Compassionate psychiatric care for kūpuna

OhanaPsych provides geriatric psychiatry — thoughtful, respectful psychiatric care for kūpuna (older adults) — and we accept both Medicare and Medicaid (QUEST), coverage that few psychiatric practices in Hawaiʻi offer to seniors. We see you by secure telehealth statewide, or in office, and we bring care directly to residents of care facilities. This page explains what we help with and how care for older adults is different.

What we help kūpuna with

We care for depression and anxiety, mood disorders, sleep difficulties, delirium, agitation, grief and adjustment after loss or life change, and the psychiatric and behavioral changes that can come with memory conditions such as dementia and Alzheimer’s disease — always tailored to the needs of older adults. When it helps to clarify memory, attention, or thinking concerns, we also offer neurocognitive testing.

How care for older adults is different — and our approach

Late-life mental health deserves real expertise. Symptoms can overlap and mislead: depression in an older adult can look like memory loss, delirium can be mistaken for dementia, and a treatable medical problem or medication side effect can masquerade as a psychiatric one. Sorting this out carefully — distinguishing dementia, delirium, and depression — is central to what we do, because each calls for a very different response.

We also prescribe with extra care in this stage of life. Older adults are more sensitive to medication side effects, so we weigh choices against the American Geriatrics Society’s Beers Criteria for medications that are potentially inappropriate in older adults, and we follow the American Psychiatric Association’s guidance on using antipsychotics only sparingly for dementia-related agitation or psychosis — after non-medication approaches, at the lowest effective dose, with a planned review. We start from lōkahi — balance across the connected parts of life — and care for each kupuna as part of an ‘ohana, with aloha (compassion) and mālama (careful stewardship), coordinating with family and primary care when you wish.

Our position on benzodiazepines — especially for kūpuna

Benzodiazepines — medications such as alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin), and diazepam (Valium) — deserve a direct, honest conversation in older adults. The evidence is clear and consistent: after age 65 these medications carry serious risks. The American Geriatrics Society’s Beers Criteria explicitly recommend avoiding benzodiazepines in older adults because they raise the risk of confusion and delirium, falls, and injury. Large analyses link benzodiazepine use in older adults to a substantially increased risk of hip fracture, and longer-term use has been associated with an increased risk of dementia, including Alzheimer’s disease. For most older adults, the long-term risks outweigh the benefits.

We understand this can be hard to hear — especially if you have taken one of these medications for years, or even decades, and it has felt like the only thing that helps. We will never dismiss that experience, and we will never stop a benzodiazepine abruptly, which can itself be dangerous. But we also have a duty to provide safe, evidence-based care, and after 65 the recommendation is firm: it is strongly advised to come off these medications. Our position, offered with both honesty and aloha: we will partner with you to taper off benzodiazepines slowly and safely, at a pace you can manage, with genuine support and alternatives for anxiety and sleep along the way. What we are not able to do is continue prescribing benzodiazepines for indefinite, chronic, long-term use that the evidence shows is inappropriate and unsafe in older adults. If you are prescribed a controlled medication with us, you’ll complete our Controlled Substance Agreement, and when we taper a benzodiazepine together we use our Controlled Substance Taper Agreement so the plan is shared and clear. As with all controlled medications, these decisions happen within an established, ongoing provider relationship — not in a one-off or crisis visit — case by case, at provider discretion.

Benzodiazepines, alcohol, and opioids — a combination we will not continue

Benzodiazepines should never be combined with alcohol or with opioids. All three depress the brain’s drive to breathe, and together they can cause profound sedation, respiratory depression, coma, and death. In 2016 the U.S. Food and Drug Administration added its strongest “boxed” warning to nearly 400 opioid and benzodiazepine products specifically because combining them drives overdose deaths, and in 2020 the FDA strengthened the benzodiazepine class warning again to address the risks of misuse, physical dependence, and dangerous combinations. A large analysis found that taking opioids and benzodiazepines together markedly increases the risk of opioid overdose compared with opioids alone.

This matters especially for anyone with a history of substance use, including opioid use disorder or alcohol use disorder. Drawing on addiction-medicine guidance, we do not prescribe benzodiazepines alongside active opioid or alcohol misuse, and we will not maintain a benzodiazepine prescription where it creates a clear and serious safety risk. This is not a judgment of you — it is us refusing to take part in a combination that takes lives. Where these risks are present, we will work with you on safer, effective treatment for anxiety, sleep, and substance use, and on a careful taper.

