Memory Care in Hawaii

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.

According to the 2019 Genworth Cost of Care Survey, the average monthly cost of assisted living in Hawaii is $4,375, which is $324 more per month than the U.S. median of $4,051. Seniors in Hawaii save $1,625 each month compared to the $6,000 average cost paid by their peers in the nearest mainland state, Alaska, and $1,125 compared to the $5,500 monthly cost in Washington. The rates are closer in the other West Pacific states of Oregon and California, where the costs for assisted living average $4,499 and $4,500 per month, respectively. Using a midrange increase of 25% over the statewide average for assisted living, seniors in Hawaii can expect to pay around $5,468 per month for memory care services.

The cost of assisted living tends to vary across Hawaii, according to the location within the state and differences in facility features. In Honolulu, Hawaii’s largest metropolitan area, seniors pay an average of $4,500 per month, which is $125 higher than the statewide average. In Kahului, the biggest city on Maui, the average cost of assisted living is $75 lower than the Hawaii median, at $4,300 per month. These averages are for basic assisted living, so the rates charged for memory care services may be $860 to $1,350 higher on a monthly basis.

• Honolulu: $4,500
• Kahului: $4,300

Hawaii Medicaid Programs for Memory Care

QUEST Integration Program

The Med-Quest Division, Hawaii’s Medicaid program, provides long-term care assistance for seniors and adults with disabilities through the Quest Integration program. Individuals who meet the program’s eligibility guidelines may qualify for help paying for memory care services in assisted living facilities, adult residential care homes and extended adult residential care homes. In these settings, the program only covers the cost of services received, and participants are responsible for the room and board portion of the facility’s fees. Quest Integration is a Medicaid entitlement program, so there is no enrollment cap or waiting list to receive services.

• Who Is Eligible: To qualify for assistance, applicants must be Hawaii residents and aged 65 or older or disabled and meet Med-Quest’s functional requirements. They must also meet the current income and asset guidelines or qualify for Med-Quest’s medically needy spend-down program.
• How to Apply: Interested seniors may call or visit their local Med-Quest Division office, apply by phone at 877-628-5076 or complete an application online at mybenefits.hawaii.gov.

Non-Medicaid Financial Assistance Programs for Memory Care in Hawaii

Optional State Supplement

The state of Hawaii provides a monthly supplement payment to eligible residents who receive Supplemental Security Income benefits through the Social Security Administration. These funds may be used to pay for necessities or put toward the cost of room and board in a licensed memory care facility. The funds are added to the SSI payment a person receives each month from the SSA, and the benefit amount varies depending on a recipient’s living arrangement.

• Who Is Eligible: Hawaii residents who meet the eligibility guidelines to receive SSI benefits are automatically eligible for state supplemental payments. To qualify for SSI benefits, applicants must be U.S. citizens or legal residents aged 65 or older or deemed disabled by the SSA and have income and assets below the program’s current limits.
• How to Apply: Seniors can apply for OSS payments by completing an application for federal SSI benefits in person at their local Social Security office.

More Ways to Pay for Memory Care

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.
• Life Insurance: Some life insurance policies allow policyholders to cash out their policy before a qualifying death. There may be some downsides to accessing a life insurance benefit early, so be sure to read more about the process.

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.

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 [email protected].