Few of us like to wait for service. Lines at the check-out counter, stalled traffic on the highway, endless button pushing to reach a live customer service representative by phone — these are the daily irritations that raise our blood pressure.

Now imagine having to wait not just minutes but months for the specialized healthcare you need to get back on your feet. That is the situation facing hundreds of our friends and neighbors today because of Hawai'i's shortage of skilled nursing facilities and community-based long-term care.

To some extent, we are a victim of our own success. As services improve in acute-care hospital facilities, patient conditions improve to the point where the next appropriate course of treatment and recovery is in a skilled nursing, intermediate nursing, home care or community based long-term care setting.

But when those beds and services are not available, patients remain in our hospitals on a waiting list. Patients on waiting lists often remain hospitalized for months waiting for space to become available at a more appropriate facility.

That sends ripples across the community and affects our healthcare system emotionally, medically and financially.

Not only are those patients not being discharged from hospitals when they should be so they can receive the kind of care they need, but patients with more immediate issues who need hospital-based care may experience restricted access because hospital beds are full of waitlisted patients.

Some waitlisted patients, particularly those with mental health issues, must remain away from their home island or be sent to Mainland facilities far from their families and familiar surroundings because of lack of appropriate community facilities and services. In these cases, hospitals bear the cost of transfer. Hospitals also shoulder the full or partial cost for waitlisted patients who have not yet been approved for Medicaid or QUEST benefits because skilled nursing facilities will not accept patients without a source of payment.

Medicaid patients and those with complex needs, such as infections or those who are on dialysis, who have a tracheotomy, who are obese or who have mental health issues, face particularly difficult challenges in the search for accessible, appropriate care and services.

Hawai'i has insufficient capacity in terms of both institutional beds and the availability of home-based or community-based services. According to 2005 data, the most recent available, Hawai'i has one of the lowest ratios of acute and long-term care beds per population in the United States, offering only 1.9 beds per 1,000 citizens.

That's why Hawai'i Pacific Health is actively supporting the efforts of the Healthcare Association of Hawai'i to address this significant medical and quality-of-life issue.

A Healthcare Association of Hawai'i task force, working in conjunction with Ernst & Young, is finishing up a professional, independent study of waitlisted patients in acute-care hospital settings in Hawai'i. Approaches deemed to be working successfully in other states also are being examined as potential best practices for adoption here. In addition, hospitals are working with the Hawai'i Health Information Corporation to provide more detailed information and data on waitlisted patients.

The solution won't be as simple as building more skilled-nursing capacity. The challenge is a multi-dimensional one that we must address collaboratively in the short and long term. A holistic approach should include home- and community-based options, staff training and workforce development, and should clear away the reimbursement and administrative obstacles facing patients seeking prompt placement in the appropriate care setting.

The aging of our population and the continued success of our improved acute-care offering means that Hawai'i will urgently require specialized healthcare services and capacity that meet the expected future demands for comprehensive rehabilitative and long-term care.

Waitlisting undermines our ongoing efforts to protect and improve the health and well-being of our citizens. We must work together to strengthen this component of our state's medical offering. Waiting in traffic or for service at a restaurant is an unfortunate but temporary inconvenience; waiting for appropriate healthcare is an unacceptable blemish on our quality of life.

Chuck Sted is the chief executive officer of Hawai'i Pacific Health, the state's largest healthcare provider. He wrote this commentary for The Advertiser.