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.
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Paying for Assisted Living in Hawaii
The Cost of Assisted Living in Hawaii
Hawaii is far removed from the continental United States, and is culturally and environmentally incomparable to any other state. These facts may justify Hawaii’s high assisted living costs for some retirees, even at a median of $1,500 more than the national average. Assisted living in California and Oregon is somewhat more affordable, yet still beyond the national average expense.
While costs of living in the world-famous destinations of Big Island and Honolulu are some of the highest in the United States, Hawaii’s other locales may be far more accessible. If Hawaii and Honolulu are excluded from a calculation of average assisted living costs, the state’s remaining areas have an average Assisted Living Facility (ALF) cost of between $4,300 and $4,500.
In any state, the type of care that is needed will significantly impact costs for seniors. The widest cost disparity for American long-term care is usually between adult day healthcare as the least expensive option and private nursing home rooms as the most expensive. Only two other American states have nursing home costs to rival those of Hawaii, which cost more than $12,167 for a semi-private unit.
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 Assisted Living Resources in Hawaii
State Health Insurance Assistance Program (SHIP)
SHIP is a national program intended to help Medicare recipients take full advantage of their benefits. The program is staffed by Medicare counselors who are put through a state-approved certification program. Counselors consult beneficiaries over the phone, in person or online, helping recipients to apply for their benefits and understand the Medicare program.
To reach a SHIP Medicare counselor, call (888) 875-9229 or fill out a contact form at HawaiiSHIP.org to have a counselor contact you.
The Hawaii Healthy Aging Partnership
The Hawaii Healthy Aging Partnership is a statewide coalition formed to promote evidence-based approaches to elder health and longevity. The ultimate goal of this program is to promote independent living and reduce nursing home residence, and participating entities include Hawaii’s Area Agencies on Aging, the University of Hawaii, and multiple health and wellness service providers.
The program offers an educational component for elderly and disabled adults. This involves fitness programs and six-week workshops that can teach participants useful skills to help them live independently for as long as they are able. Some of the major subjects covered in workshops include self-management of specific chronic diseases, such as arthritis, asthma, and diabetes.
Workshop topics include:
- Effective communication with doctors
- Relaxation techniques to deal with symptoms and stress
- Action plan development
- Problem solving
- Symptom management
To find out more about the program, visit Health.Hawaii.gov. Contact your local Area Agency on Aging to participate. Find your local Agency by using the directory included in this guide.
For Veterans and their families, the VA provides a comprehensive network of social, medical, and financial supports throughout every stage of life. Assisted living residents may be far more capable of affording their room, board, and ALF services by employing every VA program for which they are eligible. Benefits for veterans include VA loans, pensions, the Aid & Attendance benefit, and healthcare coverage.
While the VA has medical clinics and vet centers on every Hawaiian island, their Regional Benefit Office is in Honolulu at 459 Patterson Road, E Wing, Room 2A100C. Benefits counselors sometimes visit vet centers on the other islands to offer their services. To find out when a benefits counselor may be nearby, go online to Benefits.VA.gov to check their events calendar. Counselors can also be reached by calling MyVA311 at (844) 698-2311, or by dialing 7-1-1 for the hearing impaired.
The Long-Term Care Ombudsman Program
Each state has its own long-term care ombudsman program which provides individual advocacy and support for people in long-term care facilities like ALFs. Ombudsmen are volunteers coordinated by a central agency to be available for visits with assisted living residents, and they function as intermediaries between consumers and any service providers or resources they may personally benefit from. Ombudsmen can field complaints of facilities, staff, or agencies that deal with elders, and they have the authority to investigate claims of abuse or breach of contract. An ombudsman can also put residents in touch with the supports that they may need if their rights or contracts are not being honored.
Hawaii’s Office of the Ombudsman is located on Honolulu at 465 South King Street, 4th Floor, Honolulu, Hawaii 96813. To file a complaint with this office, email them at [email protected]. They can be contacted by Honolulu residents at (808) 587-0770, or for the hearing impaired, (808) 587-0774.
Neighboring islands will need to use different phone numbers to contact the office:
- Hawaii: 974-4000, ext. 7‑0770
- Maui: 984-2400, ext. 7‑0770
- Kauai: 274-3141, ext. 7‑0770
- Molokai/Lanai: (800) 468-4644, ext. 7‑0770
Area Agencies on Aging
Hawaii’s Executive Office on Aging is the central, coordinating department overseeing the Federally established Area Agencies on Aging network in Hawaii. The purpose of these offices is to provide a single point of contact where aging Americans can find greater clarity and ease of access to long-term services and supports. AAA offices are sometimes called Aging and Disability Resource Centers and there are locations in every state. Consult the directory below to find your nearest office location.
|Area Agency on Aging||Address||Phone Number|
4444 Rice Street, Suite 330
Lihue, Kauai, Hawaii, 96766
925 Dillingham, Suite 200
Honolulu, Hawaii 96817
95 Mahalani Street, Room 20
Wailuku, HI 96793
1055 Kinoole Street
Hilo, HI 96720
Social Security Offices
The Social Security Administration has many office locations throughout the United States where SSA and SSI beneficiaries can go to receive in-person counseling and assistance. The Administration also provides a user friendly website at SSA.gov where the majority of Social Security-related tasks can be completed, including applying for benefits or new Social Security cards, finding out how much benefit you are likely to receive, and learning about what you may qualify for.
Consult the directory below to find the SSA office nearest you.
|Social Security Office||Address||Phone Number|
111 E Puainako St
Hilo, HI 96720
300 Ala Moana Blvd
Honolulu, HI 96850
970 Manawai Street
Kapolei, HI 96707
4334 Rice Street
Lihue, HI 96766
2200 Main Street
Wailuku, HI 96793
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.
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.
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