Hawaii is a well-established vacation destination for Midwesterners. But when it comes to long-term care, the reverse is taking place: Hawaiians are coming to the mainland.

A shortage of long-term nursing home beds in Hawaii has resulted in an increase in the number of Hawaiian residents in Ohio nursing homes. Over the last two years, about 10 Hawaiian patients have qualified for Ohio Medicaid alone to help pay for long-term care in Muskingum County, according to a report in the Honolulu Advertiser.

The Queen’s Medical Center last year transferred 11 of its patients to the mainland for long-term care. About 40 patients a day are waiting to transfer to long-term care homes, the center said. Hawaiian lawmakers are considering legislation that would require Hawaiian healthcare providers to notify the Hawaii Disability Rights Center in advance of patient transfers to the mainland.