Inside the ER at the state's largest hospital, beds are so scarce it's become common for patients to be treated in the hallway.
Officials at the Queen's Medical Center say overall visits are up.
But the biggest spike is among the homeless population. From 2013 and 2016, the number of homeless people being admitted to the ER has nearly doubled — at a cost to taxpayers and the hospital of $90 million a year.
"We can sometimes no longer meet the needs of our community because we're full in the emergency room," said Dr. Daniel Cheng, assistant chief of Queen's ER.
To help shoulder the burden, health care companies, the city and state are joining forces to launch the Honolulu H-4 project.
The 24-7 urgent health care facility will cater to the island's needy. The project involves HMSA and Queen's — and the $5 million a year price tag will largely be covered by grants and donations. The remainder will be reimbursed by insurance companies.
The first floor of the facility, located at 431 Kuwili St., will house a hygiene center equipped with showers, restrooms and a laundry facility. The second level will be converted into a health clinic that includes drug treatment and mental health services. The top two floors are for extended care.
"A doctor can go upstairs and do a house call basically. We'd like to see sustained long term housing there too. We have nurses, doctors, psychologists, psychiatrist, care coordinators. All there in one place," said state Sen. Josh Green.
Each patient will be assessed to determine the level of care needed.
Cheng added, "If they meet the requirements of a true emergency they will absolutely be transported as quickly as possible to the Queen's Medical Center."
Currently, only 15 percent of homeless patients coming into the hospital have a true emergency.
Most just need to be cleaned up and given some prescription meds.
"Every time you go to the ER it's over $1,000," Green said. "Every time you're admitted to the hospital it's over $4,000. The moment we have H-4 the cost drop down to pennies on the dollar and people get sustained care."
In addition, medical care case workers will be on hand to get patients on the road to permanent housing.
Green hopes to have the hygiene portion of the facility open by May. The goal is to have the urgent care floor up and running by next September.