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 $137,400 in assets.

2022 Basic Medicaid Income Limits for Seniors in Hawaii

	Income limits	Asset limits
Single Applicant	No hard income limit	$2,000
Two-Person Household (Only One Person Applying)	No hard income limit	$2,000 for applicant $137,400 for non-applicant
Two-Person Household (Both People Applying)	No hard income limit	$4,000

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

Several agencies are dedicated to helping seniors and families in Hawaii find ways to pay for long-term nursing care. The Area Agencies on Aging is a one-stop shop for local and statewide programs and services, including the state long-term care ombudsman program.

Resource	Contact	Service
Area Agencies on Aging	(808) 586-4400	Hawaii’s Area Agencies on Aging provide a wide range of federal, state and local resources to help seniors and families plan for the future. With four offices spread throughout the islands, including one in the capital, the organization can assist low-income and limited English-speaking Hawaiians with meeting their social and economic needs. Case management services can help seniors assess their long-term needs and refer families for other services, such as legal aid.
Hawaii Office of Veterans’ Services	(808) 433-0420	The Hawaii Office of Veterans’ Services offers a plethora of programs, including real property tax exemptions and burials for qualifying veterans and their dependents. VA officers can also help seniors file claims with the VA, appeal denials and maintain other VA benefits and pensions. The agency is responsible for managing Hilo Veterans Homes, including the Yukio Okutsu State Veterans Home.
Yukio Okutsu State Veterans Home	(808) 961-1500	The 24-hour medical staff at Yukio Okutsu State Veterans Home consists of skilled nurses and various types of rehabilitation therapists. Services range from short-term respite to long-term care for hospice residents. The facility is also certified to accept Medicare and Medicaid to further reduce any costs of care for residents and their families.
Kupuna Legal Aid Services	(808) 536-0111 (Oahu) (888) 536-0011 (Neighbor Islands)	As part of the Legal Aid Society of Hawaii, Kupuna Legal Aid Services can assist seniors over the age of 60 and their families with civil matters, such as end of life planning. Representatives have experience with helping seniors create power of attorney and advance health care directive documents. The nonprofit organization has staff members who speak many of the prominent languages in Hawaii.
Hawaii Long-Term Care Ombudsman Program	(808) 586-4400	Ombudsmen can help seniors and their families investigate and mediate issues with staff members at long-term care facilities, including nursing homes. Residents can reach out to ombudsmen with complaints of neglect, physical or verbal abuse and medication mismanagement. Ombudsmen can advise seniors about their personal rights as residents and alternatives to nursing home placement.

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.