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Nursing Homes in Hawaii
Hawaii is home to approximately 1.4 million residents, and close to one in five are seniors aged 65 and older. The U.S. Census Bureau estimates that by the year 2030, one in four Hawaiians will be over the age of 60, and there are a number of health care services geared to meet the needs of this growing senior population. The state has over two dozen acute care hospitals, including the top-ranked Queen’s Medical Center, which offers specialized cancer, neurological and cardiac care.
Nursing homes are highly regulated medical facilities that provide 24/7 medical care, therapeutic recreational programming and personal support to those with complex medical needs. According to Genworth Financial’s 2020 Cost of Care Survey, the average monthly rate for semiprivate nursing home care in Hawaii is $12,015, while a private room costs around $13,802.
This guide covers average nursing home costs in Hawaii and how those rates compare to other types of long-term care. It also includes an overview of Hawaii’s nursing home rules and regulations and a list of free and low-cost resources for seniors and their caregivers.
The Cost of Nursing Home Care in Hawaii
Nursing home care costs in Hawaii are high in comparison to costs in most other states. According to Genworth’s 2020 Cost of Care Survey, the average monthly cost of nursing home care in Hawaii is $12,015, which is $4,259 higher than the national average of $7,756. As there are no states bordering Hawaii, we’ve included average rates from the states along the mainland’s west coast for comparison. Alaska has the highest costs in the country at $37,413 per month, while rates are much lower in Washington, $9,581; Oregon, $10,114 and California, $9,247.
Because it’s a relatively small state, long-term care cost data is only available for two cities within Hawaii. Rates for nursing home care in the capital city of Honolulu average $11,543, while costs are lower in Kahului, where seniors pay about $10,494 per month. In Los Angeles, California, skilled nursing care costs $8,060 per month, while the same level of care costs $12,471 in San Francisco. Nursing home rates average $10,083 in Portland, Oregon, and $10,624 in Seattle, Washington. In Anchorage, Alaska, nursing home rates average $31,664 per month.
Honolulu
$11543
Kahului
$10494
Los Angeles, CA
$8060
San Francisco, CA
$12471
Portland, OR
$10083
Seattle, WA
$10624
Anchorage, AK
$31664
Nursing homes provide the highest level of long-term care available in Hawaii. Seniors with less-intensive care needs may opt to remain in their own homes with help from a homemaker ($5,339) or a home health aide ($5,720). Those who also need assistance during the day can expect to pay about $1,582 for adult day health care services. Assisted living care, which includes room and board along with some nonmedical support, costs an average of $5,000 per month.
In-Home Care
$5339
Home Health Care
$5720
Adult Day Care
$1582
Assisted Living Facility
$5000
Nursing Home Care
$12015
Does Medicaid Cover Nursing Home Care in Hawaii?
In Hawaii, over 985,800 residents are enrolled in Medicaid. For seniors residing in nursing homes, Medicaid can cover long-term skilled nursing and rehabilitation therapy. The program pays for any pharmaceutical services, as well as any hygiene-related products and services. Medicaid also covers room and board, along with dietary counseling services.
There are 43 nursing homes in Hawaii, all of which accept Medicaid. Seniors and families may be eligible for a Medicaid Home- and Community-Based Services waiver that gives individuals the option to receive skilled nursing care in a non-institutionalized setting, such as their home or an assisted living community. This provides comfort and allows seniors to remain close to their loved ones without sacrificing quality of care.
Medicaid Eligibility in Hawaii
Seniors in Hawaii are not required to meet a specific income limit to qualify for Medicaid. However, all of their income, with a few exceptions, must go to cover nursing home costs. Some of these exceptions include personal needs allowances and Medicare premiums. Whether seniors are applying for themselves or as a couple, applicants can have no more than $2,000 in assets, while the Spousal Impoverishment Act allows non-applicant spouses to have up to $148,620 in assets.
| Household Size | Number of Applicants | Income Limits Per Year* | Asset Limits: Applicant(s) | Asset Limits: Non-Applicants |
|---|---|---|---|---|
| One Person | 1 | No hard limit | $2,000 | |
| Two People | 1 | No hard limit | $2,000 | $148,620 |
| Two People | 2 | No hard limit | $3,000 |
*All monthly income except for a $50/mo. personal needs allowance and Medicare premiums must be paid to the facility as a share of cost. There may also be a monthly needs allowance for a non-applicant spouse, .
