We all know costs have been rising for everything, from electricity and water to gasoline and groceries. Skilled nursing facilities face those same increasing costs, too — and to ensure that our kupuna in Hawaii continue to receive the best care, we need the state’s Medicaid payments to keep up with inflation.

To care for Medicaid patients, each of the state’s 49 nursing facilities loses around $20 per patient, per day, because state payments don’t fully cover the cost of care. With an average 70 percent of nursing home patients on Medicaid, this compounds into a huge cost burden for facilities. In 2015, nursing facilities collectively lost $16.5 million treating Medicaid patients.

This is a problem for every nursing facility on every island.

Unfortunately, the shortfall leaves no margin for reinvesting in facilities and equipment, or retooling for major shifts in the health care landscape, including new regulatory requirements. Across the board, nursing facilities are seeing more complex and higher acuity patients, and facing increasing costs from expensive new technologies and drug regimens.

Specialty equipment for bariatric care, respiratory therapy and wound care can cost tens of thousands of dollars per unit. Even just an appropriate bed and mattress designed to lessen the chances of pressure sores in patients can cost thousands.

Nursing facilities also compete for employees with other sectors such as retail and tourism, which have the ability to increase revenues. Since Medicaid rates are set by the government, nursing facilities don’t have this option. With little room to give raises or offer competitive salaries, nursing facilities can face staffing shortages that can lead to closed beds.

With the recent shortages in health care labor, nursing facilities are now relying more and more on agencies to fill shortage areas for medical staff, including certified nursing assistants (CNAs), nurses and physical therapists. This stop-gap measure is not the best long-term solution for facility costs or patient care. To be sustainable in the new era of health care, facilities need to be able to adapt to changing times, and keep up with rising costs.

Nursing facilities statewide are an important part of the state’s safety net. Some families have no other options — no long-term care insurance or sufficient income to pay for care in other types of settings. Medicaid is their only resort to get their loved ones the services and help they need.

Without inflationary adjustments, nursing facilities could soon feel the pressure to not accept Medicaid patients, in order to keep doors open. If that were to happen, patients who would be more appropriately treated in a nursing facility could face the higher costs of hospitalization. This would in turn be more expensive for the state as well. Overall, an inflation rate adjustment keeps costs lower for the health care delivery system.

That is why the industry statewide is asking lawmakers to support an inflation rate adjustment covering Medicaid patients. Hawaii’s nursing facilities appreciate that this is a difficult budget year and commend legislators and Gov. David Ige’s administration for engaging in serious discussions on these issues.

As we think about the future of our kupuna and other loved ones needing skilled nursing care, it’s vital that we ensure nursing facilities have the resources they need to provide high-quality care to those in need.

Richard Kishaba, president of Ohana Pacific Management Company, is Long Term Care Leadership chairman at the Healthcare Association of Hawaii; Wesley Lo is CEO of Hale Makua Health Services.