Pediahealth Corp.'s $20 million Kulana Malama project is expected to open in early 2007 with 28 beds.

What Kulana Malama will offer is a bridge between hospital and home care for acutely ill children, who still require 24-hour medical monitoring but are otherwise ready to make the transition back to their families.

"The medically fragile child is a growing population that requires intense, specialized needs," said Kulana Malama executive director Winifred Odo, former administrator of the state Department of Human Services' Med-Quest Division. "Many of these types of children have prolonged hospital stays because there is no place or program between the hospital and home."

Kulana Malama will offer services required by medically fragile children in a residential setting as well as educational programs needed to make the transition, Odo said. The facility's staff of 70 will include nurses, physical and occupational therapists and support personnel.

Kulana Malama is a private, for-profit operation. Its patients will range in age from infancy to 21 years. Medicaid and other federal or state insurance programs usually pay for up to 80 percent of costs, Odo said.

Willow Morton, a vice president at Kapi'olani Medical Center for Women & Children, believes Kulana Malama will provide much-needed relief for families because it will have all the medical and rehabilitation services of a hospital in a smaller, more home-like setting. Without a transitional facility, families were faced with seeking skilled nursing or case management support at home to deal with complex nursing situations, Morton said.

"Our goal is always to get children into a home because a hospital is not a home," Morton said. "It's abrupt and a big transition for a family to take full burden for care. It's overwhelming. This population of children is very, very fragile. No parent can do 24-hour care seven days a week."

Some nursing facilities such as Convalescent Center of Honolulu and Island Nursing Home have limited space available for children but there's not enough in the community to cut down extended hospital stays.

Patricia Johnson, administrator of the state Human Services' Adult and Community Care Services Branch that oversees medically fragile children's insurance waivers, said there are no official numbers on how many such cases there are in Hawai'i but she thinks Kulana Malama's 28 beds should be enough.

"What the facility will do is probably increase the number of discharges from hospitals if parents know they can get great care for their children," Johnson said. "The population we serve is around 50 children. If you look at trends, I think you can anticipate 10 children coming into our program every year and five being discharged with another five dying."

Kapi'olani will likely be a major referral source for inpatients at Kulana Malama, Morton said.

On any given day, there are three to eight children in Kapi'olani's acute-intensive-care children's unit, Morton said. Some are in the hospital only a few days; others, a few years.

Kulana Malama has been carefully designed to meet population needs and developmental issues, Morton said. "They're looking at the whole picture," she said.

"We're seriously looking at a young adult center for those who are older than 21," Odo said.

Pediahealth's original plan, presented to the 'Ewa Neighborhood Board in April 2000, was for a care center on Karayan Street that would have included a preschool, a center for Alzheimer's patients and a pediatric care facility for severely disabled children.

However, Odo said, Pediahealth decided to redirect its focus in 2002 because it saw a greater need for a facility to care for medically fragile children.

Pediahealth, a Pearl City-based corporation headed by Gordon Ito, owns Pearl City Nursing Home and O'ahu Care Facility.