This fall, one of the oldest adult care homes in the Islands will wrap up a five-year, $17 million renovation to expand its services and quadruple its skilled nursing home bed space at a time when the need for elder care has never been greater.

With the expansion project, Palolo Chinese Home emerges as a leader in the state in offering a range of services to seniors as they age, from in-home care and meals to day and respite care to skilled nursing care to hospice care. Once work on the final renovation phase is completed in late October, the home will have 61 nursing home beds (up from 15) and a new kitchen capable of preparing more meals for residents and the Meals on Wheels program.

Earlier work expanded daycare, in-home and respite services at the adult care home.

Darryl Ing, chief executive officer of Palolo Chinese Home, said the main thrust of the expansion was to create a continuum of care that starts with helping the elderly in their own homes. While they're still living independently, seniors are extended opportunities to take part in day activities or weekend stays at the 15-acre campus in Palolo Valley.

Later, residential or respite care is offered for those who need help with daily activities.

And lastly, skilled nursing home beds and hospice are available.

"We're trying to reach out to the community," Ing said.

The expansion comes as policymakers are grappling with how to meet the needs of an aging population and, perhaps most urgently, how to deal with an acute shortage of nursing home beds in the Islands — a problem that has gotten so bad that many seniors are forced to stay in hospitals for weeks or months after they have stabilized before moving on to a nursing home.

HAWAI'I'S WAIT PROBLEM

On average, there are 200 seniors at any given time in hospitals statewide who are on waiting lists to move to nursing homes, according to a 2008 report to the state Legislature. The study goes on to say that it appears that the waitlisting problem is unique to Hawai'i — a combination of the state's large and growing population of people over 65 and its dearth of nursing home beds. In fact, Hawai'i ranks 48th in the nation for its ratio of long-term-care beds, with 23 beds for every 1,000 people over 65 (compared to 47 beds nationally), AARP reports.

The addition of 46 skilled nursing home beds at Palolo Chinese Home won't solve the problem, but officials expect it to make a noticeable dent in demand.

"I would anticipate that it would provide some relief," said Coral Andrews, vice president of the Healthcare Association of Hawai'i, which represents hospitals and nursing homes.

Andrews said the waitlisting problem is one that is only expected to worsen as baby boomers age and need more skilled care. There is also an increasing need for other services for seniors, including occasional in-home nursing visits and day-care programs.

She said Palolo Chinese Home has a unique model that is one of many alternatives for meeting the needs of seniors, and she added that a range of care options for seniors is important, from institutional care to small care homes in communities — and everything in between.

Ing said there are 20 people on the waiting list for Palolo Chinese Home's existing 15 nursing home beds. The waiting list for the new beds has not yet been started, but Ing said he will reach out to hospitals and to the community to find patients.

Seniors who need nursing home beds require help with all their daily activities and often have multiple medical conditions that warrant constant supervision. Nursing home beds differ from residential care home beds, which cater to seniors still well enough for many activities.

Palolo Chinese Home administrator Darlene Nakayama pointed out the next step in upgrading the campus will be to renovate its residential-care-home component, which consists of 50 dormitory-style beds in a 1950s-era building that is showing its wear.

Seniors in the adult care home wing at Palolo Chinese Home share bedrooms and a bathroom — something officials want to change to give residents more privacy and a sense they are in a home-like setting, not an institutional one. But Ing said the next phase of work to renovate the adult care home won't kick off for at least a year because officials still need to raise money, draw up plans and figure out where to put residents while work is under way.

The home also hopes to renovate another older building on campus, which houses the kitchen and dining hall, to put in a community center. Under the plan, instead of eating in one big dining hall, residents would eat in smaller dining settings in their respective areas.

"That way, it's more of a home-like environment," Ing said.

A fundraiser Friday for the home is designed to garner the last bit of money needed to cover the current renovation. Ing said about $500,000 is still needed for the work. He added there are also several million dollars in pledges that have not yet come in.

The care home traces its beginnings to 1896, when Chinese in the Islands established a home "for the aged and infirm" in Palama. Palolo Chinese Home was formally established in 1917, and accepted its first patients — eight elderly Chinese men — three years later. Today, the home helps about 600 seniors at any one time, most of whom get in-home help with meals, referrals or occasional nursing assistance. The facility has 65 full-time residents.

That figure will jump to 111 when the new beds — housed in a brand-new, three-story building — are completed. There are also 30 slots in the popular daycare program, which has a waiting list and is open seven days a week, 365 days a year.

'I LIKE IT HERE'

In the daycare hall one morning last week, a small clutch of seniors sits in a circle, excitedly playing a trivia game with staff. The hall was quieter than usual because most of the daycare participants were on a field trip to Kaka'ako Waterfront Park.

Some of the seniors in the daycare program plan to move to Palolo Chinese Home's residential care home and nursing home components once they need them. Others say they would prefer to remain in their homes, with family and nursing assistance.

Patsy Yamane, a 92-year-old retired hairdresser, said she wants to move into Palolo Chinese Home full-time once she needs the extra help. She said she can't imagine any place better to spend her final days.

"I like it here," she said, giggling softly. "I feel alive."

Choki Yara, who has been coming to the daycare program at Palolo Chinese Home for three years, has a penchant for the bingo he gets to play when he's there. The 86-year-old also enjoys the conversation.

And, he added, with a wide smile, "the food is excellent."