Hawaii Assisted Living
Hawaii is one of the healthiest states in the country and offers stunning views of blazing sunsets, ocean waters, and sandy beaches, making it a great place to retire. For people living on fixed incomes, however, it can be challenging to afford groceries, housing, and other necessities, as Hawaii has the highest costs of living in the United States.
This guide provides an overview of the senior housing options available in Hawaii, with a special emphasis on assisted living. It also includes some resources to help older adults manage their mental health and care for their legal affairs.
The typical resident population in Hawaii's assisted living communities is 72% female. Overall, 90% of residents are ages 75 and older, with 37% of residents ages 75 to 84 and 53% ages 85 and older.
The Department of Health licenses two residential care facilities: assisted living facilities (ALFs) and adult residential care homes (ARCHs). There are three types of ARCHs: Type 1 ARCHs are for five or fewer residents, Type 2 ARCHs are for six or more residents, and expanded adult residential care homes (E-ARCHs) provide additional health services similar to what is found in nursing facilities.
An ALF is a facility that provides 24-hour access to services based on the needs of each resident. These facilities are for adults with limited mobility who can no longer live independently.
ARCHs provide living accommodations to adults requiring at least minimal assistance with activities of daily living (ADLs).
ALF agreements are required prior to and upon moving into the facility. The agreement lists the services that will be provided and their costs, the conditions for additional services, and the associated fees for these services. The facility must also outline services that it does not provide and assist with arranging and coordinating those services.
The written agreement between ARCHs and residents explains residents' rights, the responsibilities of the facility, and the services that will be provided based on the resident's care plan.
ALFs determine their own admission and retention policies based on their own judgment considering the capacity of the facility and the expertise and experience of its staff. ALFs develop discharge policies and procedures that must include a 14-day notification period. Some reasons for discharge include
ARCHs develop their own admission and discharge policies and procedures. No more than 20% of residents in E-ARCHs can require nursing facility-level care.
ALFs must provide laundry and housekeeping services, assistance with ADLs, nursing assessments, health monitoring, medication administration, services for residents with behavior issues, and recreational and social activities. ALFs will also arrange or provide transportation for ancillary services for medically-related and hospice care.
ALFs must conduct an assessment of each resident’s needs, plan and implement responsive services and periodically update the resident's service plan. A key term in the service plan is “managed risk.” This is a process of negotiating and developing a plan to address the resident's needs, decisions, and preferences to reduce the probability of a poor outcome for the resident.
ARCHs provide personal care services, medication services, assistance with self-administration of medications, laundry, and housekeeping, transportation to health care appointments, supervision, and social activities. E-ARCHs provide additional health-related services that meet nursing facility care criteria.
ARCHs must conduct an assessment of each resident’s needs and develop a schedule of activities that describes the services that will be provided. The resident’s care management agency develops the care plan for E-ARCH residents with monthly visits required to assess and evaluate the care and services provided to the resident.
ALFs provide three meals daily, modified diets, and snacks. The meals and snacks must be evaluated and approved by a dietitian on a semi-annual basis.
ARCHs provide three meals a day and snacks and may offer special diets as recommended or prescribed by a physician.
ALFs must employ direct care staff and an administrator who is responsible for training for all facility staff in providing services for assisted living residents. All staff must be qualified in first-aid and CPR. Facilities must make arrangements for an RN to conduct resident assessments and train and supervise staff.
There are no minimum staffing ratios for ALFs. Licensed staff must be available seven days a week to meet care management and monitoring needs. There must be sufficient direct care staff to meet residents' needs.
The administrator in a Type 2 ARCH manages and oversees all staff and residents. Facilities must arrange for an RN to conduct resident assessments. E-ARCHs must have an RN or case manager who is available to train and supervise caregivers. Case managers are licensed by the state as an RN or social worker. Nurse aides and direct care staff assist residents with personal care needs and some nursing tasks.
There are no minimum staff ratios in ARCHs, but they must have sufficient staff on duty at all times to meet the needs of the residents. There must be at least one nurse aide on each shift.
ALFs must provide an apartment unit with a bathroom (sink, shower, and toilet), refrigerator, the ability to cook, and a call system monitored 24 hours per day.
ARCHs may have up to four residents sharing a room. One toilet is required for every eight residents, one sink for every 10 residents, and one shower for every 14 residents.
There are several requirements that each assisted living community must provide for its residents. The facility must offer both general observations and health supervision to assist in identifying each resident's health condition and ability to function. The facility must assist residents with all ADLs and medication services and assess the need for medication attention or nursing services.
