Adult Residential Care Homes – are a great option for people who want to live in a residential setting, or need at least some supervision but maybe even assistance 24/7. Since Care Homes are required to provide that care both day and night, such homes can be a very cost-effective arrangement for around-the-clock assistance. The downsides to care homes is that there is a wide variety of quality (or perception of quality) that can discourage prospective residents and even lead them to overlook the value that care homes provide.

Type I and Type II Care Homes – are the two varieties, of which their most noticeable difference is the number of residents. Type I care homes generally have 5 or fewer residents, whereas Type II care homes typically have 8 or more residents. Behind the scenes, Type II care homes are required to have a Registered Nurse on staff, a commercial kitchen, a commercial fire alarm and sprinkler system, and to consult the services of a Registered Dietitian to plan menus and oversee the residents’ nutritional health.

That is not to say that a Type II care home is automatically better or safer than a Type I care home, but the increased occupancy means that Type II care homes tend to be operated by companies with a larger administrative structure. As a result, Type II care home base rates tend to be around 30%-50% higher than Type I base rates, and some residents with fewer care needs may not value care services that higher price point.

Expanded Care – is a special distinction for both Type I and Type II care homes that legally allows those facilities to accept and retain residents who are assessed by their Primary Care Provider to need nursing services typically associated with an Intermediate (Nursing) Care Facility or Skilled Nursing Facility. Expanded care residents are restricted to 20-25% of the facility’s population. Expanded care is generally viewed as an additional peace of mind for the resident so that he or she does not need to move out of the home if he or she needs that higher level of care. “If” is the operative word, as many care home residents may live out their entire lives without become expanded care residents.

Expanded care residents are required to hire a third-party R.N. Case Manager to oversee the care home’s services and to develop a comprehensive Nursing Care Plan as an additional layer of oversight and advocacy for the resident’s needs. This is generally be viewed as a good thing when it comes to serving residents with higher needs, but some families do not feel that the value of case management warrants its additional cost. The Office of Health Care Assurance does allow an exemption process to case management requirements for expanded care residents who enroll in a hospice program.

While expanded care homes can legally accommodate residents with higher nursing needs, it is important to note that not all are willing to accept residents at the expanded care level, often citing the fact that the population is limited to two or three expanded care residents and they do not want to jeopardize their current residents’ ability to transition into expanded care. Furthermore, not all care homes are able to accommodate all care needs, so it is important to determine what those limitations to care are, before moving in.

For a list of Adult Residential Care Homes in Hawaii, please visit the Office of Health Care Assurance State Licensing Section website.