Care Options in Hawaii
What is available to seniors in our community and how do I choose?
There are many different elderly options available in Hawaii. But figuring out which one is right for you (let alone even knowing how to find them) can be a challenge. We are here for you! Let's walk you through our recommended process.
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"Help! I am getting discharged from the nursing facility next week but it is not safe for me to go home! Where should I go?!"
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"I am looking for something for my mom and I don't get the difference between a care home, a foster care home, and a nursing home!"
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"I need to find a place for my dad, but there isn't any great website to find out more."
Unfortunately, the above statements are all too common!
In 2012, we noticed a disturbing trend. People would call us in search for care, but it was clear that they did not know what they did not know about elderly care options. They felt overwhelmed. Familiarizing themselves with the industry was difficult. Worse yet, some people would call in a frantic search because they needed to move into a facility within days!
Deciding to seek care and/or moving into a facility is a big decision at a level similar to buying a house or sending a child to college. The greatest luxury a person can have is enough time to make an informed decision. Start to familiarize yourself as early as you can. Below is our recommended five-step process:
Step 1: Understand Your Profile
"What do I need (now and in the future)?"
The first step to choosing an elderly care option is to understand your own needs. Obviously no single care arrangement is ideal for everyone, so some important factors to consider:
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Your medical condition and how that will translate into day-to-day care needs
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How independently you can accomplish your Activities of Daily Living
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The frequency that you need assistance throughout the day and night
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Your future care needs in one, two, five, eight years, or even more
Step 2: Understand the Options
"Which care options meet my needs?"
Research the available options and compare them with your needs. Depending on your level of care or the frequency that you need assistance, some arrangements might not be appropriate.
It takes time to learn about the care options, and there is little substitute for first-hand impressions. If you intend to hire a caregiver, interview him or her thoroughly. If you intend to move into a facility, that means taking a tour. Ask lots of questions about caregiver ratio, rates and increases, staffing qualifications, and anything else that would affect your ability to receive adequate care over the long term.
Step 3: Budget for Your Care
"How much do I need to prepare?"
After you find suitable care options that can accommodate your needs, then you must estimate your monthly out-of-pocket cost and determine how long you can afford the different options (click here to see approximate starting rates).
Paying a person to care for another person is expensive. It is extremely important to maintain your ability to afford it for as long as possible. If you deplete your assets too quickly, you will have fewer options available (and possibly at a time when you need even more care). Speak to a trusted advisor who can help you to plan for managing your finances. Make sure to also factor in the likelihood that the cost of care will increase over time.
Step 4: Evaluate the "Fit"
"What is really important to me?"
This step is difficult because you have to balance your 'needs' and your 'wants.' You must only consider care arrangements that can actually meet your needs. But what do you value most? Some comparisons:
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Price vs. Location vs. Setting & Services Provided
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Setting & Services Provided vs. Your Budget vs. Your Personality
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Price vs. Staff Ratio vs. Staff Qualifications
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Your Needs & Wants vs. Taking What's Available Now vs. Waiting for Your 1st Choice
Step 5: Take Action
"How long do I need to wait for an opening?"
Just about all homes/facilities have a wait list, so timing is everything. Create a shortlist of homes/facilities that meet your needs and enough of your wants, then get onto all of their wait lists as soon as possible (hopefully before you need the care). The fewer the homes/facilities on your list, the longer you may have to wait. Whichever home/facility contacts you first should be the one you move into, even if it was not your first choice.
While you wait, prepare your Advance Directive, a POLST, a 2-Step Tuberculosis exam, and other critical documents.
Below are the most common types of elderly care services in Hawaii (click on the titles for specifics). There are pros and cons to each service and the goal is to fit your current (and future) care needs with the most appropriate care service. For additional information, contact us!
In-home services. Also known as "Aging in Place"
ADULT RESIDENTIAL CARE HOMES (ARCH)
24/7 Assistance in residential setting. Also known as "Care Homes"
24/7 nursing services for the short term. Also known as "Rehab" or "Nursing Homes"
Daytime recreation, meals, and respite. Also known as "Going to School (or work)"
Care home services plus nursing-level assistance. Also known as "Expanded Care"
Chronic nursing services in a residential environment. Also known as "Foster Homes"
INDEPENDENT & ASSISTED LIVING FACILITIES
Light to Moderate Assistance. Also known as "Retirement Homes"
INTERMEDIATE NURSING CARE FACILITIES (ICF)
Intermittent nursing services for chronic care. Also known as "Long-Term Care"
End of life care services. Also known as "Comfort Care"
Type | Availability Lead Time | Capacity | Caregiver Ratio | Starting Rates | Additional Fees | Medicare Coverage | Medicaid Coverage | State Oversight | Oahu Beds |
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1. Home Care | Hours to days | 1 | 1:1 | $22-$35/hour (generally minimum 4 hours/day | Additional services, couples care | Up to 100 days (Home Health) | No | Office of Health Care Assurance (OHCA) | NA |
2. Adult Day Care | Days to weeks | 5 to 120 | 1:5 to 1:15 | $75 to $95/day | Additional services (showers, extra meals, etc) | No | No | Office of Health Care Assurance (OHCA) | 897 spots |
3. Independent and Assisted Living | Days to weeks | 80 to 120 | 1:16 to 1:24 | $1,500 to $8,000/month | Private caregivers, Entry Fees, Fee-Simple Buy In | No | No | Independent Living: None; Assisted Living: OHCA | 2091 (Assisted Living) |
4. Adult Residential Care Homes | Days to months | 1 to 5 (ARCH I); 8 or more (ARCH II) | 1:3 to 1:5 (ARCH I); 1:4 to 1:12 (ARCH II) | $3,000 to $11,000/month | Expanded Care Case Management services, personal supplies | No | Yes (some facilities) | Office of Health Care Assurance (OHCA) | 2351 |
5. Intermediate Care Facilities (ICF) | Days to months | 60 or more patients | 1:10 to 1:16 | $8,500 to $15,000/month | Personal sitters | No | Yes (with exceptions) | Office of Health Care Assurance (OHCA) | 3291 (split with Skilled Nursing) |
6. Skilled Nursing Facilities (SNF) | Hours to days | 60 or more patients | 1:10 to 1:16 | Medicare-Covered | Personal sitters | Up to 100 days | No | Office of Health Care Assurance (OHCA) | 3291 (split with Intermediate Nursing) |
7. Foster Care | Days to weeks | 1 or 3 residents | 1:3 | Medicaid-covered ($3,500 to $6,500/month private pay) | Case Management services | No | Yes | Office of Health Care Assurance (OHCA) | 2642 |
8. Hospice Care | Hours to days | 1 | 1:1 | Medicare-Covered | Generally none | Part A | Yes | Office of Health Care Assurance (OHCA) | N/A |
