Hawaiian assisted living communities and their staff must adhere to a comprehensive set of state laws and regulations. These laws govern the minimum provisions each assisted living community must offer, staff training and the rights of residents. See some of these laws listed below as they pertain to assisted living communities (ALF) and adult residential care homes (ARCH).

Assisted Living Service Plan Requirements

ALF: Before moving in, assisted living communities must create a resident's agreement and provide a copy to the resident. The agreement must include any services that are to be provided along with their cost and any additional services that may be offered and their corresponding prices. Any services not provided onsite must be described in the agreement if the assisted living community will be arranging or coordinating the services through a third party.

A comprehensive assessment must be completed for each resident to identify their needs and create a plan for services to be implemented. This service plan must be updated periodically. The resident must be involved with the development of the plan, and it should be created with the resident's dignity, choice, privacy, individuality and independence in mind. The plan should also manage risks involved with resident choices, weighing the probability for negative outcomes and risk to other residents. Third-party social work and ancillary services for medical care can be arranged by the assisted living community.ARCH: Adult residential care homes also require an agreement with residents that explains any services that will be provided according to the care plan, the responsibilities of the home and the rights of the resident.The service plans for adult residential care homes must include a schedule of activities describing provided services after a comprehensive assessment of that resident's needs. E-ARCH service plans will be created with the case management agency that represents the resident with minimum monthly required visits to reassess the residents' needs and evaluate the services and care provided. Therapeutic services prescribed by a licensed physician can be provided by third-party agencies.

Assisted Living Admission Requirements

ALF: Assisted living communities are required to have a discharge policy that includes a written 14-day notice for residents who are noncompliant with necessary assisted living rules, display behavior that puts themselves or others in imminent danger, or require care that the community is unable to provide.

ARCH: Adult residential care homes are required to develop admission and discharge policies. E-ARCHs can admit residents who need nursing home levels of care as determined by a registered nurse or licensed physician. However, these residents cannot be more than 20 percent of the home's population unless an exception is approved by the state.

Assisted Living Scope of Care

ALF: Assisted living communities must offer:

• Laundry and housekeeping services
• Opportunities for group and individual socialization
• Assistance with ADLs
• Health monitoring
• Nursing assessment and routine nursing tasks
• Administration options for medication
• Behavior problem services including supervision, intervention and staff support
• Recreational and social activities
• Transportation provisions or arrangement
• Ancillary services for medical care
• Hospice care

ARCH: Adult residential care homes must offer personal care services, medication administration assistance, medication services, housekeeping and laundry, supervision, social activities and transportation for medical appointments. E-ARCHs are required to provide additional medical services for residents who meet nursing home levels of care criteria and must arrange an appointment with a medical doctor every four months for those residents.

Assisted Living Medicaid Policy

Seniors who qualify for Hawaii Medicaid can apply some of their benefits toward personal care services under the Med QUEST waiver. The waiver cannot be applied toward meals or room and board.

Assisted Living Facility Requirements

ALF: Apartment-style units are required and must include a bathroom with a shower, toilet and sink. Residents must also be provided with a refrigerator, something with which to cook meals, and a call system monitored by staff 24 hours per day.

ARCH: Each room may house up to four residents, and the house must have a minimum of one toilet for every eight residents, one sink per 10 residents and one shower per 14 residents.ALFs and ARCHs are both required to provide three meals a day to residents and snacks. Modified diets are permitted when recommended by a licensed physician and all meals served at ALFs are required to be evaluated and approved by a dietitian twice a year.

Medication Management Regulations

ALF: Assistance with self-administered medication can be provided by unlicensed staff members who are delegated by a licensed registered nurse. Residents can keep their medications in their units if they self-administer, but those who share a unit with another resident must keep medications in a locked container. All resident medications must be reviewed every 90 days by a licensed physician or registered nurse.

ARCH: Residents are allowed to self-administer medications if they are able. E-ARCHs must administer medications by injection with a registered nurse or an unlicensed delegate, unless the resident can self-administer.

Staffing Requirements

ALF: Every assisted living community must have direct care staff and a designated administrator. The administrator must ensure all staff are trained to provide necessary services to residents and understand assisted living principles. Every staff member must also have first aid training, including cardiopulmonary resuscitation. Each community must have arrangements for a registered nurse to provide staff training and conduct assessments of residents. There are no minimum staff-to-resident ratios, but a registered nurse must be available seven days a week for resident care management, and monitoring and direct care staff must be available 24 hours a day.

ARCH: Type II ARCHs must have an administrator that oversees all residents and staff. Arrangements must be made with a registered nurse to handle resident assessments. A social worker or registered nurse must train and supervise caregivers at E-ARCHs. The other staff must be comprised of direct care staff and nurse aides. There are also no minimum staff-to-resident ratios in residential care houses, but there must be enough staff on-duty 24 hours each day to attend to resident needs, and at least one nurse aide should be present each shift.

Staff Training Requirements

ALF: Every staff member must complete orientation training that covers the organization, practice, philosophy and goals of assisted living. They are also required to complete six hours of in-service training each year.

ARCH: A registered nurse must train primary caregivers in E-ARCH communities. Type II ARCH employees must complete six hours of training annually that cover specific topics, such as pharmacology, personal care, infection control, diseases and chronic illnesses, community services and resources, and medical and behavioral management of residents.

Background Checks for ALF and ARCH Staff in Hawaii

For both community classifications, staff must not have been convicted of neglect, abuse or misappropriation of funds. A conviction or substantiated findings of any of these crimes requires denial of employment.

Requirements for Reporting Abuse

In the state of Hawaii, elder abuse includes physical injury, psychological neglect or abuse, sexual abuse, negligent treatment, maltreatment or financial exploitation. If you suspect a loved one has been a victim of abuse, or if you have experienced abuse personally, a formal complaint can be filed by calling one of the following numbers:

808-832-5115 (Oahu)808-243-5151 (Maui, Molokai and Lanai)808-241-3337 (Kauai)808-933-8820 (Hilo, Hamakua and Puna)808-327-6280 (Kau, Kona, Kohala and Kamuela)808-586-7268 (Long Term Care Ombudsman)