases in Hawaii’s Medicaid reimbursements; the Medical Licensure Act, which allows licensed physicians in other states to expedite transferring credentials to Hawaii; and additional funding for the Hawaii State Loan Repayment Program for Healthcare Professionals by $30 million over two years, helping Hawaii to recruit physicians, registered nurses and nurse practitioners, physician assistants, therapists and psychologists.

This support for training and recruitment programs is welcome. More is needed, along with sustained attention to affordable housing, so that nurses trained in the state can be retained. Both are ultimately necessary to turn this troubling situation around.