Assisted Living in Hawaii

Hawaii is one of America’s most expensive states for its residents. However, despite its high cost of living, Hawaii was recently ranked the 2nd best state for retirement by Kiplinger based on measures like tax-friendliness, general well-being, and the average health of people 65 and over. If you can afford it, the retirement lifestyle on these islands is sure to be as beautiful as it is unique, and may even promote longevity.

Directory of Assisted Living Facilities in Hawaii

Comparing costs and features to find the right facility for you can be a challenging task, unless you have the proper tools for the job. With the aim of demystifying your research process, we have compiled an informed directory of Hawaiian assisted living facilities. Below, you will find 22 of Hawaii’s ALFs listed with key data such as room and board costs, amenities, Medicaid acceptance status, and more.

How to Pay for Assisted Living in Hawaii

Determining how to finance assisted living often starts with the question, “What’s the cost?” In today’s economy, where inflation plays a significant role, having current data is crucial for senior living financial planning. AssistedLiving.org has gathered cost information from its expansive network of over 75,000 senior living providers. This data offers a glimpse into the average expenses for assisted living in Hawaii and 2 additional cities within Hawaii.

How Inflation Has Impacted the Cost of Assisted Living in Hawaii

Inflation has hit Hawaii hard, and from 2022 to 2023, the cost of assisted living increased by 32.5% to $6,039. This is much higher than the national increase of 10%. Hawaii’s monthly average cost is still lower than Alaska’s, which increased to $6,768, and higher than Oregon and California, which are $5,580 and $4,946, respectively. Washington also saw inflation, with a 14.5% increase.

Increasing costs are expected to continue, but the increase is only estimated to be about $20 a month in Hawaii. In contrast, national costs will increase by 8%. Planning for these increases is crucial for today’s seniors.

Assisted Living Costs in Hawaii's Top Cities

Average costs vary across Hawaii’s cities. In Kapolei, the cost mirrors that of the state, averaging $6,039 a month, but in Honolulu, the cost drops to $5,299. Seniors will find more affordable options in the continental United States, such as in San Diego, CA, which averages $4,479 a month, and Portland, OR, which averages $5,806 a month. Because the costs vary so much, making a plan for how to pay for them is helpful.

The Cost of Other Types of Senior Living

Knowing the appropriate level of care is an important step in planning for senior living costs. Assisted living, which averages $6,039 in Hawaii, works well for older adults who need a little extra help with personal care and hygiene. Memory care, which averages $7,271, includes caregivers with specialized training in dementia care. Seniors who can handle their personal care may choose independent living, which is the more affordable option at $4,274 a month.

Financial Assistance for Assisted Living in Hawaii

The Med QUEST Integration Program

Med QUEST Integration is Hawaii’s managed care Medicaid program for low-income elderly and disabled citizens. QUEST allows qualifying applicants to receive Medicaid reimbursements for assisted living services. Services covered include assistance with instrumental activities of daily living (IADLs), such as minor homemaker services, shopping, meal preparation, and laundry, and also assistance with activities of daily living (ADLs), which include any level of assistance with necessary personal care tasks, such as bathing, eating, and walking.

Other products and services may be covered depending on an ALF resident’s needs. Benefits may include:

• Adult day healthcare
• Environmental accessibility adaptations
• Personal emergency response systems (PERS)
• Home maintenance
• Moving services
• Caregiver respite
• Skilled or private duty nursing
• Specialized medical supplies, and more

For mentally capable individuals receiving personal or respite care, there is the option to self-direct services. Self-direction involves independent coordination of one’s services and service providers. QUEST may cover counselling for self-directing recipients who wish to learn how to manage and coordinate their own care.

Who is Eligible?

Managed care programs like QUEST have no enrollment caps or waiting lists, so eligible people may begin receiving services as soon as applications are fully processed. Once services are granted to an applicant, they will undergo quarterly level of care (LOC) assessments to determine their need for services on an ongoing basis.

