One of only a handful of home health care companies in Hawaii is permanently shutting down operations at the end of this month, leaving roughly 100 or so patients having to turn elsewhere for nursing care.

“After months of working diligently to rework our operations to address rising costs, staffing challenges, and adjustments in CMS (Centers for Medicaid &Medicare Services) regulations, we have come to the difficult conclusion to close Oahu Home Healthcare in January 2023,” CEO Jen Eaton said Friday in a written statement, after making an initial announcement in mid-December. “We are working with other healthcare providers to transfer our patients and will do our best to ensure the transition is as smooth as possible.”

The company’s departure underscores the need for this type of service here as well as obstacles this segment of the health care industry faces.

Launched in early 2015, Oahu Home Healthcare is one of nine home health care businesses in the state, leaving just eight — with some serving a single island, said Hilton Raethel, president and CEO of Healthcare Association of Hawaii. On any given day the company’s nurses cared for roughly 100 patients.

Two other home health care outfits — Bayada Home Health Care and Adventist Health Castle Home Care — have agreed to take 20 patients each. Another 30 to 40 will be discharged prior to month’s end. Twenty patients still have to be placed, but Raethel said, “We’re confident we can find homes for those other 20.”

The majority of the company’s patients are seniors and on Medicare. The relatively low Medicare reimbursements for home visits by registered nurses — compared with the reimbursement amounts hospitals and skilled nursing facilities receive — have contributed to staffing shortages, Rae­thel said.

While Oahu Home Healthcare’s 35 full-time employees must seek other work, 20 have been offered jobs at two sister companies: Islands Hospice and Islands Skilled Nursing and Rehabilitation, he said.

Eaton said the others will be “provided with resources for other potential opportunities.” He added, “We appreciate our employees for providing quality care and compassion to our patients, families, and community for their support and entrusting us with their medical care.”

Those employees will likely find opportunities quickly, as the home health care has the highest job vacancy rate in the overall health care industry: a 39% vacancy rate, Raethel said. That statistic is drawn from data in a comprehensive statewide survey of 89 health care professions.

The high vacancy rate can be attributed to some nurses opting not to work in home care, given the prospect of less pay and a potentially challenging schedule that could involve driving to the homes of four to six patients a day, Raethel said. However, some nurses prefer the home visits to working in a hospital ward.

The vacancy rate, Raethel said, is “a little more critical in health care than some other industries.” For example, if a restaurant does not have enough workers, it can’t serve would-be diners, he said. “If you don’t have enough nurses, therapists, technicians, it means they may not get the care they need or not as quickly.”

In many cases, home health care patients have been hospitalized and need continued care when discharged, such as wound care or intravenous antibiotics, he said. Some need follow-up care for surgery or illness and need their vital signs checked.

The advantages of home care are that patients can be around family and sleep in their own bed rather than staying in an unfamiliar hospital setting.

These patients require services that can be provided by a registered nurse, and cannot be cared for exclusively by a certified nurse’s assistant. Hospitals having to ensure these patients are properly cared for must discharge them to a home health care company or to a nursing or care home to service tailored to their needs. In some cases a discharged patient’s family can end up trying to provide care or having to drive them to a physician’s office to receive treatment, Rae­thel said. In the absence of a plan to discharge a patient into a safe environment, a hospital may have to keep the patient for additional weeks, Raethel said.

With the cost of care to Medicare patients set at zero and reimbursement set at fixed rates by the federal government, home health care companies must bear the burden of rising costs.

Home health visits range from $250 to $300 per visit, with most patients requiring two to three visits a week. Skilled nursing facilities are reimbursed at rates of $600 to $700 a day, and hospitals receive a couple thousand dollars a day, Raethel said.