{"id":692738,"date":"2026-06-09T03:07:29","date_gmt":"2026-06-09T03:07:29","guid":{"rendered":"https:\/\/www.newsbeep.com\/us\/692738\/"},"modified":"2026-06-09T03:07:29","modified_gmt":"2026-06-09T03:07:29","slug":"dying-at-home-is-harder-for-these-hospice-patients-stuck-on-o%ca%bbahu","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us\/692738\/","title":{"rendered":"Dying At Home Is Harder For These Hospice Patients Stuck On O\u02bbahu"},"content":{"rendered":"

Medical facilities on Moloka\u2018i aren\u2019t equipped to provide the level of treatment some residents need, but when they fly to Honolulu for advanced care it can be difficult to make it back to spend their remaining days on the island.<\/p>\n

Medical facilities on Moloka\u2018i aren\u2019t equipped to provide the level of treatment some residents need, but when they fly to Honolulu for advanced care it can be difficult to make it back to spend their remaining days on the island.<\/p>\n

\"\"<\/p>\n

Civil Beat Photo Illustration\/Source photo: David Croxford<\/p>\n

When a bout of pneumonia put Robert Granger in the hospital on Moloka\u2019i in December 2024, an emergency room doctor called for an air ambulance to send him to a better-equipped hospital in Honolulu.<\/p>\n

For Granger, who had lived on Moloka\u2019i for four decades, it was a well-worn 36-minute flight. Boarding an aircraft to see a doctor is a widely accepted way of life in rural Hawai\u2019i.<\/p>\n

Doctors at The Queen\u2019s Medical Center on O\u2019ahu treated his lung infection. But Granger\u2019s health quickly deteriorated. When it became clear that the 84-year-old patient was likely to die soon, a nurse began the process of discharging him from the hospital to enroll in hospice care.<\/p>\n

Before he slipped into semiconsciousness, Granger voiced very clear instructions about his wish to die on Moloka\u2019i. A hospice bed had been set up for him at his home 5 miles east of Kaunakakai. But there was no straightforward way for his family to get him there.<\/p>\n

\"TheMoloka\u2019i is a largely unspoiled volcanic island 8 miles northwest of Maui. (Kevin Fujii\/Civil Beat\/2026)<\/p>\n

Taking an air ambulance back to Moloka\u2019i was out of the question. Insurance companies typically do not provide medical-evacuation coverage unless a patient\u2019s condition is life-threatening and local facilities cannot provide adequate treatment.<\/p>\n

Yet Granger\u2019s condition was too fragile for a commercial flight.\u00a0Mokulele Airlines, the lone public air carrier that serves Moloka\u2019i, requires passengers to be able to take a few steps<\/a> to board its small planes.<\/p>\n

Even if Granger could miraculously manage to walk onto the nine-seat Cessna, his family wouldn\u2019t have been able to buy him a ticket. All of the airline\u2019s flights to Moloka\u2019i were booked solid for several days.<\/p>\n

So Granger\u2019s family spent over $4,000 to charter a plane. Coordinating a private flight to Moloka\u2019i, just 26 miles southeast of the state\u2019s Honolulu medical hub, took four days, which turned out to be all the time Granger had left. About an hour after he arrived home, Granger died surrounded by family, neighbors and friends.<\/p>\n

\u201cI think he had been just trying to hang on,\u201d Elizabeth Johnson, Granger\u2019s widow, said. \u201cWhen he knew he was home, he let go.\u201d<\/p>\n

\u2018The Biggest Heartbreak\u2019<\/p>\n

Granger\u2019s uncertain journey to arrive in his chosen destination for death is an emotional portrait of the difficult realities of small island life.<\/p>\n

Moloka\u2019i is a largely unspoiled volcanic island 8 miles northwest of Maui with craggy mountains, windswept beaches, towering sea cliffs and bone-dry ranch lands loaded with the inch-long thorns of gnarled kiawe trees. Dirt roads, wooden churches, family farms and ancient fishponds define the landscape.<\/p>\n

\"MokuleleMokulele Airlines pilots taxi a nine-seat Cessna Grand Caravan at the tiny, two-strip Moloka\u02bbi Airport in Ho\u2019olehua. The Covid-19 pandemic collapsed the number of commercial airlines serving the island from three to one. (Kevin Fujii\/Civil Beat\/2026)<\/p>\n

The island, which is shaped like a fish, is devoid of fast food chains, traffic and nightlife. There are fewer vacationers \u2014 the island has just one hotel \u2014 and more Native Hawaiians here than anywhere else in the state. Moloka\u2019i is only 40 miles from all of the tourist dollars in Waik\u012bk\u012b\u00a0on O\u2018ahu but it could just as well be a world away.<\/p>\n

