Q. How has Hale Makua changed since you've taken over?

A. Hale Makua is 60 years old this year and it started out as an old-persons home way before the nursing home moniker was even identified. Over the years it turned into quite an interesting organization that I've had something to do with. The board of trustees for years has always looked forward to provide care not only in our two nursing homes, but we're one of the oldest medicare-certified home health agencies. We provide skilled care for people at home. We have a day health program at the Salvation Army. We put that together in the mid-'90s so people, who come in the day and are pretty frail but they are pretty alert, they go home in the evenings and it prevents an early stay at a nursing home. We've expanded into outpatient and inpatient rehabilitation. We've cloned a program that Queen's Medical Center started that works with families that are willing to adopt a frail elder who otherwise would be in a nursing home into their homes.

Q. As baby boomers get older, what will their impact be on elder care?

A. I've always been interested in what are we going to do with this age-wave that's already upon us. Hale Makua is the lead agency for a Robert Wood Johnson grant, one of 19 in the country, that's been working in the community on Maui to get some dialogue going among community leaders, the general public and the providers about how we might change the way things occur. As we speak, we are flying 13 nurses in from the Mainland to staff our two nursing homes of 352 beds, and without those nurses from the Mainland, I would have to stop admitting people. One of the things our Robert Wood Johnson grant has done is worked with the high schools. There are career pathways for kids looking at elder care as a career. Both the daycare centers and the nursing homes are used to introduce these kids to elders.

Q. Will there be a shortage of beds in addition to workers?

A. Already on Maui, all of the nursing home beds are full and the hospital continues to strain under the situation where the people can't get out. To build a nursing home bed is tens of thousands of dollars, and it's millions of dollars to build a 120-bed nursing facility. We're working with Kaiser to create a program of all-inclusive care for the elder, which is the PACE program. It's only for people who are eligible for Medicare and Medicaid, so it's essentially for the poor. But it provides care in all settings — hospital care, nursing home care — and it puts the PACE entity, which will be us, at risk for a set dollar per member per month. But then we get to use those dollars very flexibly to buy meals, personal care, transportation, home-delivered nursing, home medical visits from physicians, such that we can care for people much longer and support families much longer because they don't get a lot of support now. We're one of 15 rural PACE grantees in the country. Hale Makua has been on the cutting edge with these kinds of programs.

Q. What about people in the middle-income bracket?

A. There are no services or packages like this. What I see is trying to bring together a group of insurers and major health providers in the state to take a look at how we can provide more cost-effective elder care because while definitely capacity for nursing home beds is an issue, I don't believe there's enough money to build enough nursing home beds. So there are other ways and other models, and our state needs to work first within the private sector and then approach government.

Q. What's the biggest challenge that you and the industry face?

A. The biggest challenge, and it's a thorny issue, is who pays for care for older people. Should it be government's responsibility, and I think most people think it should be. I think people get shocked at what it's going to cost and really don't think about it. So this conversation needs to happen within families and in people's personal planning. At the same time, the industry that cares for people needs to develop new products and services at different price points so that people are more apt to take money and pay for things directly without thinking that the only choice that they have is to pay $85,000 in 2007 dollars for a nursing home. The demand on the system for healthcare and the demand on younger people for a decent education, that tension in terms of our tax dollars is a huge problem that needs to be looked at.

Q. Is funding for care homes like Hale Makua an annual challenge?

A. Absolutely. Eighty-five percent of our revenues come from the Medicaid program, and Medicaid is doing a good job of trying to manage funds. The Legislature and the executive branch for the last 10-12 years have really tried to help nursing homes stay afloat, but it's rapidly becoming more and more difficult. What Hale Makua needs to do is to continue to innovate its product line and not just have home health, foster families, rehab and nursing homes. We're going to have to work to build housing that has embedded in it supportive services in that people's maintenance fees perhaps support some of the personal care that they could use to stay in those residences longer.

Q. How did you get into the elder-care business?

A. I was impressed by a family that was (related) to my first wife, and they were living with the grandmother of the clan. She was an Okinawa lady. I was working in health planning and I was fascinated by how this family was able to care for this elder, who had a number of strokes and was frail. But they did what they could to keep her part of the family. Occasionally, she would go into a nursing home, and that would be a very sad time for everybody. I became interested in what was going to happen to me and to this giant group of baby boomers, and this was back in the late '70s. When I moved to Maui, my boss at Hale Makua needed an administrator, so he offered me a job, and essentially two years later he passed away and I've been the CEO of this organization ever since.

Reach Curtis Lum at culum@honoluluadvertiser.com.