In Hawaii, ALFs must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services, with 49% of communities providing skilled nursing. Many have health care specialists and on-site services, with 47% of communities offering dental care. In addition, 39% of ALFs have hospice services.
Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In Hawaii, 80% of communities conduct depression screenings, and 36% offer mental health counseling. Social work programs are also found in 33% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents can access all the resources they need.
Some assisted living residents live with various medical conditions. In Hawaii, 38% have Alzheimer's disease or another form of dementia. In addition, 45% have high blood pressure, 19% have heart disease, 17% have depression, and 11% have diabetes.
Hawaii also has resources for people who need help managing their mental health. The state's Adult Mental Health Division operates state hospitals and community mental health centers, giving individuals somewhere to turn when they need mental health services.
Mental Health America of Hawai'i also advocates for the needs of Hawaiians with mental health conditions. Mental Health America of Hawai'i operates a crisis hotline to help Hawaiians experiencing mental health emergencies. Those who need immediate assistance should call (808) 832-3100 in Oahu or (800) 753-6879 in other parts of the state.
ALFs may provide assistance with the self-administration of medications, which can be provided by unlicensed staff as delegated by an RN. Residents who self-administer medications may keep their medications in their unit as long as they are in a locked container in units shared by two residents. Resident medications must be reviewed every 90 days.
ARCHs may make medications available unless the resident is capable of and prefers to self-administer their medications. E-ARCHs require licensed nurses to administer medications by injection unless the resident is capable of self-medication.
A primary service of assisted living that benefits residents is receiving help with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglecting household chores.
Residents in Hawaii’s assisted living facilities often receive help with their ADLs. In Hawaii, 23% of residents need help eating. Other commonly used services include bed transfer (24%), toileting (31%), and walking (38%). Caregivers in ALFs help 34% of residents dress, and 41% need help bathing.
The average cost of assisted living care in Hawaii is $5,375. This is $875 higher than the monthly national average of $4,500. The cost of living in Hawaii is more than the national average by 93.3%, with health care costs more than the national average by 15.3% and housing costs more than the national average by 215.0%.
The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges from a low of $3,825 in the Kahului area to a high of $5,375 per month in the Honolulu area of Hawaii.
Although the islands that comprise the state of Hawaii do not share a border with any other U.S. state, you may find more affordable assisted living options in other areas on or near the West Coast. California's monthly average cost of assisted living is $5,250. Adjacent to California is Arizona, which has an average monthly cost of $4,000. Oregon and Nevada also have lower average monthly costs, at $5,045 and $3,750, respectively.
How to Pay for Assisted Living
The Hawaii Department of Health oversees assisted living at the state level. In addition to granting licenses, this agency conducts inspections of assisted living communities throughout Hawaii, ensuring they comply with regulations designed to keep residents safe and healthy. Suppose an inspection uncovers a particular area of concern. In that case, the Department of Health also has the authority to take corrective action, which may include suspension or revocation, depending on the severity of the issue.
The Department of Health protects residents by licensing and inspecting assisted living communities in Hawaii. According to the regulations, every resident is entitled to an apartment unit with a refrigerator, cooking capacity, and a separate bathroom with a sink, toilet, and shower. The apartment must be a minimum of 220 square feet, excluding the bathroom. Assisted living communities must also keep detailed records and have comprehensive safety plans to protect residents in the event of a fire or natural disaster.
All assisted living facilities in Hawaii must be licensed to operate. To obtain an initial license, the owner of an assisted living community must provide three references, disclose the identity of any individual who owns 10% or more of the ALF and submit details regarding any contracts or agreements related to the community. The owner must also provide a list of corporate officers and directors if the community is organized as a corporation.
Not everyone treats older adults respectfully, creating a need for legal services to help seniors deal with fraud, neglect, abuse, and other serious issues. The Legal Aid Society of Hawai'i is a nonprofit organization that offers assistance with various civil matters, including taxes, housing, immigration, debt collection, and access to Medicaid, Social Security, and other public benefits.
The University of Hawai'i Elder Law Program offers limited assistance with some of the most common legal issues affecting older adults. Program volunteers can provide referrals to private attorneys who can provide more in-depth help with complex legal matters. Seniors in Hawaii can also call the Hawai'i Lawyer Referral Service at (808) 537-9140 to find an attorney with expertise in elder law.
This guide provides an overview of the senior housing options available in Hawaii, with a special emphasis on assisted living. It also includes some resources to help older adults manage their mental health and care for their legal affairs.
The typical resident population in Hawaii's assisted living communities is 72% female. Overall, 90% of residents are ages 75 and older, with 37% of residents ages 75 to 84 and 53% ages 85 and older.
