The state is looking for a private company to build and operate a long-term-care facility near the State Hospital in Kane'ohe that would cater to hard-to-place elderly patients.

To accommodate a graying population, it is estimated that Hawai'i will need 2,392 more long-term care beds by 2020. That's 56 percent more than the state had at last report.

The planned Kane'ohe facility will add 120 to 240 beds on 4.8 acres. The state Department of Health, which oversees the State Hospital, would provide the land at a reduced lease, said Janice Okubo, DOH spokeswoman. The state will stipulate that 30 percent to 40 percent of the beds be set aside for State Hospital users.

The state hopes construction can begin in September 2010, Okubo said.

Already, need far outstrips the supply of long-term-care beds in Hawai'i.

"It's estimated that once we open this facility, that every single bed will be filled," Okubo said. "On any given day, there's a wait list for about 200 beds for patients that need a nursing facility that provides a higher level of care."

High-level care would include dialysis, breathing apparatus and accommodations for the obese, she said. "It's also going to provide state psychiatric long-term care as well."

NEED IS GROWING

The need for long-term facilities is growing along with the growth of Hawai'i's aging population. The U.S. Census Bureau estimates 14.8 percent of Hawai'i's population was 65 years or older in 2005 and it will be 23.6 percent by 2020.

In 2005, there were 4,257 long-term care beds in Hawai'i for people 65 or older, or 24 beds for every 1,000 people. Nationally, the ratio is 43 beds per 1,000 people, according to the state's RFP.

It's even harder to find beds for elderly patients with mental illness.

"In addition to the shortage of long-term care beds in Hawai'i, there is a shortage of beds for the care of persons with mental illness," the state said in its request for proposals. "In 1998, there were only 198 psychiatrist inpatient hospital beds not located at Hawai'i State Hospital; this number is likely lower at the present."

The state wants to fill its need but also hopes to address some of the needs in the general population, Okubo said.

The Hawai'i State Hospital has 24 individuals that could be placed in such a facility, she said.

"Right now we keep all of those patients at Hawai'i State Hospital, so they take up that space even though they may not need the kind of services we have there," Okubo said.

She noted that providing the land at the hospital campus eliminates the need to go out into the community, where it could be difficult to find support for building an elderly care home.

The facility could also have a teaching component, Okubo said.

The additional capacity will help but won't satisfy the need, said Coral Andrews, vice president for the Healthcare Association of Hawaii, which organized a Waitlist Task Force and submitted reports to the state Legislature in 2008.

The new facility "doesn't mean that we rest now," Andrews said. "We still have a long ways to go to make sure we're prepared for what's coming."

Often, hospitals are forced to wait-list patients, holding them in acute-care beds long after they can be discharged because the right type of facility to release them to is not always available, said Kathy Bodendorfer, with Kuakini Medical Center.

"We had a patient sit in the hospital for three years," said Bodendorfer, a member of the Waitlist Task Force.

The task force found that uncompensated cost for waitlisted patients in Hawai'i was about $73.5 million in 2008, up from $60 million in 2007.

In the report, the task force recommended that the state use its land to build long-term care facilities to eliminate the high land cost for a project. Other recommendations to address the problem included increasing Medicaid reimbursement for waitlisted patients, creating incentives for long-term care funding and supporting initiatives that address workforce shortages.

Bodendorfer said the need for the new facility is huge and all hospitals can benefit from having a place to put long-term patients.