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.
The United States
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.
Los Angeles, CA
San Francisco, CA
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.
Home Health Care
Adult Day Care
Assisted Living Facility
Nursing Home Care
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 Medicaid Income Limits for Seniors in Hawaii
Annual Income Limits
No hard income limit
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
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.
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 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 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:
- A semiprivate room
- 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.
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 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.
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.
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.
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.
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.
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.
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.
(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.
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.
COVID-19 Rules for Nursing Homes in Hawaii
The following information is based on research done on several government websites, including health.hawaii.gov/coronavirusdisease2019. These rules apply to Independent Living Communities and other types of senior living facilities. We’ve most recently updated this data on 2/7/2022, but since COVID-19 is a rapidly evolving pandemic, contact your local senior living facility or Area Agency on Aging for more specific and up-to-date information.
Are loved ones allowed to visit to provide emotional support?
Are relatives allowed to visit for end-of-life care?
Are residents required to quarantine after visiting with a loved one?
Are visitors required to wear PPE (including masks) in order to visit residents?
Are non-medical contractors (such as hairdressers and entertainers) allowed in senior living facilities?
Are visitors checked for elevated temperatures?
Are visitors required to answer questions about health, travel, and potential virus contact?
Outings & Social Activities
Are residents allowed to leave (errands, visiting family, etc.) for non-medical reasons?
Are residents who leave required to quarantine when they return?
Are senior living communities required to cancel all group outings?
Are residents allowed to eat meals together in a common area?
Are residents allowed to gather in common areas for group activites?
COVID-19 Safety Measures for Staff and Residents
Are staff members regularly required to do a temperature check?
Are staff members regularly tested for COVID-19?
Are staff members members regularly required to do a health and safety screening, including questions about travel, contact with positive cases, etc?
Are residents regularly screened for COVID-19 symptoms?
Are residents regularly checked for elevated temperatures?
Are residents regularly tested for COVID-19?