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. 

$12015

Hawaii

$7756

The United States

$37413

Alaska

$9581

Washington

$10114

Oregon

$9247

California

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. 

$11543

Honolulu

$10494

Kahului

$8060

Los Angeles, CA

$12471

San Francisco, CA

$10083

Portland, OR

$10624

Seattle, WA

$31664

Anchorage, AK

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. 

$5339

In-Home Care

$5720

Home Health Care

$1582

Adult Day Care

$5000

Assisted Living Facility

$12015

Nursing Home Care

Financial Assistance for Nursing Home Care in Hawaii

Most people do not pay for skilled nursing care entirely out-of-pocket. Rather, they utilize financial assistance programs to help cover the cost of nursing care. Of public financial assistance programs, Medicaid provides the most comprehensive coverage of nursing home care. But, not all seniors are eligible for Medicaid. And because each state operates its own Medicaid program within federal guidelines, eligibility and benefits vary from state to state. Below, we provide more information on Medicaid in Hawaii.

Hawaii’s Medicaid Program

As of September 2020, 367,960 of Hawaii’s 1.4 million residents were covered by Medicaid/CHIP, and three out of every five nursing home patients in the state were in Medicaid-funded beds. Of Hawaii’s Medicaid beneficiaries, 17% were elderly or disabled, and just over half of the state’s Medicaid expenditures went to support these two groups of enrollees. 

The most recent long-term care capacity report for Hawaii was published in 2017, and at that time there were a total of 7,658 skilled nursing and intermediate care beds in the state. Hawaii’s Medicaid Fee-For-Service Program provides long-term care services to Medicaid beneficiaries who are physician-certified as needing the level of care provided in a nursing home for at least 30 consecutive days. Because institutional/nursing home Medicaid in Hawaii is an entitlement program, there are no limits on the number of Medicaid beneficiaries who can receive care in a Medicaid-funded nursing home. 

Medicaid Eligibility in Hawaii

Hawaiians aged 65 and older may qualify for Medicaid-funded nursing home benefits if they’re a U.S. national or citizen, a legal alien or a permanent resident of the state. Seniors must also meet the current income and asset criteria, which are adjusted on an annual basis. 

Seniors can apply for Medicaid by calling (877) 628-5076, online or in-person through the nearest Medicaid Community Partner.

Alternative Financial Assistance Options

  • Medicare: Medicare will cover the cost of one’s care in a skilled nursing facility for the first 20 days of their stay, and a portion of the costs up until day 100. After 100 days, the individual is responsible for all costs. Seniors must also have a “qualifying hospital stay” of at least 3 days prior to their admission to a nursing home in order to qualify for Medicare coverage.
  • Aid and Attendance: 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: 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. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.
  • Long-Term Care Insurance: Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy.

Free and Low-Cost Resources for Seniors in Hawaii

A number of government agencies and nonprofit organizations offer programs to help seniors access long-term care financing and connect with community-based supports. Services are also available to protect the elderly against financial exploitation, fraud and abuse. 

ResourceContact Service
Kupuna Legal Aid Services(808) 536-0111 (Oahu)(888) 536-0011 (Neighbor Islands) Kupuna Legal Aid Services provides free legal advice and assistance to seniors aged 60 and older. Operated by the Legal Aid Society of Hawaii, lawyers help seniors with advanced planning, including creating advanced health care directives, powers of attorney, basic wills and property deed transfers. The organization also operates the Senior Victims of Crime project to help older adults who are victims of physical, sexual, financial or emotional abuse. 
Hawaii Office of Veterans’ Services(808) 433-0420Hawaii’s Office of Veterans’ Services oversees the state’s programs and services for vets and their dependents and works to ensure every eligible vet receives all the county, state and federal benefits they are entitled to. Veteran Service Officers can assist with VA benefit claims and appeals; arrange for internment at a Veterans’ cemetery; provide copies of service records and help vets apply for tax exemptions on property, such as real estate and passenger vehicles. 
Alzheimer’s Association — Aloha Chapter(800) 272-3900The Aloha Chapter of the Alzheimer’s Association provides a wide range of free services to the 29,000 Hawaiians currently living with Alzheimer’s disease and other forms of dementia. Programs include peer and caregiver support groups, educational workshops and information on clinical trials. Staff can help those with Alzheimer’s find long-term care services, and help is available in English, Japanese, Korean and Chinese. 
Area Agencies on Aging(808) 586-4400Hawaii’s seniors can learn about regional resources, such as case management, assisted transportation, adult day care and skilled nursing care, by contacting their county Area Agency on Aging. Each of Hawaii’s four counties has a designated AAA, and services are focused on those living with a disability, such as seniors who need 24/7 care. 
Hawaii State Health Insurance Assistance Program (888) 875-9229Hawaii’s State Health Insurance Assistance Program provides free, confidential one-on-one Medicare, Medigap and Medicare Advantage counseling to seniors and their families. The program has volunteer counselors throughout the state who are available for in-person and phone appointments. 

Nursing Home Laws and Regulations in Hawaii

Licensing RequirementsHawaii 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 RequirementsAt 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 RequirementsStaff must complete a comprehensive orientation and annual in-service training that covers patient rights, infection control, first aid and CPR. 
Admission RestrictionsNursing 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 RequirementsUpon 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 RequirementsEvery 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 ServicesFacilities 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 ServicesNursing 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 CoverageHawaii’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. 

Nursing Homes Facilities in Hawaii (4)