Eligible applicants must meet the following requirements:

• 65 or older/disabled
• Income at less than 138% of the federal poverty level ($1,396.10 per month in 2018)
• Up to $2,000 in countable assets for individuals
• Up to $3,000 in countable assets for couples

Even if you do not meet the above requirements, there are multiple pathways to coverage. If your income is over the Medicaid limit but payments for healthcare leave you with a remainder of $470.40 per month, you may still qualify. Under certain circumstances, asset limitations may be negotiable as well. To fully understand whether you are eligible for Med QUEST, contact your local field office.

How to Apply

Go online to MyBenefits.Hawaii.gov to start an online application or visit your nearest Med QUEST application center for in-person assistance. The state has eight Med QUEST office locations on the islands. The Med QUEST central office can be reached by calling (877) 628-5076. TTY/TDD users can reach them at (855) 585-8604.

Supplemental Security Income

Low-income Hawaii ALF residents may be eligible to receive monthly cash payments from the Social Security Administration. Coupled with Medicaid coverage of some services provided in assisted living facilities, this monthly stipend can significantly improve affordability of room and board costs. The amount of SSI assistance an ALF resident can receive depends on the size of the facility (whether it houses less than five people or more than five) and an applicant’s marital status.

People who live in facilities that accommodate five or fewer residents may receive monthly payments of $1,401.90 if they are single or $2,765.80 for couples. For those living in a facility that houses more than five people, SSI can provide $1,509.90 if they are single and $2,981.80 if they are married.

Who is Eligible?

Applicants who are 65 and older may qualify for SSI assistance if they have also applied for any other government benefits for which they may be eligible, and if they meet certain financial limits for SSI eligibility. Applicants must have an income that does not exceed the Federal Benefit Rate for individuals and couples.

In 2019, the Federal Benefit Rate is $771 a month for individuals and $1,157 for couples, and any married person whose partner is not SSI eligible will be paid as a single individual. Asset limits are also enforced, and eligible applicants will have no more than $2,000 worth of countable assets or $3,000 if married. However, certain assets are not counted in this calculation, including the value of a home or car, and sometimes other assets are discounted as well, such as burial plots.

How to Apply

The Hawaiian islands host five Social Security Administration office locations. Applicants who desire in-person assistance can consult the SSA office directory included in this guide. The Administration can be reached by telephone at (800) 772-1213, or at (800) 325-0778 for the hearing impaired. The SSA also has a user-friendly website at SSA.gov where interested parties can apply for benefits and complete most Social Security-related tasks.

More Ways to Finance Assisted Living

Some additional ways to finance assisted living costs include:

• Veterans Benefits: Veterans can take advantage of several different pension programs to help cover the cost of assisted living. For more information, see the article on benefits.va.gov.

• Life Insurance Policies: Even if a spouse or loved one hasn’t died, certain types of life insurance policies can be used to pay for assisted living. More information is available at longtermcare.acl.gov

• Long-Term Care Insurance: Long-term care insurance is a type of insurance policy that pays for long-term care when it becomes necessary, including the cost of assisted living. For more information on the benefits and drawbacks of this financing method, visit longtermcare.acl.gov.

• Reverse Mortgages: Reverse mortgages allow seniors to access the equity from a home that they own, and these funds can be used to pay for assisted living. The U.S. Department of Housing and Urban Development offers a federally insured reverse mortgage program.

Free and Low-Cost Resources for Seniors in Hawaii

There are many resources in Hawaii that assist seniors in their retirement. Assistedliving.org has compiled information on local organizations, programs and agencies and categorized them into care types for easy reference.

Area Agency on Aging

Retirees can find support and advice on various senior-related issues from their local Area Agency on Aging. The agency provides advice on topics such as financial assistance programs, in-home care and long-term care planning. It also connects seniors and caregivers with community-based resources.

Cash Assistance Programs

Cash assistance programs in Hawaii provide financial support to help low-income retirees remain in their own homes for as long as possible. Seniors and caregivers can apply for tax rebates and reductions, discounts on vital services and help covering the cost of heating and cooling their home.

Financial Assistance for Senior Care and Senior Living

Whether living in their own home or in a senior living community, Hawaii seniors can find financial assistance from numerous local resources. These organizations help residents cover some of the costs associated with in-home or long-term care and connect them with other helpful community-based resources.

