Every Sunday, “Back in the Day” looks at an article that ran on this date in the Honolulu Star-Bulletin. The items are verbatim, so don’t blame us today for yesteryear’s bad grammar.

Alternative care programs must be provided for Hawaii’s growing elderly population outside standard-care facilities, representatives of social and health groups stressed yesterday.

They said the needs of many older citizens could be met with home health-care, day-care or group home programs, thereby eliminating the need to build more nursing facilities to accommodate them.

The issues and problems of long-term care — a critical problem nationwide — were discussed yesterday at a public forum of the Health and Community Services Council of Hawaii.

The council expected a small group for an informal discussion, but about 70 persons showed up for the meeting at noon at the Harris United Methodist Church.

The unexpectedly large turnout reflects the community’s increasing concern with the problems of long-term care for sick and aged residents.

The Star-Bulletin focused attention on the issue last month with reports by state officials of a severe shortage of medical-care facilities that is expected to become worse.

The "dilemmas" were described yesterday by Andrew I.T. Chang, director of the state Department of Social Services and Housing, which administers the Medicaid program for low-income and welfare families.

He said the state constitutional ceiling on state expenditures, combined with inflationary pressures, "puts a damper on innovative ideas" because new programs can’t be initiated without knocking out some old ones."

The federal rules under which "we play the game" also are constantly changing, he said.

Chang said the Medicaid cost-containment problems are only part of a broader spectrum of rising costs in Hawaii’s entire medical system.

He called for restructuring of Medicaid and Medicare provisions of the Social Security Act and he said that while the community prefers alternative care arrangements, "the current system does not provide those kinds of incentives."