By Aneika Falcon
I am writing to bring to your attention a growing concern on Hawaiʻi Island that deserves public awareness. The current landscape of hospice care on the island is increasingly being defined not by progress and patient-centered care, but by stagnation and limited access – especially troubling given our rapidly aging population.
Specifically, existing hospice providers on Hawaiʻi Island appear to be impeding the development and entry of new hospice organizations. This resistance to competition not only limits diversity and innovation in hospice services but also restricts patient choice – essential in end-of-life care where cultural values, trust, and quality of care are paramount.
The population of kūpuna is growing, yet available hospice options have remained largely unchanged. This lack of development limits not only healthcare options, but also economic opportunities that new providers could bring to Hawaiʻi Island. The introduction of new hospice organizations would encourage job creation for healthcare professionals, administrative staff, and support workers, benefiting local employment and economic health.
Monopolistic or exclusionary practices in any area of healthcare threatens to undermine fairness and equity. In a place as diverse and culturally rich as Hawaiʻi, the ability to choose a hospice provider that aligns with one’s cultural values and care philosophy is essential. The current lack of options does not reflect the needs or the diversity of our community.
This story touches multiple areas of public interest: healthcare access, economic development, patient rights, and the health of our elderly population. I believe this issue is worthy of further exploration and reporting.
An application that was submitted to the Certificate of Need (CON) office clearly demonstrates that the proposal meets the regulatory criteria for approval. Despite this, the application was denied following a public hearing held on April 25, 2025. The hearing was overwhelmingly attended by representatives and staff of existing hospice providers, with minimal representation from patients, families, or neutral stakeholders.
The denial letter suggests that the decision was influenced primarily by testimony from current hospice providers who argued that, because there is no existing waitlist for hospice care, there is no need for an additional provider. This rationale is both flawed and insensitive. The implication that a waitlist to die must exist before expanding end-of-life care is a disturbing standard that disregards the real needs of patients and families seeking dignity, timely care, and culturally appropriate support at life’s end.
Moreover, the exclusion of new hospice organizations curtails economic development, job creation, and innovation in healthcare delivery. New providers bring fresh energy, culturally responsive care models, workforce opportunities, and much-needed competition to elevate care standards. The current providers’ opposition appears more motivated by protectionism than public interest.
It is time to call attention to how entrenched hospice providers are shaping policy outcomes that prioritize institutional self-interest over patient choice, community growth, and equitable access to care.
This has broad implications for healthcare equity and transparency on Hawaiʻi Island.
Aneika Falcon is a healthcare professional with 15+ years in the industry. She has family on Hawaiʻi Island and friends that are a part of the aging kūpuna population.
