A new analysis of Hawai'i hospital data shows the state's long-term-care problem for hospitals is larger than previously believed, with patients occupying more beds and adding to losses sustained by medical centers.

The Healthcare Association of Hawaii yesterday reported that on average 200 long-term-care patients were "wait-listed" in hospitals for transfer to nursing homes or other places. It said on some days the number goes as high as 275 patients.

The wait-listing problem is one of the most visible aspects of the state's long-term-care crisis. Patients who otherwise would be housed at long-term-care facilities, nursing homes or in their own homes remain in hospitals because not enough facilities or home-care personnel are available. In some cases, hospitals have transferred patients to the Mainland because facilities or care personnel weren't available here.

The long-term-care patients occupy beds that otherwise would be reserved for patients with more acute medical problems. Hospitals receive less reimbursement for long-term-care patients, which leads to about $90 million annually in losses for Hawai'i hospitals, the healthcare association said yesterday.

"From what I'm hearing, it sounds as if we're in a perfect storm already," said State Rep. John Mizuno, chairman of the House Health Committee, during an informational briefing yesterday.

"If we don't act now, it's going to get worse."

The healthcare association, which is conducting a long-term-healthcare study, had previously said 180 beds were occupied by long-term-care patients on a daily basis. At The Queen's Medical Center, the state's largest private hospital and most-used trauma center, the number of wait-listed patients reached 66 in December.

"When Queen's serves these non-acute patients in the acute hospital bed, we are less able to respond to our community's needs for acute-care services," said Christina Donkervoet, Queen's director of care coordination and patient flow, in testimony submitted to the committee.

Donkervoet said Queen's has had to divert patients elsewhere in the past because it didn't have bed vacancies due to wait-listed patients whom they were unable to discharge to qualified care elsewhere.

LITTLE SUCCESS

The state, healthcare officials and legislators have been working to find a solution to the long-term-care problem but have had little success attracting new construction of nursing homes because Hawai'i's land costs are prohibitive.

"There is insufficient capacity both institutional and home-community based to meet the needs of wait-listed patients," said Coral Andrews, healthcare association vice president and a member of a wait-list task force examining the problem for the state Legislature.

She said a 2006 AARP study found Hawai'i is 48th in the nation in a long-term-care beds ranking.

The state has 23 beds per 1,000 people over age 65. That's less than half the national average of 47 beds per 1,000. The problem is forecast to get worse because Hawai'i's population over age 65 is forecast to grow faster than the national average.

A number of solutions are being examined, including getting higher Medicaid reimbursements for long-term care and initiatives to increase the number of long-term-care workers. Rep. Josh Green, chairman of the House Health Committee and a Big Island doctor, noted a major part of the $150 million in operating losses suffered by hospitals in Hawai'i last year could be wiped out if the long-term-care problem goes away.

"We should find a way to build out some large number of beds," said Green, who said the answer may lie in establishing health enterprise zones on different islands where long-term-care operators could build facilities on state land without incurring large land costs.

He and others acknowledged the problem won't be solved by just building beds, since many factors are involved in placing a patient, including geography and a desire by many families to have care provided in their homes.

EFFICIENCY SOLUTION

Green also supported the idea of creating an electronic interchange that would make the placing of long-term-care patients more efficient as needs, regions and payment coverages are matched with providers.

Andrews said the current system is akin to Honolulu International Airport operating without air traffic controllers. She said there are companies that provide electronic systems already.

She said the task force will receive more data in coming months. It also has formulated more than a dozen recommendations to help solve the wait-list problem that it is submitting to the Legislature. These range from increasing reimbursement, to getting more long-term-care infrastructure and workers, to proposing regulatory changes.

Reach Greg Wiles at gwiles@honoluluadvertiser.com.