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Home Healthcare and Hospice: A Pacific Islands Perspective

Fernandes, Ritabelle, MD, MPH, FACP; Osarch, Sylvia, DCHMS; Allen, Nancy E., BSN, RNC, CMC

doi: 10.1097/NHH.0000000000000668

The Pacific Islands Geriatric Education Center of the University of Hawaii conducted situational assessments of caregivers, older adults, and healthcare professionals in the Republic of Palau. The findings revealed an urgent need for a solution to the identified crisis of an aging population, increasing chronic diseases and their corresponding impact on caregivers and society. In 2010, the National Healthcare Financing Act was signed into law, becoming Palau's first step in helping residents and workers in Palau pay for medical expenses. This program is referred to as the Health Care Fund and consists of two parts: National Health Insurance and Medical Savings Account. Advocacy and promotion of home healthcare services in Palau was facilitated by the Pacific Islands Geriatric Education Center. Because of these efforts, systems changed to establish home healthcare services and expand the Health Care Fund with a proposed Home Health Insurance Benefit from the National Health Insurance. This is a huge leap forward to improve access to care for older adults and homebound in Palau.

Ritabelle Fernandes, MD, MPH, FACP, is an Associate Professor, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii.

Sylvia Osarch, DCHMS, is a Public Health Physician, Homebound Program, Belau National Hospital, Ministry of Health, Koror, Palau.

Nancy E. Allen, BSN, RNC, CMC, is a Senior Consultant and Chief Executive Officer, Solutions for Care, Inc., Jacksonville Beach, Florida.

Funding to carry out this project was received from the Pacific Islands Geriatric Education Center Grant No: IB4HP19065, Department of Health and Human Services (DHHS), Health Resources and Services Administration (HRSA) and from the Palau Ministry of Health Grant No: 5U58DP003939, Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations. We appreciate the Palau Health Care Fund Governing Committee for its collaboration. We are grateful to the Health Services of the Pacific, Bristol Hospice, Briggs Healthcare, and Visiting Nurse Associations of America for their donations and generous assistance.

The authors declare no conflicts of interest.

Address for correspondence: Nancy E. Allen, BSN, RNC, CMC, Solutions for Care, Inc., Jacksonville Beach, FL 32240 (

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