Assisted Living Facility (ALF) Definitions
The Department of Health licenses two residential care facilities: assisted living facilities (ALFs) and adult residential care homes (ARCHs). There are three types of ARCHs: Type 1 ARCHs are for five or fewer residents, Type 2 ARCHs are for six or more residents, and expanded adult residential care homes (E-ARCHs) provide additional health services similar to what is found in nursing facilities.
An ALF is a facility that provides 24-hour access to services based on the needs of each resident. These facilities are for adults with limited mobility who can no longer live independently.
ARCHs provide living accommodations to adults requiring at least minimal assistance with activities of daily living (ADLs).
Resident Agreements and Disclosures
ALF agreements are required prior to and upon moving into the facility. The agreement lists the services that will be provided and their costs, the conditions for additional services, and the associated fees for these services. The facility must also outline services that it does not provide and assist with arranging and coordinating those services.
The written agreement between ARCHs and residents explains residents' rights, the responsibilities of the facility, and the services that will be provided based on the resident's care plan.
Assisted Living Admission and Retention
ALFs determine their own admission and retention policies based on their own judgment considering the capacity of the facility and the expertise and experience of its staff. ALFs develop discharge policies and procedures that must include a 14-day notification period. Some reasons for discharge include
- A resident’s behavior poses a danger to themself or to others.
- A resident’s needs exceed the ability of the ALF to provide for those needs.
- A resident does not abide by the agreements necessary for assisted living.
ARCHs develop their own admission and discharge policies and procedures. No more than 20% of residents in E-ARCHs can require nursing facility-level care.
Assisted Living Services and Service Planning
ALFs must provide laundry and housekeeping services, assistance with ADLs, nursing assessments, health monitoring, medication administration, services for residents with behavior issues, and recreational and social activities. ALFs will also arrange or provide transportation for ancillary services for medically-related and hospice care.
ALFs must conduct an assessment of each resident’s needs, plan and implement responsive services and periodically update the resident's service plan. A key term in the service plan is “managed risk.” This is a process of negotiating and developing a plan to address the resident's needs, decisions, and preferences to reduce the probability of a poor outcome for the resident.
ARCHs provide personal care services, medication services, assistance with self-administration of medications, laundry, and housekeeping, transportation to health care appointments, supervision, and social activities. E-ARCHs provide additional health-related services that meet nursing facility care criteria.
ARCHs must conduct an assessment of each resident’s needs and develop a schedule of activities that describes the services that will be provided. The resident’s care management agency develops the care plan for E-ARCH residents with monthly visits required to assess and evaluate the care and services provided to the resident.
Assisted Living Food and Dietary Provisions
ALFs provide three meals daily, modified diets, and snacks. The meals and snacks must be evaluated and approved by a dietitian on a semi-annual basis.
ARCHs provide three meals a day and snacks and may offer special diets as recommended or prescribed by a physician.
Assisted Living Staffing Requirements
ALFs must employ direct care staff and an administrator who is responsible for training for all facility staff in providing services for assisted living residents. All staff must be qualified in first-aid and CPR. Facilities must make arrangements for an RN to conduct resident assessments and train and supervise staff.
There are no minimum staffing ratios for ALFs. Licensed staff must be available seven days a week to meet care management and monitoring needs. There must be sufficient direct care staff to meet residents' needs.
The administrator in a Type 2 ARCH manages and oversees all staff and residents. Facilities must arrange for an RN to conduct resident assessments. E-ARCHs must have an RN or case manager who is available to train and supervise caregivers. Case managers are licensed by the state as an RN or social worker. Nurse aides and direct care staff assist residents with personal care needs and some nursing tasks.
There are no minimum staff ratios in ARCHs, but they must have sufficient staff on duty at all times to meet the needs of the residents. There must be at least one nurse aide on each shift.
Assisted Living Housing Requirements
ALFs must provide an apartment unit with a bathroom (sink, shower, and toilet), refrigerator, the ability to cook, and a call system monitored 24 hours per day.
ARCHs may have up to four residents sharing a room. One toilet is required for every eight residents, one sink for every 10 residents, and one shower for every 14 residents.
What Is Included With Assisted Living Care In Hawaii?
There are several requirements that each assisted living community must provide for its residents. The facility must offer both general observations and health supervision to assist in identifying each resident's health condition and ability to function. The facility must assist residents with all ADLs and medication services and assess the need for medication attention or nursing services.