Decades of anti-development politics and activism have squashed Moloka\u2019i\u2019s economic growth, making it more difficult to recruit healthcare workers to the island of 7,400 residents, where housing is expensive and career options are narrow.<\/p>\n

Even for those who hope Moloka\u2019i stays this way, there are plenty of reasons to leave: a college degree, a good-paying job, a doctor appointment, a nursing home, even childbirth<\/a>. Transportation on and off the island is limited to a single, generally unreliable airline<\/a>.<\/p>\n

\u201cIt takes a special person to live on Moloka\u2019i,\u201d Kimberly Svetin, president of family-owned Moloka\u2019i Drugs, said. \u201cSo it\u2019s sad when, for healthcare reasons, they can\u2019t stay. I think for me the biggest heartbreak is when someone is air ambulanced off-island and wants to pass away here and is not able to get back.\u201d<\/p>\n

Hospice Maui CEO Melanie Dwyer said it happens several times a year, when a hospice patient who sought off-island medical care wants to return home to die but finds themselves stranded.\u00a0The nonprofit provides palliative and end-of-life care to residents of Maui, Moloka\u2018i and L\u0101na\u02bbi.<\/p>\n

\u201cOur unique island geography is nothing new,\u201d Dwyer said. \u201cIf we cannot provide them with the treatment they need in their local community and they have to fly elsewhere to get it, then we should also be getting them back home.\u201d\u00a0<\/p>\n

\u2018It Really Matters\u2019<\/p>\n

In Hawai\u2018i, where\u00a0it\u2019s common for people to fixate on where others were born and raised<\/a>, a person\u2019s place of death is another important identity marker. This is particularly true for some Native Hawaiians who trace a long lineage in certain rural areas whose populations have been ravaged by a century of displacement.<\/p>\n

Yet Moloka\u2018i has few medical resources to support people approaching the end of life. Healthcare on the island, which measures 38 miles long and 10 miles wide, is limited.\u00a0Although many people there say they do not want to leave their island home as they age, Moloka\u2018i, which heavily relies on fly-in physicians to bolster healthcare services, has few options to help them stay.<\/p>\n

\"AMoloka\u2019i is one of the least visited of the Hawaiian Islands. Much of what the island boasts is bound up in what it lacks: overtourism, fast food chains, traffic jams, sprawling neighborhoods. Residents relish a simple lifestyle that closely resembles that of old Hawai\u2019i. (Kevin Fujii\/Civil Beat\/2026)<\/p>\n

Moloka\u2019i has no nursing homes or assisted living facilities. There is no local provider of comprehensive in-home nursing care. Aging residents typically must board a plane to access long-term care on O\u2019ahu or Maui.<\/p>\n

The island has about 75 resident deaths a year<\/a>. About a quarter of them occur off-island. It\u2019s not clear how many residents who die away from home would have spent their last moments on Moloka\u2019i if it weren\u2019t for the combined effects of healthcare shortages and transportation hurdles.\u00a0<\/p>\n

Of course, not all Moloka\u2019i residents have the same wish to die on the island. But it\u2019s a compelling request that has become more common<\/a> with the expansion of home hospice care nationwide.<\/p>\n

\"AnTens of thousands of axis deer roam Moloka\u2019i. Many local families rely on the hunting of free game to put food on the table. (Kevin Fujii\/Civil Beat\/2026)<\/p>\n

\u201cA lot of Moloka\u2018i people, they don\u2019t want to live a longer life if they\u2019re going to have to leave Moloka\u2018i \u2014 they would rather have a shorter life,\u201d said Maui County Council member Keani Rawlins-Fernandez, who lives on Moloka\u02bbi. \u201cI don\u2019t know of a family that hasn\u2019t been affected by not having long-term care on island and I don\u2019t know of a family who isn\u2019t wishing to have their final breaths on Moloka\u2018i.\u201d<\/p>\n

The issue affects residents from other neighbor islands, but the problem is especially bleak for people from Moloka\u2018i, which has among the most limited elder care resources and transportation options in the state.<\/p>\n

In rare cases, insurance companies have paid for medevac transport to fulfill a patient\u2019s wish to die at home. It happened earlier this year when AlohaCare, which serves primarily Medicaid and some Medicare clients, covered costs to fly a dying patient to their home in Maui County from The Queen\u2019s Medical Center in Honolulu.\u00a0<\/p>\n

Hospice staff and the patient\u2019s family sent the insurer thank-you cards.<\/p>\n

AlohaCare chief medical officer Dr. Gary Okamoto said in a statement that the insurer will sometimes make an exception to its coverage rules to support a patient\u2019s desire to receive end-of-life care on their home island.<\/p>\n

\u201cSometimes getting home, it seems very brief, but for the families, to have your whole extended ohana around you, it really matters for people,\u201d Dwyer said. \u201cThe death of a loved one is very similar to the birth of a loved one in that way. People remember every detail. It stays with them for years after they\u2019ve said goodbye.\u201d<\/p>\n