In some cases, applicants can spend down on necessities, such as medical care, to meet the income and asset criteria. In addition to the financial qualification, seniors must also need skilled nursing care and meet the following requirements:
- Must be a United States citizen
- Must reside in Hawaii
- Must be 65 years of age or older
How to Apply for Medicaid in Hawaii
Medicaid applications are accepted online through KOLEA, Hawaii’s official Medicaid website, which also offers PDFs that can be filled by hand or computer and submitted by mail or fax to a MedQuest office. Applicants can call MedQuest customer service at (800) 316-8005 with any questions about eligibility or the application process. Seniors and families can find application assistance and apply in person at a local MedQuest Office. If applications need to be changed or updated, it can take up to 3 weeks to resubmit and reprocess the application. To prevent this from occurring, be sure to collect all the appropriate documentation beforehand.
Information You Will Need:
- Birth certificate
- Social Security card or proof of citizenship if born outside the United States
- Proof of earned and unearned income for up to 60 months prior to the date on the application
- Bank statements, including closed accounts, for the previous 60 months
- Proof of pensions, such as private and government pensions, and must include a letter of verification from the provider
- Copies of life insurance documents
- Property deeds and proof of any sold or transferred real properties during the previous 60 months
- Car registration and insurance
- Preneed burial contracts
- VA discharge (DD 214) papers for veteran applicants
- Any documents related to end-of-life-planning, including wills and power of attorney
- Other documents that support the applicant’s claim
Additional Medicaid Support & Resources in Hawaii
Applying for Medicaid doesn’t have to be a complicated task. Seniors and families can reach out to the Hawaii Aging and Disability Resource Center for local Medicaid resources and one-on-one guidance. Additionally, Medicaid Planning Assistance has in-depth articles about the application process and details on qualifications.
| Resource | Contact | Service |
|---|---|---|
| Hawaii Aging and Disability Resource Center | (808) 643-2372 | Hawaii's Aging and Disability Resource Center provides information and referral assistance regarding local and statewide programs for seniors and their caregivers. Programs, such as Healthy Aging Partnership, promote health and education for disease prevention. The agency also has connections with the state’s health insurance counseling and long-term ombudsman programs, in addition to resources for individuals with dementia. |
| Medicaid Planning Assistance | Online Only | Medicaid Planning Assistance has a plethora of information about how Medicaid works and how you can use it with other benefits, such as Medicare and VA benefits. The website offers an eligibility tool and detailed guide regarding income limits and other qualifications. Users can also read about the advantages and disadvantages of working with a professional Medicaid planner or self-planning. |
| Benefits.gov | (800) 316-8005 | Benefits.gov is the official website to search for a wide variety of federally and state-funded programs and services that can promote quality of life in aging adults. Users can search for programs to offset medical expenses and search by category or agency. The Social Security Administration provides a Benefits Eligibility Screening Tool that you can use to determine eligibility for Medicaid and SSI benefits. |
Does Medicare Cover Nursing Home Care in Hawaii?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it’s most valuable for those who are recovering from an injury, illness or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers a number of specific services, including:
- Meals
- A semiprivate room
- Medications
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn’t Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors’ day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support and Resources in Hawaii
While Medicare can’t cover long-term care, it can cover the first 21 days in a nursing home, giving families time to find other ways to cover the costs. The official Medicare website has a page dedicated to cost-saving programs and a search tool to find local planning professionals. Additionally, individuals can use BenefitsCheckUp to make sure they aren’t missing out on other financial aid programs.