Working with your primary care team — and why we do the right thing

You may have been referred to us by your primary care team, and we are grateful for that trust. We keep strong, ongoing relationships with primary care providers across our community for a simple reason: we do the right thing. We render honest clinical opinions, we practice evidence-based care, and we report our findings and recommendations back to your primary care team so everyone caring for you is working from the same page. Those referral relationships exist precisely because we have honest conversations — not because we tell people only what they want to hear.

We will be candid: if you are hoping to continue a treatment that the evidence does not support, we have real empathy for how hard that can be — but this practice will not provide non-evidence-based care. And with a wink to the occasional keyboard warrior who promises us a one-star review across every platform after not hearing what they wanted: we have come to wear that as a badge of honor. Our providers are encouraged to have the difficult, honest conversations. We will not make everyone in our community happy, but we will do the right thing — 100% of the time — and we will do it with aloha.

One more honest point, offered with respect. Many people arrive already carrying a psychiatric diagnosis made in primary care. That is no knock on primary care: because of a real and worsening shortage of mental health specialists, primary care now delivers most of the mental health treatment in this country — in our experience, well over half of it here at home — and those clinicians work hard under enormous constraints. But you are now being seen by a specialist. A brief primary-care visit is not the same as a full psychiatric evaluation, and conditions such as bipolar disorder are frequently misdiagnosed as ordinary depression when they are not assessed by someone who does this every day. So we do not automatically inherit a diagnosis made elsewhere; we conduct our own evaluation and reach our own conclusions — which is exactly what a specialist consultation is for, and exactly why your primary care team sent you to us.

A note on clinical judgment — and our shared approach

None of this ties a provider’s hands. The positions on this page are recommended, evidence-based treatment guidelines — not rigid rules. Medicine is individual, and your provider may, in their clinical judgment and within a genuine, ongoing relationship with you, decide that an exception is appropriate as part of a thoughtful treatment plan made with your best interest and wellbeing in mind. Guidelines inform care; the provider who knows you makes the call.

At the same time, we want to be honest about who we are. The clinicians in this practice group practice alike and hold to the same evidence-based standards, so moving from one of our providers to another simply because you didn’t like what you heard is not how we work. We have firm, caring conversations and keep proper boundaries because that is part of good, safe care — always offered with aloha. If you are looking for a practice that won’t have those conversations, we may not be the right fit, and we say that with respect and genuine goodwill.

Insurance for kūpuna — Medicare and Medicaid

We welcome Medicare and Hawaiʻi QUEST / Med-QUEST (Medicaid) — including dual-eligible (Medicare + Medicaid) members — plus most commercial insurance plans. Not sure about your plan? Call (808) 777-9460 and we’ll check for you. Language assistance is available.

On-site care in facilities

We also bring psychiatric care directly to seniors living in skilled nursing facilities and assisted living communities across the islands. Learn more about our facility-based psychiatric care.

Telehealth made simple for seniors

Visits happen by secure video from the comfort of home, anywhere in Hawaiʻi — and we keep the technology simple, with help getting connected and family members welcome to join with your permission. In-office visits are available as well.

One more note on access: as we complete the final stages of becoming a Rural Health Clinic (RHC), telehealth for mental-health care is here to stay with us. Under Medicare’s rural-health rules, RHCs are permanently authorized to provide behavioral and mental-health care by telehealth — including into your home, anywhere in Hawaiʻi — not under the temporary flexibilities that expire and must be renewed. (Prescribing of controlled medications still follows the separate Ryan Haight Act and DEA rules.) For our patients, that means dependable, lasting telehealth access to the care you need.

Wherever you live, OhanaPsych is your statewide practice. We provide care across the entire state of Hawaiʻi by telehealth, reaching every island — Hawaiʻi Island, Maui, Oʻahu, Kauaʻi, Molokaʻi, Lānaʻi, and Niʻihau. If you would rather be seen in person, you have that option at our offices in Hilo and Honolulu.

Brief screening (96127)

As part of getting started — and to track your progress over time — we use brief, validated questionnaires that are administered, auto-scored, and documented on the CNS Vital Signs platform and billed under code 96127 (brief emotional/behavioral assessment). For older adults, that includes the Stanford Geriatric Depression Scale (SGDS), the Memory Questionnaire (MEMQ), and the Falls Risk Scale (CNS Vital Signs, n.d.). Each takes only a few minutes and gives your provider objective information to guide care.

