Long-Term Care in Remote Settings: A Qualitative Case Study on Lāna‘i, Hawai‘i

As the global population ages, age-friendly communities are becoming a priority. However, most initiatives have an urban bias, overlooking the unique challenges in rural and remote areas. These regions, experiencing high rates of population aging due to youth out-migration, older adults aging in place, and retiree in-migration, often lack the resources and infrastructure to support aging in place, with gaps in long-term care exacerbated by geographic isolation. This study focuses on Lāna'i, Hawai'i to explore the challenges in providing long-term care to older adults in remote areas. By engaging older adults, caregivers, and service providers, it examines the factors essential for their wellbeing, and how remote communities can support aging in place. The study highlights the importance of community assets like social connectedness, leadership, and advocacy in overcoming resource constraints. At the same time, it reveals gaps in long-term care, especially during extreme events like the COVID-19 pandemic, and emphasizes the need for context-specific, community-driven solutions for better healthcare coordination, investment in infrastructure, and specialized services. Findings underscore the need to integrate local efforts with broader political and policy changes to improve age-friendliness so that remote communities are not disadvantaged in resource allocation.