Home By Any Means: Fishing Boat, Private Flight<\/p>\n

Some older residents who leave Moloka\u02bbi in search of better healthcare go to great lengths to return home to die.\u00a0<\/p>\n

Moku Buchanan, a longtime Moloka\u02bbi mortician, recalled one determined resident who made a perilous sea crossing to Moloka\u02bbi from O\u02bbahu on a small fishing boat. The 26-mile Ka\u02bbiwi Channel that separates the two islands is considered one of the roughest ocean passages to navigate in the state.<\/p>\n

Buchanan counts several families over the years who have hired a private plane, but he notes that most residents don\u2019t have the money to charter a flight.<\/p>\n

\u201cI wish I was a millionaire,\u201d Buchanan said. \u201cI would build a care facility for the older folks on Moloka\u02bbi so they wouldn\u2019t have to leave.\u201d<\/p>\n

Hawai\u02bbi economists have found that a rural ZIP code is one of the strongest predictors of poor health outcomes<\/a> for people in Hawai\u2018i. The finding published in a June 2025 report by the University of Hawai\u02bbi Economic Research Organization underscores just how tightly bound a person\u2019s wellbeing is to their place of residency.<\/p>\n

Moloka\u02bbi has the state\u2019s lowest household incomes and highest unemployment. Its population is predominantly of Native Hawaiian ancestry, a group with significant socioeconomic disparities<\/a>. Native Hawaiians face high rates of food insecurity and chronic disease, studies show.<\/p>\n

\"AMoloka\u2019i has three major roads, two gas stations and no traffic lights. (Kevin Fujii\/Civil Beat\/2026)<\/p>\n

Roughly two-thirds of Moloka\u2018i residents rely on government health insurance. In Hawai\u2018i, doctors who serve Medicaid and Medicare patients receive some of the nation\u2019s lowest reimbursement rates, sometimes lower than the cost of providing care. The discrepancy makes it difficult to recruit and retain medical staff in the state\u2019s rural areas.<\/p>\n

The island would need to grow its supply of doctors by 83% to meet patient demand, said Dr. Kelley Withy, a physician at the University of Hawai\u02bbi\u2019s John A. Burns School of Medicine, who oversees an ongoing study of the state\u2019s medical workforce needs<\/a>.\u00a0<\/p>\n

\"Farm-grownRoughly 35% of Moloka\u02bbi\u2019s population receives federal food aid, while more than a third of the residents report that they farm, hunt and fish to feed their families. (Kevin Fujii\/Civil Beat\/2026)<\/p>\n

It\u2019s long been customary for Moloka\u02bbi patients to fly to hospitals and treatment centers in Honolulu, where the state\u2019s medical resources are concentrated. But the Covid-19 pandemic worsened rural health access, slashing flights<\/a> to Moloka\u02bbi and reducing the number of public airlines servicing the island from three to one.\u00a0<\/p>\n

It\u2019s since become a logistical nightmare to get to off-island medical appointments, many residents say. It\u2019s also more expensive. Doctors who routinely traveled to the island to prop up medical care have stopped coming as fewer flight options and more frequent flight delays have raised the risk of being stranded overnight.\u00a0<\/p>\n

Flying to the doctor, however, will likely always be part of the equation. It\u2019s widely accepted that a population as small as Moloka\u02bbi cannot sustain most medical specialists. There\u2019s a significant cost to keeping cardiologists or neurologists on deck, especially if they sit idle most of the time.<\/p>\n

Sean Ibara, a spokesman for The Queen\u2019s Health Systems, declined interviews for this story. The health network runs six Hawai\u02bbi hospitals, including The Queen\u2019s Medical Center in Honolulu and Moloka\u02bbi General Hospital in Kaunakakai.<\/p>\n

Moloka\u02bbi General Hospital President Janice Kalanihuia said in a written statement that the hospital strives to assist island residents who wish to receive end-of-life care on the island but noted that air transportation options for these patients is extremely limited.<\/p>\n

For a time the hospital had 21 long-term care beds. The unit shut down in 2008 due in part to staffing challenges.<\/p>\n

\u201cNot having long-term care is a biggie and I don\u2019t know how to fix it,\u201d Donna Gamiao, a Moloka\u2019i hospice nurse, said. \u201cThe population is small, we\u2019re mostly a welfare island, we rely heavily on government funding, we don\u2019t pay many taxes. I don\u2019t know how it would work without an outside agency supporting the bottom line.\u201d<\/p>\n

\u2018If I\u2019m Going To Die, I Want To Die Here\u2019<\/p>\n

\"ATransportation on and off Moloka\u02bbi is limited to a single airline. (Kevin Fujii\/Civil Beat\/2026)<\/p>\n

Some residents turn down off-island medical care as the end of life nears.<\/p>\n

