Since the long-term care facility Hale Makua in Kahului started taking patients displaced from storm-damaged Kula Hospital a month ago, its capacity has reached nearly 95%.

Staff are working long hours and the facility has hired more than a dozen travel nurses to handle the influx of about 21 patients from Kula and the continuous flow of patients discharged from Maui Memorial Medical Center.

“We are as busy as I think I’ve ever seen at Hale Makua right now,” CEO Wes Lo said Friday, adding that “I don’t want to make people afraid, but we just need to closely monitor the situation because we are getting close to critical capacity.”

Lo continues to keep careful tabs on Hale Makua’s daily numbers as Maui Health and state officials work to hammer out long-term plans for the displaced patients and for Kula Hospital, which suffered widespread water damage from a massive Kona low storm in mid-March that dumped nearly 50 inches of rain on Upcountry in one weekend.

The water damage forced the critical access hospital to evacuate 112 patients, including many who lived there long term and required specialized care. 

The affected areas included the emergency department, a floor where 41 patients lived, and Hale Makamae, the only intermediate care facility on Maui for patients with developmental disabilities. Eight of the nine Hale Makamae residents had to be sent to O‘ahu.

Hawaiʻi Gov. Josh Green, who toured Kula Hospital last month after the storms, told the Hawai‘i Journalism Initiative last week that with the loss of emergency services, putting in a facility that could handle urgent cases is “the first goal.” The state is considering deploying one of its own mobile facilities or a temporary modular clinic like the one Kaiser built in Lahaina after the 2023 wildfires. 

“We need to essentially replace the capacity for those few ER/urgent care beds,” Green said April 17. “The long-term care facility is going to take a big decision whether or not we should repair it.” 

The mobile facilities, essentially like military field tents, could accommodate a handful of patients for minor emergencies and urgent care. While Green said he likes “the idea of having a little more structure,” the advantage of the mobile units is that they can be set up in a matter of days, and the state already has several in stock for hurricanes and other major disasters.  

The benefit of a clinic like the one Kaiser built is that it would last longer, be more sophisticated and more capable of withstanding another storm. But that could take several months to install.

“If I see a delay coming, I will deploy the mobile facility,” said Green, who is also a longtime emergency room doctor.

Green said he is meeting with Maui Health and the state Department of Health and hoped to make an announcement soon about the next steps for the hospital. 

Whether facilities are repaired or replaced will depend on the extent of the damage. Wade Ebersole, who will step in as interim CEO of Maui Health on May 3 after the departure of Lynn Fulton, said in a statement on Friday that assessments of the damage “have advanced significantly” but there is still work to do to determine the necessary repairs and long-term needs. 

“What we can share is that the damage is significant and addressing it will require substantial work and coordination,” Ebersole said.

Maui Health is “considering a range of options that could help support continued access to care for the Upcountry community and meet the needs of our long-term care residents,” said Ebersole, who currently serves as vice president and chief operations officer of Maui Health.

He said no decisions have been made regarding any specific interim solution, but Maui Health would share updates with the community as more information becomes available.

The repairs are complicated because the facilities are owned by the state and leased to Maui Health, so the insurers have to decide who is responsible.

“We won’t let that hold us up,” Green said, adding the state is prepared to use emergency funds as needed and additional funding could be available under the recently approved federal disaster declaration.

Adam LeFebvre, a spokesperson with the state Department of Health, said Tuesday that the state is in talks with Maui Health and that “all parties are working with urgency to stabilize the situation and identify pathways that best support residents, their families and care teams.”

“The Hawaiʻi State Department of Health continues to provide regulatory oversight to ensure the health and safety of all residents, including decisions related to facility conditions and appropriate care settings,” LeFebvre said. 

Green said the thought of people living Upcountry having to drive half an hour to Maui Memorial Medical Center in Wailuku “worries me.” Maui Memorial is the only acute-care facility on island, and now with Kula’s facilities out of commission, it’s the only hospital on Maui.

The damage to Kula also means that about a quarter of the island’s long-term care beds are no longer available, and Hale Makua is starting to feel the effects.

Lo said the Kahului facility usually averages about 210 patients. Now, it’s up to about 236, which Lo said is the highest level he’s seen in his time at the helm.

With a total of about 313 residents in its Kahului and Wailuku facilities, Hale Makua is nearing capacity, which means there is increasingly less space for patients discharged from the hospital. Hale Makua has hired 13 more traveling nurses to help out, with three more coming on next week.

“This is almost like a silent disaster right now, because … as soon as we get busy, guess what?” Lo said. “They’re going to be stuck in the emergency room, right? Because there are no beds.”

Hale Makua also helped Maui Health transfer 50 patients to a facility in the Kīhei Research and Technology Park that ‘Ohana Pacific Health, a sister company of Hale Makua, had been trying to sell. A wing of Maui Memorial has also been cordoned off for Kula patients. Fulton said Kula staff have also relocated to the facilities where their patients have gone.

Lo said until the damage assessment is complete, it’s difficult to know what the next steps should be.

In the meantime, he said, Hale Makua will continue to handle the higher patient load: “We’re going to do whatever we can to take care of the community, because I mean, frankly, there is no other choice.”