Food Assistance Programs

Local organizations help ensure elderly citizens have a balanced diet and receive essential vitamins and minerals to remain healthy. Through nutrition programs, congregate meals, home-delivered meals and food pantries, these programs help Hawaii seniors afford the nutritious food they need.

Free Used Medical Equipment

Due to the high cost of purchasing new medical equipment, several organizations in Hawaii collect lightly used medical devices such as wheelchairs, ramps and walkers and distribute them to local seniors and residents in need.

Home Repair and Modifications

Seniors and those with disabilities can access a variety of local resources to help them pay for home repairs and modifications. Programs in Hawaii have different eligibility criteria and often assist retirees by providing grants or loans.

Senior Engagement

Senior engagement resources and programs in Hawaii help older adults remain active and ensure they contribute to the community. Resources include wellness programs, volunteer opportunities, support groups and organizations that help residents connect with the community to live fulfilling lives.

Social Security Offices

Social Security offices in Hawaii help seniors and disabled people access the benefits they’re entitled to. Older adults can contact their local office for information about receiving retirement benefits, disability allowance and Supplemental Security Income.

Utility & Energy Bill Assistance

Low-income seniors who are struggling to meet the costs of maintaining their homes can find support from organizations that offer assistance with utility and energy bills. Hawaii retirees could also qualify for emergency funding programs if they’re in danger of losing utility services due to unpaid invoices.

Veteran’s Services

Hawaii retirees who have served in the U.S. military can find support from local veteran services. These offices and organizations help vets access the benefits they’re eligible for and provide advice and information on a variety of issues.

Assisted Living Laws and Regulations in Hawaii

Assisted Living Service Plans

Assisted living service plans function as a documented statement of new residents’ needs and expectations, and of their facility’s plans to fulfill their obligations to the resident. It is an important part of the contract between consumers and facilities, establishing things like assistance needs, medication schedules, and evacuation plans for people with limited mobility.

By the first day of new residence at a Hawaii ALF, individuals must undergo a comprehensive medical examination and discuss their results with facility administration so that the best plan of service can be determined. Plans of service are periodically updated through re-evaluations of residents’ health. The service planning meeting is also used to establish a residency agreement, which serves to inform new tenants of their rights and responsibilities in their new community as well as all costs associated with their services.

Assisted Living Admission Requirements

Assisted living facilities in Hawaii can admit residents who may need minor assistance with activities of daily living, such as eating, personal grooming, and walking. People who are nursing home-eligible and may need more complete assistance can also be admitted, though the total number of such residents is sometimes limited. Refusal of residence can occur if an applicant has a condition requiring restraint or if they may be a danger to themselves or others.

In general, ALFs can only accept residents whose medical and other needs the facility has sufficient staff and equipment to accommodate. If a resident’s health deteriorates beyond their facility’s means to provide adequate care, or if a resident demonstrates a pattern of disregard for community regulations, a letter of dismissal must be provided to them within 14 days of eviction.

Assisted Living Scope of Care

Hawaii ALFs are required to provide a list of services and supports to residents, including the provision of social activity, housekeeping, and health monitoring, but the fundamental benefit of assisted living is the provision of personal care services. Hawaii classifies personal care services in two categories: Level I and Level II. All such services may be self-directed by residents who are mentally capable of making their own care decisions.

Level I personal assistance is for people who need minor assistance with activities of daily living, like walking, bathing, and eating, as well as some instrumental activities, like doing laundry, running errands, and meal preparation.

Level II personal assistance is for those who require moderate to total assistance with activities of daily living as well as health maintenance tasks. This extent of service requires the aid of a home health professional, personal care aide, or a nurse’s aide. Level II residents are also provided any Level I services they may need if they are essential to the resident’s health and welfare.

Assisted Living Medicaid Policy

Hawaii has integrated all of its previous Medicaid waivers for the aged into an entitlement program called Med QUEST Integration. The benefit of an entitlement program is that, because funding is provided jointly by the state and federal governments, there are no funding caps and no waitlists for coverage. This program provides reimbursement of costs for personal care services offered by ALFs to Medicaid recipients as long as recipients live in facilities licensed by Med QUEST.

