Hawaii’s Silver Tsunami: Navigating the Growing Crisis in Kupuna Care
Hawaii’s enviable longevity is creating a pressing challenge: a rapidly aging population and a healthcare system struggling to keep pace. As the state’s number of residents over 65 grows faster than the national average, access to specialized geriatric care is becoming increasingly difficult, leaving kupuna (elders) facing lengthy waits and physicians overwhelmed.
The Strain on Hawaii’s Healthcare System
The state faces shortages not only in geriatric physicians but across the entire elder care workforce. This includes nurses, nurse practitioners, social workers, pharmacists, and certified nursing assistants. Kamal Masaki, chair of the Department of Geriatric Medicine at the University of Hawaii John A. Burns School of Medicine, emphasizes the growing demand, stating the aging population in Hawaii is expected to continue expanding for decades.
Beyond the Numbers: The Reality for Patients
While some reports suggest an adequate supply of geriatricians, physicians on the ground paint a different picture. Current estimates, relying on national models, don’t fully capture Hawaii’s unique demographic trends. Patients often face months-long waits for appointments, even on Oahu. On Hawaii Island, only three geriatricians are currently practicing, Kauai has three, and Maui has none.
The Complexities of Geriatric Care
Geriatric care is inherently more complex than standard medical appointments. Older patients often manage multiple chronic illnesses, extensive medication lists, and intricate family or caregiving situations. Aida Wen, a geriatrician at The Queen’s Health Systems, notes that evaluations and care plans require significantly more time and coordination. “It’s the only specialty in which you do more and get less,” she says.
Financial Barriers and the Need for Investment
The financial realities of geriatric medicine also contribute to the shortage. Reimbursement systems often prioritize volume over time-intensive care, making geriatrics one of the lowest-paid specialties. Initiatives like the Nohara-Abaya Loan Repayment and Scholarship Award, providing $50,000 to physicians pursuing geriatric medicine, are helping, but more substantial investment is needed. Kiana Choo Loy, a geriatric consultant at Straub Medical Center, points out that the system isn’t adequately funding geriatricians.
The Rising Tide of Dementia
The demand for specialized care is further amplified by the increasing prevalence of dementia. An estimated 31,000 people in Hawaii live with Alzheimer’s disease or another form of dementia, a condition that is now the sixth-leading cause of death in the United States. Alzheimer’s also carries significant financial burdens, with Medicaid spending for patients with the disease being roughly 16 times higher than for those without it.
Preparing for the Future: Workforce Enhancement Programs
Educators at the University of Hawaii are actively working to address the workforce shortage through the Pacific Islands Geriatric Workforce Enhancement Program. This initiative trains students across multiple healthcare disciplines and partners with clinics and community organizations to promote “age-friendly” health systems. The program focuses on four key elements: patient priorities, medication management, mobility, and cognitive health.
A Cultural Imperative: Caring for Kupuna
For many healthcare professionals in Hawaii, caring for kupuna is deeply rooted in cultural values. Kaimana Kalei, a Hilo-born physician practicing on Hawaii Island, chose geriatrics after caring for his grandmother, stating, “I wanted to offer back to my community. Taking care of kupuna is important in our culture.”
Frequently Asked Questions
- What is a kupuna? A kupuna is the Hawaiian word for elder or grandparent, and holds a place of respect in Hawaiian culture.
- What is being done to address the shortage of geriatricians in Hawaii? Programs like the Nohara-Abaya Loan Repayment and Scholarship Award and the Pacific Islands Geriatric Workforce Enhancement Program are working to attract and train more professionals in geriatric care.
- How can I help support kupuna in my community? Volunteering with organizations like Our Kupuna, or simply offering assistance to elderly neighbors, can make a significant difference.
To learn more about resources for kupuna in Hawaii, visit Our Kupuna or Hā Kūpuna, the National Resource Center for Native Hawaiian Elders.
Share your thoughts: What steps do you think Hawaii should grab to better support its aging population? Leave a comment below!
