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Hawaii has fewer nursing home beds per 1,000 elderly residents than any other state, and the gap is widening: of nearly 800 beds planned in 1992, Stanley Snodgrass reports, fewer than 300 will ever be built. Snodgrass, Oscar Kurren, and Patricia Blanchette argue from different angles about what long-term care should look like. Kurren traces the problem to the 1965 Medicare and Medicaid amendments, which embedded a costly medical model; Blanchette, phoning in from the UH Geriatric Program, estimates that 25 to 35 percent of Hawaii's hospital beds are occupied by patients waiting for nursing home placement. All three support expanding assisted living, which costs roughly half as much as a nursing home, and Snodgrass describes two facilities he is developing — one in Punaluu and one on Maui. A central obstacle is Hawaii's failure to apply for the federal Medicaid waiver that Oregon, Washington, and Ohio have used to fund assisted living. Callers press for more home-based alternatives, and Blanchette argues that long-term care insurance is essential to ease pressure on Medicaid, which already covers 85 percent of Hawaii's nursing home occupants — far above the national average of 55 percent.
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