Home is where the heart is, but too often it's not where enough of Hawai'i's elderly residents find themselves in their later years.

Certainly, most of those in an institutional setting would rather be home if the right support systems were in place. Making this happen must become the focus of government now.

A long-term care commission has just been established by law that can help grapple with the issue, but it needs action by Gov. Linda Lingle to begin its urgent work.

The lack of sufficient at-home care support is the impetus of a study by the AARP Public Policy Institute, which recently concluded that this state has further to go than most in transitioning more senior citizens and disabled people on Medicaid to at-home care.

Hawai'i allots 83 percent of its long-term-care spending for Medicaid recipients to nursing homes, compared with 75 percent nationally.

Between 2001 and 2006, the increase in spending on nursing homes was about three times as much as the increase in outlay for home- and community-based services.

At the root of this imbalance is the cost of institutional care. For every person whose nursing-home bills are underwritten by Medicaid, two to three people could have been supported in living at home with supplemental services.

And this state, like most, lacks the institutional capacity, anyway. On any given day in Hawai'i, more than 200 people are on the waiting list for admission to a nursing home.

So enhancing at-home care systems makes sense on every level. Most importantly, people want that option.

The state Department of Human Services has recognized the trend for several years and has launched its own initiatives:

• Next February, the state will begin QUEST Expanded Access. Among its features: Clients will receive additional health services, including special programs for diabetes, obesity, heart disease and expanded home- and community-based care.

• The Going Home Project started in 2003 and is now being expanded to needy children and others, enabling Medicaid recipients requiring intermediate and skilled nursing care to relocate from hospitals and nursing homes to community-based facilities. This includes adult foster homes which, through state recruitment efforts, have grown by more than a third.

Deinstitutionalizing residents saves taxpayers more than $78,000 per patient each year in Medicaid funds.

Making these improvements for Medicaid recipients is a good start and will provide the model for better community services for all. But much more work is needed to reach the largest proportion of the population: those who need help accessing services for at-home care but don't qualify for federal and state subsidies.

So it's imperative that the state follow this lead and begin planning a broad network of services to support its citizens in their goal of "aging in place."

First, the governor needs to release the $100,000 appropriated for the new long-term care commission so that the panel, established in Act 224, can find ways to fill the gap. Ten of the 15 voting members have been named; the governor needs to tap the remaining five. Including some from business — which has lost productivity of workers who are juggling duties as elder caregivers — would be wise.

With baby boomers approaching elder status, there's no time to lose. Hawai'i must maintain its cherished tradition of keeping kupuna close to their loved ones — at home whenever possible.