An 81-year-old woman confined to a wheelchair was evicted from a Nu'uanu nursing home and, with no permanent place to stay, was dropped off at the emergency room of a Honolulu hospital just days before Christmas.

Florence Ko, whose nursing-home bill apparently no longer was being paid, spent roughly 12 hours at Straub Clinic & Hospital's ER on Dec. 17 and later that evening was taken to an 'Aiea respite home as a temporary solution. She was still at the home as of Friday afternoon.

Ko told The Advertiser she had no idea what was happening and where she would be staying when she was taken from Nu'uanu Hale, where she had lived since July 2007, to Straub's emergency room a week before Christmas, wearing only a hospital gown.

"I wish someone (at the nursing home) had the courage to tell me what was going on," Ko said in a brief interview last week from her bed at the 'Aiea facility.

When she was left at Straub, Ko had no personal belongings except her purse, which contained less than $3 and her cell phone — but not the charger, according to members of her church who have been helping her.

At least one state agency investigated the circumstances surrounding Ko's eviction and determined no elder abuse occurred because she was dropped off at a safe place, a hospital. But the Department of Human Services, the agency that investigates elder abuse, called Nu'uanu Hale's actions related to the drop-off inappropriate and was referring the matter to the Department of Health, which licenses Hawai'i nursing homes.

Because Ko's physician was affiliated with Straub, the hospital had been aware that Ko was to be brought there, worked with the family to get the temporary placement and was helping look for permanent housing, according to Toni Schwartz, a DHS spokeswoman. But the drop-off was "not a usual thing," prompting the referral to the licensing agency, she said.

Nu'uanu Hale was one of six Hawai'i nursing homes last month to receive the poorest rating possible from the federal government in a newly created system for publicly assessing quality of care at the nation's roughly 16,000 homes. The Pali Highway business received a single star out of a possible five.

CARE GAP

The Ko case reflects what many say is a broader problem that will only get worse as Hawai'i's populace ages — the state has one of the fastest-growing elderly populations in the country, and the Islands have too few nursing-home beds to meet demand.

More elder residents with insufficient resources to pay for long-term care will fall through the gaps in the system, and their families often will be overwhelmed trying to deal with the level of care they require.

"What's worrisome is that this kind of thing, with variations, is getting to be routine," said the Rev. Mike Young of First Unitarian Church of Honolulu, Ko's longtime church. "It's an incredibly difficult job finding an appropriate facility."

First Unitarian members, who have been helping Ko in recent years as she became increasingly less mobile because of polio-related ailments, said her family stopped paying the nursing-home tab. But the family and others tried to get Medicaid to cover Ko's long-term-care bills, just as the government insurance program does to some degree for income-eligible seniors, the church members said. Ko's application, however, has twice been rejected, they said.

Even though she received regular income from Social Security and an annuity, the amount wasn't enough to cover her nursing-home tab, according to Mickey Selwyn, a First Unitarian lay minister and a close friend of Ko.

The church members didn't know why the Nu'uanu Hale bill no longer was being paid or when the payments stopped. A message left Friday at the home of a son in Honolulu was not returned, and another message left at a New York phone number listed for a daughter also was not returned.

An attorney for Nu'uanu Hale said he could not comment on Ko's case because of federal law governing patient-privacy rights.

But in a brief phone conversation last week, Gayle Lau, the nursing home's administrator, said her organization was cooperating with investigators and cautioned the newspaper about writing a story without all the facts. "It is one-sided at this point," Lau said, without providing any details.

TURNING TO CHURCH

Church members said they were told Ko was taken to Straub to get treatment for an anxiety problem. While she was there, she used her cell phone to call Selwyn, clearly upset about not knowing what was happening, Selwyn said. But the line abruptly cut off during their conversation and the lay minister couldn't reach her friend after that.

Straub representatives did not return calls seeking comment.

Young, the pastor, said there was no question that Nu'uanu Hale could have handled the situation differently, adding that Ko essentially was abandoned at Straub.

"A week before Christmas? Yes, there's a certain lack of compassion," Young said.

Ko, an articulate, feisty woman with a head full of white hair and an occasional memory lapse, said she had thought her financial situation with Nu'uanu Hale was going to be resolved. Yet when she returned to her room after physical therapy on Dec. 17, her personal belongings had been piled on a gurney and people were cleaning her room, she said.

"To just kind of toss you out — that's it," she said. Ko stressed, however, that many of the nursing home's workers "were very nice."

Later that day, Ko's belongings were placed under a tarp outside Nu'uanu Hale, where church members later retrieved them.

Just weeks before the eviction, Ko's situation got complicated when a social worker at a nonprofit agency assigned to her case was laid off — not an uncommon occurrence in a time of tight fiscal times for Hawai'i's charitable groups.

Ko's application for Medicaid apparently was affected by a Portlock property she and her late husband once owned, church members said.

The couple purchased their house in the late 1980s, property records show. In the mid-'90s, the property was transferred to a family trust, and after Ko's husband fell ill, the home began to deteriorate and was demolished last year.

The property was deeded to Ko's New York daughter in 2008 and was last valued by the city at more than $1 million, the records show.

PATCHWORK SYSTEM

In determining asset limits for eligibility for long-term-care coverage, Medicaid does not consider an applicant's primary residence, but property held in a family trust could affect such eligibility, according to those familiar with Medicaid rules.

Because Ko's finances apparently did not allow her to qualify for Medicaid but were too little to cover her nursing-home tab, she is part of a growing "gap group" that increasingly will have a tough time affording the long-term care they need as they enter their 70s, 80s and 90s, experts say.

"We will likely see more people needing assistance," said Anne Holton, a long-term-care ombudsman specialist with the state Executive Office on Aging. "With the boomers coming up, there's going to be a whole new tide of people looking at that."

Whatever the financial situation, elder residents have a right to be consulted about their own care, she added.

"Nobody should be treated that way — just carted about town," Holton said.

But with the gaps in the system, the elderly being affected are among the most vulnerable and often don't have someone to advocate on their behalf, First Unitarian's Young said.

"That's essentially the problem," he said. "There is no coherent system. There's this patchwork of private entrepreneurs, charity groups, nonprofits, state programs and some state laws that are virtually impossible to enforce."