Health Care Services
In Hawaii, ALFs must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services, with 49% of communities providing skilled nursing. Many have health care specialists and on-site services, with 47% of communities offering dental care. In addition, 39% of ALFs have hospice services.
Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In Hawaii, 80% of communities conduct depression screenings, and 36% offer mental health counseling. Social work programs are also found in 33% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents can access all the resources they need.
Some assisted living residents live with various medical conditions. In Hawaii, 38% have Alzheimer's disease or another form of dementia. In addition, 45% have high blood pressure, 19% have heart disease, 17% have depression, and 11% have diabetes.
State Mental Health Resources
Hawaii also has resources for people who need help managing their mental health. The state's Adult Mental Health Division operates state hospitals and community mental health centers, giving individuals somewhere to turn when they need mental health services.
Mental Health America of Hawai'i also advocates for the needs of Hawaiians with mental health conditions. Mental Health America of Hawai'i operates a crisis hotline to help Hawaiians experiencing mental health emergencies. Those who need immediate assistance should call (808) 832-3100 in Oahu or (800) 753-6879 in other parts of the state.
Medication Provisions
ALFs may provide assistance with the self-administration of medications, which can be provided by unlicensed staff as delegated by an RN. Residents who self-administer medications may keep their medications in their unit as long as they are in a locked container in units shared by two residents. Resident medications must be reviewed every 90 days.
ARCHs may make medications available unless the resident is capable of and prefers to self-administer their medications. E-ARCHs require licensed nurses to administer medications by injection unless the resident is capable of self-medication.
Activities of Daily Living (ADLs) Assistance Services
A primary service of assisted living that benefits residents is receiving help with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglecting household chores.
Residents in Hawaii’s assisted living facilities often receive help with their ADLs. In Hawaii, 23% of residents need help eating. Other commonly used services include bed transfer (24%), toileting (31%), and walking (38%). Caregivers in ALFs help 34% of residents dress, and 41% need help bathing.
Cost Of Assisted Living Care In Hawaii
The average cost of assisted living care in Hawaii is $5,375. This is $875 higher than the monthly national average of $4,500. The cost of living in Hawaii is more than the national average by 93.3%, with health care costs more than the national average by 15.3% and housing costs more than the national average by 215.0%.
The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges from a low of $3,825 in the Kahului area to a high of $5,375 per month in the Honolulu area of Hawaii.
How Costs Compare In Nearby States
Although the islands that comprise the state of Hawaii do not share a border with any other U.S. state, you may find more affordable assisted living options in other areas on or near the West Coast. California's monthly average cost of assisted living is $5,250. Adjacent to California is Arizona, which has an average monthly cost of $4,000. Oregon and Nevada also have lower average monthly costs, at $5,045 and $3,750, respectively.
How to Pay for Assisted Living
Hawaii Assisted Living Oversight
The Hawaii Department of Health oversees assisted living at the state level. In addition to granting licenses, this agency conducts inspections of assisted living communities throughout Hawaii, ensuring they comply with regulations designed to keep residents safe and healthy. Suppose an inspection uncovers a particular area of concern. In that case, the Department of Health also has the authority to take corrective action, which may include suspension or revocation, depending on the severity of the issue.
Quality And Safety Of Assisted Living Facilities In Hawaii
The Department of Health protects residents by licensing and inspecting assisted living communities in Hawaii. According to the regulations, every resident is entitled to an apartment unit with a refrigerator, cooking capacity, and a separate bathroom with a sink, toilet, and shower. The apartment must be a minimum of 220 square feet, excluding the bathroom. Assisted living communities must also keep detailed records and have comprehensive safety plans to protect residents in the event of a fire or natural disaster.
All assisted living facilities in Hawaii must be licensed to operate. To obtain an initial license, the owner of an assisted living community must provide three references, disclose the identity of any individual who owns 10% or more of the ALF and submit details regarding any contracts or agreements related to the community. The owner must also provide a list of corporate officers and directors if the community is organized as a corporation.
Legal Resources
Not everyone treats older adults respectfully, creating a need for legal services to help seniors deal with fraud, neglect, abuse, and other serious issues. The Legal Aid Society of Hawai'i is a nonprofit organization that offers assistance with various civil matters, including taxes, housing, immigration, debt collection, and access to Medicaid, Social Security, and other public benefits.
The University of Hawai'i Elder Law Program offers limited assistance with some of the most common legal issues affecting older adults. Program volunteers can provide referrals to private attorneys who can provide more in-depth help with complex legal matters. Seniors in Hawaii can also call the Hawai'i Lawyer Referral Service at (808) 537-9140 to find an attorney with expertise in elder law.
