Lanai-style collaboration for elderly kamaaina or kupuna

Contributed by Valerie Janikowski, Program Administrator, Lanai Kinaole; Dr. John Janikowski, Straub Medical Center; and Jared Medeiros, Associate Medical Director, Lanai Community Health Center

Representatives from Straub Clinic, Lanai Community Health Center and Lanai Kinaole, along with Lanai residents, discuss plans for the island’s first Adult Residential Care Home.

It’s often been said that it’s “hard to be born on Lanai and hard to die on Lanai.” While both may not be totally true, it’s a fact that almost every delivery of our newest residents occurs on either Oahu or Maui because of the lack of specialty services for newborns and pregnant women with complications. As for dying on Lanai, well, there’s no place designed for our elderly kama‘āina or kupuna to live out the last chapters of their lives if they cannot be cared for in their home(s) (clearly most folks’ first preference) or can’t afford the long-term care (LTC) beds at our hospital.

Our communities’ elderly members (nearly 30% of the overall population) and their families often have no choice but to place their tūtū, aged mother or grandfather in a care home on another island, forcing an emotional and expensive relocation for both individuals and families. This may be for extended periods of time when care is needed that can no longer be safely achieved in the home and/or there are not enough care providers to achieve the 24-hour care that may be required — and doesn’t include the imminent end of life. End-of-life care and hospice are available in homes as long as there are adequate care providers available, and is typically for shorter periods of time. This too, however, requires 24-hour care which is usually done by family members supported by clinical staff.

But in a unique collaboration, three of Lanai’s health care organizations (Straub Clinic, Lanai Community Health Center (LCHC), and Lanai Kinaole (LK)) have come together to establish a two-part kupuna services and facility response. It’s been an exceptional collaboration between our three organizations and a number of community residents, with many meetings, lots of planning, innumerable discussions, successful fundraising, professional studies — and we’re getting closer to having two new facilities on Lanai for those in need.

We began more than a year ago by commissioning a study of Lanai’s kupuna needs. A team of faculty and graduate students from the University of Hawaii’s Department of Urban and Regional Planning, the UH Community Design Center and the Social Science Research Institute at UH undertook interviews and group meetings with over fifty Lanai residents. Among their findings were these three recommendations: 

• An adult day health care facility would be invaluable for Lanai

• Some type of long-term care facility would prove useful for our island

• Enriching the capacities of in-home care should be a priority

The three independent organizations started working more closely together during the COVID-19 pandemic out of necessity. The push for adult daycare and assisted living is a continuation of the collaboration these organizations have been successfully making to advance health care on this island. Finding solutions for our kupuna care deficiencies has brought us into an amazingly rich collaboration.

So, what’s it all about? For starters, we’re looking to create Lanai’s first adult day health service/care facility. Hawaii’s State Department of Health defines that this way: 

Adult day health care means an organized day program of therapeutic, social, and health services provided to adults with physical or mental impairments, or both, which require nursing oversight or care, for the purpose of restoring or maintaining, to the fullest extent possible, their capacity for remaining in the community.

With funding from Maui County, a potential lease from Pulama Lanai, and the support of Lanai’s own Manele Koele Charitable Fund (MKCF) and the Lanai Community Benefit Fund (LCBF), we’re exploring building a state-of-the-art adult day health care facility adjacent to Lanai Kinaole’s offices — just across the lawn from the LCHC. This will be altogether different from our great Maui County Senior Center, offering a range of health care services for our elderly residents

At the same time, we are working to build Lanai’s first Adult Residential Care Home (ARCH). Again, a definition:

Adult residential care homes provide 24-hour accommodations to adults who require at least minimal assistance in activities of daily living (e.g., bathing, dressing, eating, toileting, and walking) in a residential home setting. 

We’ve already found a potential space for our ARCH. The Lanai Hongwanji has a residential facility attached to its temple, and with their cooperation and encouragement, we’ve begun the process of exploring the requirements of renovation. We’ve drafted building plans and have a conceptual drawing for an ADA-compliant space that would house up to four residents. Four may not seem like a lot but compared to our current availability of zero we think it will be a great start.

So, you may ask, “How can I help?” First, thinking long term, would you consider using your home for an ARCH? If you’re wondering what will happen to your home as you age, consider converting it to a residential facility for yourself and other aging Lanai residents.

Are you interested in learning new skills and becoming an ARCH administrator or a nursing assistant or volunteer for in home care or adult day health services? Or, if you are experienced in these specialty areas or just want to participate in the planning of these projects, let us know by writing to lanaielderlycare@gmail.com.