We have a rapidly aging population, and a shortage of younger workers entering health care fields to take care of our increasing number of kupuna.
This puts Hawaii and the nation in a race against time, and our most recent 2024 Healthcare Workforce Initiative report from the Healthcare Association of Hawaii (HAH) shows the growing need, even as our state is at least making some modest progress in training more workers.
The advancing “silver tsunami” means Hawaii’s health care providers must work collaboratively with partners in government, education and the wider business community to find and train more employees. It doesn’t matter if the provider is a hospital, nursing home, assisted living facility, home health agency or hospice, they all need more workers.
Certified nurse aides (CNAs) are in demand, as are registered nurses. The home health providers saw some improvement in that the percentage of openings declined slightly, to 30%, down from 39% in 2022, but home health agencies still struggle most to find sufficient employees.
According to the state Department of Business, Economic Development and Tourism, there were 7.35 caregivers aged 18 — 44 per kupuna aged 80-plus in 2020. By the year 2050, this ratio is expected to drop by more than half — to just 3.02. The ratio of caregivers to kupuna is rapidly shrinking.
But Hawaii can — and has — made headway in increasing the number of health care workers through concerted efforts, and with state support. Since 2022, Hawaii has reduced job vacancies in non-physician patient-facing health care professions from 17% to 14%. We have launched a number of innovative workforce programs and demonstrated a proof of concept for new strategies.
HAH’s successful “glidepath” programs enable students to join or remain in the workforce without sacrificing their studies. Previously, many certified nurse aides had to choose between working or going to school to advance their careers, but one of today’s “earn-and-learn” programs, the CNA-to-LPN Bridge program, coordinates participants’ work/study demands so CNAs can work while studying to become LPNs (licensed practical nurses). This career development model helps address the persistently high demand for CNAs and fosters a home-grown workforce.
At the high school level, the state Department of Education offers health academies that train students via the DOE’s Career Technical Education division. While attending public high school, students learn about health care careers and can earn health certificates, enabling them to join the workforce right after graduation.
Recognizing that nearly half of all Hawaii public high school graduates do not pursue post-secondary education, HAH’s Healthcare Certificate Employment Programs train high school seniors and recent graduates for high-demand, entry-level positions. During the 2023–2024 school year, 105 students from 14 schools were trained as CNAs in HAH coordinated programs, with an impressive 98% completion rate and 77% employment rate. A number of Hawaii’s health care employers sponsor similar programs.
Looking ahead, HAH is expanding the earn-and-learn programs, collaborating with private funders across the state to renovate public high school health-academy classrooms and labs, and advocate for student loan forgiveness for college-educated health professionals.
The Healthcare Education Loan Repayment Program is supported by Gov. Josh Green, philanthropic gifts and taxpayers. Another priority is developing in-state programs for high-demand specialties, such as sonography.
As residents of the most isolated land mass on Earth, we know that cultivating a strong health care workforce benefits every person in Hawaii. Attracting and training sufficient healthcare professionals in the face of rapidly shifting demographics will take many hands. We thank the many collaborators who have already come to the table and welcome others to join us.
Hilton R. Raethel is CEO of the Healthcare Association of Hawaii; Jason Chang is CEO of The Queen’s Health Systems; Wesley Lo is CEO of Ohana Pacific Health and Hale Maku.
