Memory Care in Hawaii

Table of Contents

Memory Care in Hawaii

Table of Contents

• The Cost of Memory Care in Hawaii
• Hawaii Medicaid Programs for Memory Care
• Can You Use Medicare To Pay for Memory Care in Hawaii?
• More Ways To Pay for Memory Care in Hawaii
• Memory Care Laws and Regulations in Hawaii
• Free and Low-Cost Resources for Seniors in Hawaii
• Hawaii COVID-19 Rules for Memory Care Facilities

Because of the specialized staff training and resources required to provide high-quality memory care, memory care typically costs more than other types of residential care. On average, memory care will cost 20-30% more than assisted living.

We added 25% to the assisted living costs reported by the 2021 Genworth Cost of Care Survey to calculate memory care costs.

In Hawaii, the average monthly cost of memory care is $6,719. This is $1,094 more than the United States average of $5,625. In comparison to the coastal states of California ($6,563) and Oregon ($6,306), communities in Hawaii charge slightly more each month. However, seniors in Hawaii pay less on average than those in Washington ($7,500).

There's a big difference between the costs of care in Hawaii, depending on location. In Urban Honolulu, seniors pay an average of $6,719 for memory care, while those in Kahului pay significantly less at $4,781. Across the ocean in San Francisco, CA, seniors pay $7,899, and those in Los Angeles, CA, pay $6,563 each month.

Med-QUEST is the Hawaiin version of Medicaid. It covers residential care and support services for low-income seniors in assisted living communities and other residential facilities. This means that Medicaid in Hawaii covers some of the memory care costs. The exact services covered will depend on the care requirements of the senior and the plan they are approved for. Some of the services covered include personal care, skilled nursing care, housekeeping, nonmedical transportation and medical equipment.

• Who Is Eligible: To qualify for coverage, seniors must be 65 years or older and reside in Hawaii. In addition, they must be U.S. citizens or legal residents, and they're required to meet certain medical, asset and income guidelines.
• How To Apply: Interested parties can apply in person at their local Med-QUEST division office or by phone at (877) 628-5076. Alternatively, they can apply online at mybenefits.hawaii.gov.

Medicaid Eligibility for Seniors in Hawaii

Medicaid eligibility in Hawaii is based on several factors, including age, health and income. Individuals who desire to live in an assisted living facility instead of receiving nursing home care have an annual income cap of $14,820, and married couples are limited to $29,640. Assets are limited to $2,000 per person; however, this excludes properties and vehicles.

In addition to meeting the above financial requirements, seniors must also provide the following documentation:

• Medical evaluation to prove the requirement of nursing care
• Birth certificate
• Proof of U.S. citizenship or legal residency
• Proof of address in Hawaii
• Power of attorney
• Bank statements for the past 60 months
• Proof of income
• Insurance policies
• Title deeds of any property owned

How To Get Help Applying for Medicaid in Hawaii

Seniors and their family members have easy access to assistance when applying for Medicaid in Hawaii.

Unfortunately, Medicare does not generally cover the cost of Memory Care. Most Memory Care Facilities are considered to be "social settings," so Medicare does not cover the cost incurred in these facilities. The only exception to that is if you are receiving memory care services in a Nursing Home. While this situation is much less common, Medicare would sometimes cover the cost, depending on a number of circumstances.

That being said, Medicare does still cover qualified doctor visits, medications, etc., as it would if you were still at home, but it will not cover the cost of care received at the Memory Care Facility.

In addition to the state programs mentioned above, those looking for resources to finance memory care may consider:

• Long-Term Care Insurance: Depending on the policy details, long-term care insurance may be used to pay for memory care services. It's best to sign up for a policy early, as coverage will likely be denied if one already has long-term care needs. More information about the intricacies of long-term care insurance can be found at longtermcare.acl.gov.
• Reverse Mortgages: Reverse mortgages allow some homeowners to take out a loan as an advance from the eventual sale of their primary residence. This can be a good way to fund memory care in the short-term, but the loans will need to be paid back after the sale of the home. The most commonly used type of reverse mortgages for seniors is the Home Equity Conversion Mortgage, which is the only reverse mortgage insured by the federal government.
• Veterans Benefits: The Department of Veterans Affairs offers several programs that veterans and their spouses may use to cover health care needs such as memory care. More information about these programs can be found on the VA website.

Memory Care Regulation

In Hawaii, residential care facilities that provide memory care are regulated by the Department of Health, Office of Health Care Assurance (OHCA). There are two types of facilities licensed by the OHCA: Assisted living facilities (ALFs) and adult residential care homes (ARCHs). Type I ARCHs may house up to five residents, while Type II ARCHs may have six or more residents. The state also licenses expanded adult residential care homes, or E-ARCHs, which may provide services similar to those offered in nursing facilities. Hawaii’s state regulations do not include memory care specific licensing requirements for ALFs, ARCHs or E-ARCHs.

The Department of Health inspects all licensed facilities in the state every two years. Unannounced inspections may also take place at any time to ensure compliance with state regulations or in response to filed complaints.

Facility Scope of Care

Assisted living facilities must provide certain care services to residents, in addition to room and board, including nursing assessments, health monitoring, medication management and supervision and intervention with behavior problems. The scope of care also includes assistance with daily living activities and personal care services.