That was the case for Harvey Place. Doctors in Honolulu had already treated his cancer with chemotherapy and radiation. But the cancer was advancing.<\/p>\n

\u201cA lot of people are not ready to die,\u201d his widow Jan Place said. \u201cIf you have that determination to fight, fight, fight until you\u2019re out of options, you\u2019re inevitably going to have to go to Honolulu because we don\u2019t have all of those medical resources here. But Harvey said, \u2018I\u2019m not going to fight this anymore. If I\u2019m going to die, I want to be here.\u2019\u201d\u00a0<\/p>\n

\"KimberlyKimberly Svetin, president of Moloka\u02bbi Drugs, says \u201cthe biggest heartbreak is when someone is air ambulanced off-island and wants to pass away here and is not able to get back.\u201d (Kevin Fujii\/Civil Beat\/2026)<\/p>\n

Staying on Moloka\u02bbi may have shortened his life. But to leave would have meant parting with the things that made life worth living.\u00a0\u00a0<\/p>\n

Two fly-in palliative care nurses from Hospice Maui visited the Places at their Moloka\u02bbi home during the summer of 2023 for about an hour up to three times a week. But the brunt of the work \u2014 intimate, constant, exhausting \u2014 fell to Jane Place. She was her husband\u2019s primary home caregiver for three months until his death at age 70.<\/p>\n

Looking back, Jan Place said she is grateful that she was able to help him achieve his wish to die in familiar surroundings. She credits hospice workers, as well as her own physical and mental stength.<\/p>\n

\u201cThe thought of sending him off-island never even occurred,\u201d Jan Place said. \u201cI just wouldn\u2019t risk him dying away from home. I knew I\u2019d take care of him until the day he passed no matter what the cost of that.\u201d<\/p>\n

Options narrow for people without family.<\/p>\n

Catherine Aki, a 74-year-old substitute teacher, lives alone in her two-story home on Moloka\u02bbi. She suffers from age-related macular degeneration, an eye disease that is eroding her vision. Over time, she is expected to become blind.<\/p>\n

When she can no longer live without assistance, Aki said she will be forced to move to Maui, where she has two daughters, eight grandchildren and nine great-grandchildren.\u00a0She has no on-island relatives.<\/p>\n

Beyond proximity to family, Maui offers something that Moloka\u02bbi lacks: The option to hire in-home care professionals who can help with bathing, cooking and waning mobility.<\/p>\n

\u201cIt feels sad,\u201d Aki said. \u201cI\u2019ve lived here more than half of my life. I raised my children here. And it\u2019s my hope to live here as long as I can. There\u2019s this other part of me that knows I\u2019ll be in good hands if I\u2019m on Maui because they have services there.\u201d<\/p>\n

\"PhotoLolita \u201cNina\u201d Tanora Greenleaf was 71 when complications from a stroke forced her to leave Moloka\u2018i in search of long-term care. She lives on Kaua\u2018i with her niece, who has become her caregiver. (Courtesy: Moloka\u2018i Drugs\/2017)<\/p>\n

Svetin, the drug store owner, counts the island\u2019s disappearing elders by the number of prescription transfer requests for off-island pharmacies. She estimates that about a dozen aging residents move off-island each year in search of better healthcare services.<\/p>\n

Lolita \u201cNina\u201d Tanora Greenleaf was one of them. Born and raised on Moloka\u02bbi, she was sure she\u2019d live out her life on the island. She was so proud when she paid off her mortgage after decades of work as a pharmacy buyer and cashier.<\/p>\n

Her dream to age in place was stolen by a stroke when she was 70. Paralysis left her bedridden and in need of constant care.<\/p>\n

Greenleaf is a widow with no children. She had friends to help with small tasks around the house and keep her company, but no on-island family to take on the heavy lifting of caregiving.<\/p>\n

So in early 2024, Greenleaf\u2019s closest relative, a niece, moved her into her home on Kaua\u2019i.\u00a0It\u2019s unlikely that she\u2019ll ever return to Moloka\u02bbi.<\/p>\n

\u201cWe had to coach her to understand that it was for the better to leave,\u201d Reiko Muratake, Greenleaf\u2019s 50-year-old niece-turned-caregiver, said. \u201cBecause on Moloka\u02bbi, where do you go? There\u2019s no solution other than family.\u201d<\/p>\n

Civil Beat\u2019s health access reporting is supported in part by the Atherton Family Foundation.<\/p>\n","protected":false},"excerpt":{"rendered":"Medical facilities on Moloka\u2018i aren\u2019t equipped to provide the level of treatment some residents need, but when they…\n","protected":false},"author":2,"featured_media":692739,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[97,252,253],"class_list":["post-692738","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-care","tag-health","tag-health-care","tag-healthcare"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/692738","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=692738"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/692738\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/692739"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=692738"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=692738"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=692738"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}