1093: How Palau Is Rethinking Care Beyond the Hospital

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Wednesday, March 25, 2026. I'm John Sheehan with news from the Association of State and Territorial Health Officials.

Today: how Palau is rethinking care beyond the hospital. We talk with Gaafar Uherbelau, an advisor to the president of Palau and former minister of Health and Human Services. He'll tell us about a long-awaited solution to a quiet but growing challenge in public health: finding a place for individuals who are medically cleared to leave the hospital, but have nowhere to go or no one to care for them. I spoke with Gaafar at this year's ASTHO Spring Leadership Forum in Washington, D.C., earlier this month.

Gaafar Uherbelau, welcome to the show.

GAAFAR UHERBELAU: 

It's a pleasure being here, as always, for this ASTHO newscast.

SHEEHAN: 

So, Gaafar, what have you seen from the Leadership Forum this year, and what have you been hoping to see?

UHERBELAU: 

Well, I haven't been back in a couple of years, actually. So, it's good to be back among familiar faces, and, of course, a lot of the issues that we try to tackle during this Spring Leadership [Forum] are usually the same, but I think there's progress in everything that we've done to this point, and as I mentioned, it's an event I look forward to every year to connect with people and just sort of bounce ideas around with that collective spirit of trying to better public health.

SHEEHAN: 

And one of Palau's recent initiatives is a transition facility designed for patients who have been medically cleared to go home but don't have a place to go. Can you tell us a little bit more about the facility?

UHERBELAU: 

Absolutely. So, you know this facility has been a long time coming in terms of getting it built and properly staffed, and it goes back at least 20 years when the discussions started propping up about the need to have a facility of this kind to take care of those patients that, as you mentioned, are medically cleared, so they no longer need any medical treatment, but because of the lack of caregivers or a home that they go back to after they're discharged, now we have to look for a facility, and of course the wraparound services to ensure that they're cared for after they're discharged. Finally, this year the building itself was constructed right before COVID, or right during COVID, but because it's a new facility, you know, we had to train folks to come in to provide that caregiving service, so it's taken several years to finally get it opened and able to receive clients, I won't say patients, but clients rather, but yeah, it's been a long time coming, and they think we have at least three at this point who are residents or clients of the facility so far.

SHEEHAN: 

What were the conditions like in Palau that sort of necessitated the facility? Like, what was the initiating incident? Because it seems like a very common-sense solution to an issue.

UHERBELAU: 

Yes, absolutely. I think you know, at this on the surface, it appears to be something that's logical and common-sensical, to have, but you know, we have to understand that with the Palauan culture, which is still fairly strong. The expectation is that family members take care of their elderly loved ones or family members with disabilities, etc. And so, the reason why it's taken, you know, around 20 years just to get to where we're at is that counter-argument that there is no need, you know, that there are expectations of family to take care of their own when they are no longer in need of treatment, but the reality is that there are people that would need this service, because, as I mentioned, there's nobody at home to take care of them, or there's no home to go back to. So, you know, it's taken a lot of willpower as well as additional resources to construct and to start this facility, and that's really, you know, telling of changes in culture, changes, changes in economic situations that now force us to start thinking about these types of facilities that would otherwise would not have been needed, you know, 20 years ago.

SHEEHAN: 

And what does care in the facility look like? And what is what does it mean to be a transition facility? What does the transition look like?

UHERBELAU: 

Yeah, so, you know, the reason why it took a little bit of a longer time to get it from when the building was built until now is because it's something new, it's a new service, and the fact that it doesn't require clinicians or medical providers necessarily. We had to develop a whole new training program for caregivers, and along with that, a special licensure requirement. And that's probably not as stringent as you know licensure requirements for physicians or nurses, but nevertheless have something in place to ensure that training is afforded to the workers of the facilities and making sure that there's some, sort of, certification in place before we offer it to clients that are you know coming in from the community and because it is a government-run facility, and the name of the facility is Transition, because it's not meant to be a long-term care facility, nor is it a hospice or a nursing home. Because I think the idea is that while they're there temporarily, the bigger challenge is how do we ensure that you know there are enough homes for people to go back to if they don't have a home, or how do we train community members, or if they have family members to be able to provide the caregiving they need once they're out of the hospital. And, you know, so those are sort of more community-based, longer-term strategies and investment that need to be made, so that it truly becomes just a transient sort of temporary facility, because you know we don't, we don't want to have it overcrowded eventually. It is a small facility, and you know we don't want to open a door where there might be potential, you know, abuse of people just leaving their family members, and so on, so forth. And so, it's more of a temporary measure while we figure out ways to deal with the bigger issue, which is, you know, lack of housing and lack of caregiving out in the community, and really, you know, trying to ensure that people can age happily and healthily in place.

SHEEHAN: 

Yeah, it is. It sounds like one of those facilities or situations that is filling a need that isn't obvious at first glance. It's not direct medical care, because it's no longer an emergency. It's not a direct housing need, because the person still needs some care, and it's a very specific use case. And, as you say, it does sort of illuminate the bigger issues, it sounds like are certainly not unique to Palau, but which are nonetheless pressing.

UHERBELAU: 

Right, absolutely, and of course, you know, like many other countries around the world, we're seeing now that we're having an aging population. So, we have projections that the percentage of the population in Palau who are over 60 or so is going to jump up by, you know, nine or 10% within the next 20 to 30 years. And so, you know, it makes sense that we should start thinking about these other facilities and services that we may not have had the foresight, you know, 20 years ago, to have to deal with or to have to provide now.

SHEEHAN: 

Yeah, are you spreading the word of the facility at the forum, and is it finding reception?

UHERBELAU: 

Well, you know, it's more on the human services side. We still pretty much prioritize public health issues, and of course, for the freely associated states, one of the biggest issues now. You know, our continuing efforts to try to expand veterans medical services and benefits to veterans from the freely associated states who live in the islands to be able to get that, so I think those remain as sort of top priorities, but you know this is something that's evolving and I can foresee that moving forward now that it's opened and receiving clients, then you know we can always seek opportunities to improve the facility and the services we provide in it.

SHEEHAN: 

And what would you like other federal, regional, or global partners to understand about these kinds of facilities that sort of illustrate Palau's needs?

UHERBELAU: 

Because of our respect for the elders, we've now drafted and endorsed and finalized our first-ever national aging policy, which is fairly unique in the Pacific region, and that's really looking at how can we better serve our senior citizens, looking at not only quantity of life but also quality of life. And this facility fits into that in some ways, and part of that longer-term strategy of how do we take care of our citizens all the way to the silver and golden years.

SHEEHAN: 

Gaafar Uherbelau, thanks so much.

UHERBELAU: 

Thank you for having me.

SHEEHAN: 

Gaafar Uherbelau is an advisor to the president of Palau and former minister of Health and Human Services.

In 2022, Hurricanes Fiona and Ian caused significant damage and loss of life across several states and Puerto Rico. The following year, CDC awarded funding to ASTHO to assist health agencies in North Carolina, South Carolina, Florida, and Puerto Rico in building their capacity to better prepare for, respond to, and recover from the environmental health impacts brought on by these hurricanes. To highlight this work, join ASTHO for part two of a webinar series featuring Florida's Department of Health. Find a registration link to "Weathering the Storm Part Two: The Importance of Environmental Health Preparedness and Response" in the show notes.

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This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.