Molokai, the most Hawaiian of the Hawaiian Islands, has a population of approximately 8,000; 40 percent of which are of native Hawaiian descent. The people of Molokai have fought to preserve their lifestyle and as a result it has no malls, no elevators, no building taller than a palm tree, no traffic lights, but it lacks nursing homes and struggles with high unemployement.
However, it is the home of some 600 Veterans, many of whom have no other health care except for the VA. So, when the Office of Rural Health, in conjunction with the Office of Geriatrics and Extended Care, provided funding for new Home Based Primary Care (HBPC) programs there, our Veterans of Molokai were grateful. The nearest Community Based Outpatient Clinic (CBOC) is located on another island, separated by an expanse of ocean and requiring a trip by airplane or ferry to access. Until then, the only VA presence on Molokai was an Outreach Clinic, where VA Pacific Islands Health Care System (VA PIHCS) operated out of the Molokai General Hospital two afternoons a week with periodic visits from VA mental health providers. In-home services were not available or provided by VA staff, yet Veterans needed those services.
One of these Veterans was John, a 73-year old 100% native Hawaiian, who had sustained leg and ankle injuries during his service in the Air Force. Following his return home to Molokai, he was injured on the job when a bus he was working on rolled over his already injured leg. He then had two serious strokes and became wheelchair bound.
When referred to the Home Based Primary Care Program, John’s lipids and blood pressure were not controlled. With closer monitoring by the HBPC team and enrollment in the Care Coordination Home Telehealth program, John’s medical condition stabilized.
A visit by the HBPC occupational therapist led to home improvements and proper equipment including a hospital bed, shower chair, safety bar and raised toilet seat, which increased his ability to have his personal needs met and enhanced his safety in the home.
John began an exercise program with the assistance of a HBPC physical therapist, increasing his strength and prevented contractures, which were already starting. The HBPC social worker obtained Homemaker/Home Health Aide services to assist his wife to provide her with some respite.
According to John, the best thing that happened was that the team helped him obtain a motorized power chair. He loves to venture outdoors and enjoy his beautiful Molokai Island home; another example of how VA PIHCS strives to achieve patient-centered care.
John is one of many Veterans serviced by the Home Based Primary Care program who have expressed high satisfaction with the outreach they received. John’s wife sums up the sentiments of the Veterans best with her remark, “We thought the Veterans on Molokai were forgotten, but now we know they are not.”
According to Charlotte Kuwanoe, VA PIHCS HBPC Program Director, Veterans are offered dignity and decision-making by having the option to remain on their home island, rather than being displaced to a neighbor island skilled nursing facility, during their end of life. “We want our Veterans to be comfortable, especially during this time,” said Kuwanoe. “We look for ways to reach out, restore hope and remind our Veterans that we honor them, respect their preferences and strive to provide Veteran-centered care,” she said.