Hawai'i's oldest medical facilities — Leahi was built in 1901 — have been showing their age for some time. Endless smaller improvements seem to be needed in all of them, and keeping up with repairs and modern medical needs has been challenging.

But in the past decade, they have made a turnaround under the leadership since 1996 of the Hawai'i Health Systems Corp. and an infusion of money for capital improvements from the Legislature.

This year the Legislature set aside about $8.8 million for repairs for "life safety" priorities for Leahi and medical facilities like it, many of them serving rural communities and dating back to plantation days.

"For so many years there was no money available to look at the structures and make the improvements to keep them up with modern medicine as it developed," said Rich Meiers, president of the Healthcare Association of Hawai'i, a hospital advocacy group. "For years these facilities were neglected until the last few years. They've come a long way to get to where they are today."

Barbara and Francis Nakano of Kapahulu like what they have found at Leahi, a complex in Kaimuki that provides long-term care and adult daycare.

Barbara Nakano said Leahi has been life-saving for her mother, 86-year-old Clara Yoshikawa, who suffers from Alzheimer's and needed more nursing care two years ago than a care home could provide.

"She came alive when she came here," said Nakano. She said her mother wakes up singing, and shares a cheerful room with three other elders.

In the early 1990s, before 10 Neighbor Island and two O'ahu acute and long-term care facilities were organized under Hawai'i Health Systems, a quasi-public corporation, they were competing for money and asking the Legislature for $50 million annually, said Meiers.

"If that corporation had not been put into effect, that $50 million back then would be somewhere around $200 (million)-$250 million today," said Meiers. "That's what they'd need from the state to survive."

"We were clearly headed in that direction, no question about it," said Tom Driskill, chief executive officer of Hawai'i Health Systems Corp.

Today the corporation receives around $32 million annually from the state for operating expenses and has reorganized itself so that it pays 90 percent of its own costs, compared with county hospitals in other states that pay about 80 percent of their own costs before government subsidies.

"You will never see the day when HHSC breaks even, but they're doing better than they've ever done, better than most governmental hospital systems on the Mainland," said Meiers. "I think the quality of care has been the biggest improvement."

Though some of the hospitals were built a century ago, they continue to serve a key role in the community, providing about 800 long-term care beds, 400 acute-care beds, 150 daycare program spaces and seven emergency rooms. About 60 percent of the patients receive government assistance, compared with about 50 percent in the state's private hospitals.

"We're a safety net system," said Driskill.

The estimated $8.8 million allocated for repairs this year by the Legislature is part of a six-year plan for as much as $200 million in improvements that the facilities hope the state will finance through 2010.

In the eight years ending in 2004, the Legislature provided $104 million for capital improvements, including a new $42 million wing for Maui Memorial Hospital that's about to start construction.

The estimated $2.3 million Leahi will receive this year will take care of the roof repairs as well as fixes to the elevator and an electrical upgrade.

The money hasn't yet been released by the governor, but administrators expect work will move forward quickly once the money is forthcoming. Repairs to the aging fire escape have already been completed this year with money from a previous session.

Though Leahi's walls are still institutional beige and the facility has the look of yesteryear, it is cool, breezy and clean. Barbara Nakano credits "the warmth and the 24-hour care and all the activities," for her mother's improvements. "Everybody thought she was going already. Before she came here she was talking to the mirror. I really credit this place."

Barbara Nakano sees the long-term and adult daycare services that Leahi provides as life-saving for her mother, Clara Yoshikawa. Gregory Yamamoto • The Honolulu Advertiser

"We'll screen patients to see if this is appropriate for them," said Dr. Linda S.H. Tom, geriatric clinic director who also works with private physicians and families to recommend care for elderly patients. "If we had more funds we could have more support services, but we make do with what we have."

What's available for her mother at Leahi is already comforting to Barbara Nakano.

"After she's gone," said Nakano, "I want to remember that this is not just some place she stayed. It was her home."