| Program | Contact | Service |
|---|---|---|
| Hawaii State Health Insurance Assistance Program | (888) 875-9229 | Hawaii State Health Insurance Assistance Program helps Medicare beneficiaries with applying for and maintaining their benefits. Seniors can learn about the basics of Medicare and supplemental coverage options one-on-one or in a group presentation. Counselors have experience with identifying individuals who qualify for financial assistance to cover out-of-pocket medical expenses, including prescription medical and assistive devices. |
| BenefitsCheckUp | (800) 794-6559 | BenefitsCheckUp helps seniors and families find statewide and local resources to cover health care and other long-term needs. After answering a short questionnaire, users can search for benefits using their zip code. Some programs include free mobile phone services, along with tax reliefs and exemptions. Provided by the National Council on Aging, the website is available in English and Spanish. |
| Medicare.gov | (800) 633-4227 | The official Medicare website allows users to create an online account to apply for and maintain their benefits, as well as access to savings programs. Seniors and families can find local Medicare-registered health care providers and medical equipment suppliers using the search tools backed by the Centers for Medicare & Medicaid Services and National Supplier Clearinghouse, respectively. |
Other Financial Assistance Options for Nursing Home Care in Hawaii
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
| Name | How To Apply | How It Works |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov | If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be able to use it to pay for skilled nursing care. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not typically be eligible to sign up for a LTC insurance policy. |
Free and Low-Cost Resources for Seniors in Hawaii
There are many resources in Hawaii that assist seniors in their retirement. Caring.com 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.<
| Program Name | Phone Number | Description |
|---|---|---|
| Hawaii Area Agencies on Aging | The Hawaii Agency and Disability Resource Centers manage Area Agencies on Aging throughout the state. Services are provided through County Offices on Aging as well as the Kauai Agency on Elderly Affairs. Programs include help with in-home chores, transportation, personal care and housing assistance with the goal of helping elderly residents to continue living in their own homes or community. Eligibility criteria include being 60 years or older, a resident of Hawaii, a U.S. Citizen or a legal alien. |
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.
| Program Name | Phone Number | Description |
|---|---|---|
| Hawaii Lifeline Program | 800-234-9473 | The LifeLine Program offers a discount on landline or mobile telephone service, ensuring that participants can stay in contact with loved ones. |
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.
| Program Name | Phone Number | Description |
|---|---|---|
| Hawaii Medicaid I/DD Waiver | The Medicaid I/DD waiver is Hawaii's 1915c Home- and Community-Based Waiver that the state and federal governments sponsor. It's intended for those with limited incomes and resources. This waiver pays for a wide range of personal care services, including: • Grooming • Housekeeping • Transportation • Meals • Medication administration • Bathing • Toileting • Dressing • Personal emergency response systems (PERS) • Skilled nursing |
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.
| Program Name | Phone Number | Description |
|---|---|---|
| Hawaii Supplemental Nutrition Assistance Program (SNAP) | The Supplemental Nutrition Assistance Program (SNAP) in Hawaii promotes wellness by offering food benefits to low-income seniors in need. The government-funded program offers electronic benefit transfers that beneficiaries can use at food retailers across the state. The aim of these funds is to increase residents' grocery budgets, enabling them to prioritize buying quality and nutritional foods and snacks. Eligibility is determined based on household size and gross income. | |
| Hawaii Meals on Wheels | Hawaii's Meals on Wheels provides healthy, home-cooked dishes for adults aged 60 and older with disabilities or limited mobility that prevents them from shopping for food or preparing nutritious meals. Costs for the program vary from zero to full price, depending on the ability to pay. Volunteers delivering food ensure seniors receive regular communication and safety checks to confirm their well-being. Seniors with transportation can socialize and eat at local centers, promoting wellness. |
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.
| Program Name | Phone Number | Description |
|---|---|---|
| Assistive Technology Resource Centers of Hawaii (ATRC) | 808-532-7111 | ATRC allows individuals with disabilities to test assistive technologies free of charge to see which ones work best and provide the greatest benefit. The organization also offers training classes on the latest technologies. In addition, the ATRC provides financial aid for wheelchair vans. |
| Relay Hawaii Equipment Program (RHEP) | 808-847-9032 | RHEP provides relay equipment to seniors with communication challenges and those without access to any assistive equipment to keep them connected with family and friends. Training and installation are available at no extra cost. This equipment may include speech-to-speech services (STS) or hearing carry-over (HCO). |
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.
| Program Name | Phone Number | Description |
|---|---|---|
| Hawaii Weatherization Assistance Program | WAP helps seniors on a budget lower their energy costs by updating the weatherization on their homes. This includes installing low-flow showerheads, CFL or LED lighting, advanced power strips, air conditioner replacement, solar water heaters, refrigerator replacement, insulation installation and window and door replacement. |
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.