Assisted Living Facility Requirements

Hawaiian ALFs must adhere to safety codes specific to populations with diminished physical capacities. They must also provide apartment-style units with a minimum of 220 square feet (not including restrooms) which are stocked with modern conveniences, like running water, a full kitchen with common appliances, and easily accessible bathrooms. Apartments must also have a call system that is monitored 24 hours per day. Each unit will have its own bathroom that is fully separate from other units. A type of assisted living facility that is technically called an expanded adult residential care home (EC-ARCH) must meet these same requirements, but with the added stipulation that no more than four residents may share a unit.

Medication Management Regulations

ALFs will integrate residents’ medication needs into their service plans so that prescriptions, dosage, and medication schedules are on file. Every 90 days, each resident will have their prescriptions reviewed by a pharmacist, or a registered nurse or physician to help assure the resident’s safety. Direct care staff can help residents take their own medications. This level of assistance is minor, and often involves providing cues to take medicines, help getting packaging open, and help reading labels. Residents who are incapable of self-administering medications may be more fully assisted either by a nurse or a direct care staff member who is directly supervised by a nurse. Help with administration can be provided at levels of assistance deemed acceptable under Hawaii’s Nursing Model Act.

Staffing Requirements

Hawaii assisted living facilities are operated by administrators. Administrators hire registered nurses to be available seven days per week for training and staff supervision, as well as to conduct periodic assessments of residents’ health and medication regimens. There is no legal standard for how many direct are staff members must be employed at a facility, but it is required that ALFs hire sufficient staff to meet the needs of their resident population, and that staff members are available 24 hours a day. All staff must be trained to administer CPR and first-aid.

Staff Training Requirements

Facility administrators must have two years of pre-existing management experience in the housing, healthcare, or personal care industries. When administrators are hired, they must complete a certification course specifically designed for the training of assisted living administrators by state licensing agencies. Nursing staff at Hawaii ALFs must also undergo training specific to assisted living. The Hawaii State Board of Nursing provides regular continuing education courses, and on passing each course, an assisted living nurse can renew his or her license. All direct care staff must take orientation training upon employment and must complete six hours of in-service training every year. CPR and first-aid training are required for all staff.

Background Checks for Assisted Living

Hawaii disqualifies anyone from administration or employment at an assisted living facility if they have any past convictions or substantiated accusations of abuse, neglect, misappropriation of funds, or any related offense. Facility owners will be disqualified from licensure for the same reasons. Background checks involve state and federal criminal database checks, usually performed with the use of an applicant’s Social Security number and/or fingerprints.

Reporting Abuse

The state of Hawaii provides different means of consumer reporting for cases of elder abuse and cases of long-term care facility breach of contract.

When reporting a long-term care facility for breach of contract, it is best to first take complaints to administrators of the facility. If no resolution can be reached this way, then consumers should call their local long-term care ombudsman to begin the process of formally launching a complaint.

Elder abuse should be reported as soon as it is suspected. Elder abuse can take many forms, including neglect, abandonment, emotional/physical assault, and financial exploitation. Adult Protective Services can be reached by filling out a complaint form online at HumanServices.Hawaii.gov.

To reach APS by phone, people on different islands will need to use different phone numbers:

• Oahu: (808) 832-5115
• Kauai: (808) 241-3337
• Maui/Molokai/Lanai: (808) 243-5151
• East Hawaii (Hilo/Hamakua/Puna): (808) 933-8820
• West Hawaii (Kau/Kona/Kohala/Kamuela): (808) 327-6280

Hawaii COVID-19 Rules for Assisted Living Facilities

Note: The following information was compiled and most recently updated on 2/7/22. Since COVID-19 is a rapidly evolving crisis, be sure to contact your assisted living facility or local Area Agency on Aging for the most up-to-date information.

Sources: health.hawaii.gov www.cdc.gov

*Note: This information was not available for this state, contact your local area agency on aging or senior living facility for more information.