Additionally, ALFs must provide or arrange services not related to health care, including:

• Three dietitian-approved meals per day, plus snacks, that meet residents’ dietary needs and preferences
• Social and recreational activities
• Laundry and housekeeping services
• Transportation
• Beauty and barber services
• Access to medical care, such as doctor visits, therapies and podiatry services

Adult residential care homes must provide residents with three meals plus snacks each day, with accommodations made for doctor-prescribed diets. Additionally, facilities must offer supervision, assistance with personal care, management and assistance with self-administration of medications, social activities and transportation to medical appointments. Extended adult residential care homes must provide health care related services for residents who meet the criteria of a nursing home level of care. E-ARCH facilities are also required to arrange medical evaluations by a physician for these residents every four months.

Admissions Requirements

ALFs and ARCHs in Hawaii may accept individuals with a wide range of conditions and care needs. State regulations do not limit who may be accepted, beyond prohibiting the admission of individuals who require a nursing facility level of care, but they do define why a resident must be discharged from an ALF. State regulations stipulate that each ALF and ARCH must develop its own admittance guidelines, based on the facility’s capacity and staff training and experience, and ARCHs must also establish discharge policies. The following table offers examples of conditions and situations that may determine admission to an ALF or ARCH, the expanded admissions allowed in E-ARCHs and the discharge guidelines for ALFs, per state regulations.

Residents Who May Be Admitted to ALFs and ARCHs

Seniors and adults with:

• Physical, intellectual or developmental or disabilities
• Stable chronic illnesses
• Alzheimer’s disease or other forms of dementia
• Controlled behavioral issues

Residents Who May Be Admitted to E-ARCHs

Seniors and adults who meet the criteria for a nursing facility level of care, as certified by an RN or physician

Residents Who May NOT Be Retained in ALFs

Individuals who:

• Require a nursing facility level of care
• Exhibit behavior that poses an imminent danger to themselves or other residents
• Have care needs the facility is unable to support
• Do not abide by the facility’s assisted living agreement on an ongoing basis

Medication Management Requirements

ALFs may provide assistance to residents with self-administration of medications, and an RN may delegate direct care staff to deliver this assistance. A resident’s medications may be stored in their private quarters, but in shared units, stored medications must be kept under lock and key. A physician or RN must review the medications of all residents every 90 days.

ARCHs may provide assistance to residents who wish to self-administer medications and are capable of doing so. Medications taken by injection must be administered by an RN or delegated to direct care staff if a resident cannot self-administer the injection.

Care Plan Requirements

ALFs and ARCHs must conduct a comprehensive initial assessment on each resident admitted to determine their care needs. Facilities must then develop a written care plan for the individual that reflects their assessed needs and choices. The plan should detail the care services to be provided, who will deliver the services, when they will be provided and how often, as well as the expected outcome. Each resident’s care plan must be updated periodically and in response to changes in the individual’s condition.

Facility Requirements

Facility requirements differ for ALFs and ARCHs. ALFs must provide residents with apartment-style units that include a private bath equipped with a sink, toilet and shower. The unit must have a kitchen or kitchenette equipped with a refrigerator, sink and cooking appliance, which may be disconnected or removed according to the resident’s needs. A unit must be 200 square feet in size, excluding the bathroom.

In ARCHs, rooms may be shared by up to four occupants. The facility must provide one toilet for every eight residents, a sink for every 10 residents and a shower or bathtub for use by up to 14 residents.

Staffing Requirements

Assisted living facilities are required to employ an administrator who is responsible for day-to-day operations. Although state regulations do not stipulate a minimum staff-to-resident ratio, sufficient direct care staff must be on duty to meet the needs of residents, 24 hours a day. Licensed nursing staff must be on hand seven days a week to manage and monitor residents’ care. All staff must be trained in first aid and CPR, and a registered nurse must be employed to train and supervise staff and conduct resident assessments. All staff members are required to complete orientation training and at least six hours of in-service training annually.

Type II adult residential care homes must employ an administrator to oversee staff, residents and day-to-day facility operations and employ an RN to complete resident assessments. E-ARCHs must have a social worker or RN available to train and supervise direct care staff. The state does not mandate a minimum staff-to-resident ratio, but facilities must have sufficient staff on duty around the clock to meet residents’ needs and at least one caregiver on duty during each shift. All staff of ARCHs and E-ARCHs must complete six hours of annual training on specific topics.

Medicaid Policy

Hawaii’s Medicaid program, Med-Quest, offers coverage for memory care services received in ALF, ARCH and E-ARCH facilities through its Quest Integration program. This managed care program is an entitlement of Med-Quest, so individuals who meet the residency, functional and financial criteria are eligible for assistance. The program covers the cost of provided services, but not room and board.

Reporting Abuse

Individuals who have concerns about the treatment or quality of care received by a resident in an ALF, ARCH or E-ARCH facility in Hawaii can contact the Long-Term Care Ombudsman by calling 1-808-586-7268. Alternatively, concerns about elder neglect or abuse in a licensed care facility may be reported by emailing john.mcdermott@doh.hawaii.gov.

Hawaii is home to several resources that provide support and guidance for seniors with dementia-related disorders and their caregivers. 

Note: The following information was compiled and most recently updated on 2/7/2022. Since COVID-19 is a rapidly evolving crisis, be sure to contact your Memory Care Facility or local Area Agency on Aging for the most up-to-date information.