When to reach out — and when it’s an emergency

If you’re noticing low mood, anxiety, sleep trouble, confusion, or memory or behavior changes in yourself or a loved one, it’s worth reaching out — these are treatable, and earlier care helps. New patients are welcome; call (808) 777-9460 or start your request online.

If you or someone you love is thinking about suicide or self-harm, get help right away. Call or text the 988 Suicide & Crisis Lifeline (call or text 988, or chat at 988lifeline.org). In Hawaiʻi, Hawaiʻi CARES is available by calling or texting 988, or at 808-832-3100 / 800-753-6879. In a life-threatening emergency, call 911.

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Medically reviewed by George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP — President & Owner, OhanaPsych / Ohana Care Clinic.
Last reviewed: June 28, 2026. Citations verified: June 28, 2026.

This page is general health education from OhanaPsych. It is not a substitute for a personal evaluation by a qualified clinician who knows your situation, and reading it does not create a provider–patient relationship. If you’re concerned about yourself or a loved one, reach out to us or another licensed provider. In an emergency, call 911.

References

CNS Vital Signs. (n.d.). CNS Vital Signs computerized rating instruments. https://www.cnsvs.com/WhitePapers/CNSVS-RatingInstruments.pdf

American Geriatrics Society 2023 Beers Criteria Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052–2081. https://doi.org/10.1111/jgs.18372

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Billioti de Gage, S., Moride, Y., Ducruet, T., Kurth, T., Verdoux, H., Tournier, M., Pariente, A., & Bégaud, B. (2014). Benzodiazepine use and risk of Alzheimer’s disease: Case-control study. BMJ, 349, g5205. https://doi.org/10.1136/bmj.g5205

Brunner, E., Chen, C.-Y. A., Klein, T., Andrews, C. M., Ashworth, H., Crystal, S., Dziura, J., Fiellin, D. A., Galuska, M., Heyward, J., Kraemer, K. L., Larkin, K., Olfson, M., Rana, A., Smith, K. D., & Tilstra, S. A. (2025). Joint clinical practice guideline on benzodiazepine tapering: Considerations when risks outweigh benefits. Journal of General Internal Medicine, 40, 2814–2859. https://doi.org/10.1007/s11606-025-09499-2

Culpepper, L. (2014). Misdiagnosis of bipolar depression in primary care practices. The Journal of Clinical Psychiatry, 75(3), e05. https://www.psychiatrist.com/jcp/misdiagnosis-bipolar-depression-primary-care-practices/

Donnelly, K., Bracchi, R., Hewitt, J., Routledge, P. A., & Carter, B. (2017). Benzodiazepines, Z-drugs and the risk of hip fracture: A systematic review and meta-analysis. PLOS ONE, 12(4), e0174730. https://doi.org/10.1371/journal.pone.0174730

Hughes, P. M., Annis, I. E., McGrath, R. E., & Thomas, K. C. (2024). Psychotropic medication prescribing across medical providers, 2016–2019. Psychiatric Services, 75(5), 477–480. https://doi.org/10.1176/appi.ps.20230156

Reus, V. I., Fochtmann, L. J., Eyler, A. E., Hilty, D. M., Horvitz-Lennon, M., Jibson, M. D., Lopez, O. L., Mahoney, J., Pasic, J., Tan, Z. S., Wills, C. D., Rhoads, R., & Yager, J. (2016). The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia. American Journal of Psychiatry, 173(5), 543–546. https://doi.org/10.1176/appi.ajp.2015.173501

Sun, E. C., Dixit, A., Humphreys, K., Darnall, B. D., Baker, L. C., & Mackey, S. (2017). Association between concurrent use of prescription opioids and benzodiazepines and overdose: Retrospective analysis. BMJ, 356, j760. https://doi.org/10.1136/bmj.j760

U.S. Department of Health and Human Services. (2026). Telehealth policy updates. Telehealth.HHS.gov. https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates

U.S. Food and Drug Administration. (2016). FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines [Drug safety communication]. https://www.fda.gov

U.S. Food and Drug Administration. (2020). FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class [Drug safety communication]. https://www.fda.gov

U.S. Preventive Services Task Force. (2023). Screening for depression and suicide risk in adults: US Preventive Services Task Force recommendation statement. JAMA, 329(23), 2057–2067. https://doi.org/10.1001/jama.2023.9297