| Program Name | Phone Number | Description |
|---|---|---|
| Alzheimer's Association Hawaii Chapter | 800-272-3900 | As the Hawaii branch of the national organization, Alzheimer's Association Aloha works to advocate for local seniors and offers education and services to those impacted by Alzheimer's. Supportive services include educational workshops and support groups for seniors to connect with others who share their experiences. |
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.
| Program Name | Phone Number | Description |
|---|---|---|
| Hawaii Social Security | Social Security is a source of income available to retirees and people who can no longer work because of a disability. The money for Social Security comes from a payroll tax levied on employers, employees and self-employed individuals. When you retire, you'll receive monthly payments based on how much you earned when you were working. |
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.
| Program Name | Phone Number | Description |
|---|---|---|
| Hawaii Low-Income Home Energy Assistance Program (LIHEAP) | Seniors who find it financially challenging to pay their home energy bills can apply for help once a year through the Hawaii Low-Income Home Energy Assistance Program (LIHEAP). This state-wide program provides emergency assistance to pay heating and cooling bills. LIHEAP provides either an energy credit for eligible seniors or an energy crisis intervention for those at risk of utility disconnection due to nonpayment. |
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.
| Program Name | Phone Number | Description |
|---|---|---|
| Hawaii VA Benefits and Health Care | Seniors who served in the armed forces may qualify for benefits through the Hawaii VA Benefits and Health Care program. This veterans services program provides health care and financial aid to veterans. Some older veterans may also qualify for retirement income. The main medical center and regional benefit office are in Honolulu, but there are clinics and centers in other parts of the state. |
Nursing Home Laws and Regulations in Hawaii
| Topic | Rule |
|---|---|
| Licensing Requirements | Hawaii nursing homes, also known as nursing facilities or skilled nursing facilities, are licensed and regulated by the Department of Health, Office of Health Care Assurance. Facilities must have a current license in order to accept and retain patients, and each administrator must hold a valid Nursing Home Administrator license. Licenses are renewed on an annual basis following successful completion of a state-administered inspection. |
| Staffing Requirements | At least one medical professional must be on-site at all times, and the facility needs to maintain staffing levels that match or exceed patient care requirements. Each facility must have a physician who is retained to act as the medical director. |
| Staff Training Requirements | Staff must complete a comprehensive orientation and annual in-service training that covers patient rights, infection control, first aid and CPR. |
| Admission Restrictions | Nursing homes may only admit individuals who require around-the-clock assistance with activities of daily living and who cannot be safely supported in a less-restrictive setting. Facilities cannot admit or retain individuals who pose a threat of injury to themselves or others due to communicable disease or aggressive behavior. |
| Care Planning Requirements | Upon admission, a comprehensive care plan must be created that addresses the patient's physical, emotional and social needs. This plan must be reviewed annually or more frequently if the patient experiences a significant change in their health. |
| Dietary and Nutritional Services Requirements | Every facility must either employ or contract with a dietetic service supervisor who is either a qualified dietitian; a dietetic technician training program graduate or has the equivalent combination of education and experience. At least three meals must be served daily, and menus cannot be repeated within a four-week time frame. |
| Specialized Rehabilitative Services | Facilities need to provide specialized rehab services, such as occupation, speech and physical therapy, either on-site or at an off-site location. |
| Medication and Pharmaceutical Services | Nursing homes must either employ or contract with a licensed pharmacist who oversees medication administration and record keeping. Only licensed staff can administer prescription medications to patients. |
| Activities Requirements | Facilities must plan and deliver independent and group recreational activities that match the needs and interests of residents. A designated staff member should be assigned to oversee the activities program. |
| Infection Control Requirements | Nursing facilities must follow standardized infection control procedures in accordance with local, state and federal guidelines. Personal care equipment must be either disposable or sterilized between patients, and resident rooms can house no more than four patients. At least one single bedroom with a private toilet room must be designated for use as an isolation room. |
| Medicaid Coverage | Hawaii's Medicaid program covers the cost of nursing home care for those who meet the income and asset criteria for Medicaid enrollment and who are medically certified as requiring nursing home care for at least 30 days or more. |
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