Located in the Pacific Ocean, approximately 2,000 miles from the coast of California, Hawaii is the only state outside of North America. Consisting of 137 islands spanning 1,500 miles, Hawaii is home to about 1.4 million people, and 18.4% are aged 65 or older. The elderly population in the state is growing at a rate of 3.6% per year, and predictions show that by 2045, one in four seniors in The Aloha State will be aged 85 or older.

The cost of living in Hawaii is relatively high compared to costs in many mainland states, so seniors in Hawaii can expect to pay care costs that are above the national average. For instance, in Hawaii, the average monthly cost of assisted living care is $4,375, which is $324 higher than the U.S. average. Seniors who need help covering senior living costs can find in-depth information on local, state and federal programs in this guide.

The Cost of Senior Living in Hawaii

Note: There currently isn’t authoritative data on the average cost of Independent Living Facilities nationwide, so instead, we use the cost of Assisted Living to estimate it. Since the cost of Independent Living is typically 30-40% lower than the cost of Assisted Living, the numbers below were calculated by subtracting 35% from the cost of Assisted Living.

Note: Memory care is typically provided in communities licensed as assisted living facilities, and in general, costs 20-30% more than standard assisted living services. No authoritative cost data is available for this type of care, so we estimated memory care rates by adding 25% to assisted living fees in the Genworth 2021 Cost of Care Survey.

According to Genworth’s 2021 Cost of Care Survey, long-term care typically costs more in Hawaii as compared with national figures. Depending on financial considerations, health needs and preferences, there are several care options in Hawaii for seniors to choose from.

Older adults who need help with day-to-day activities can obtain support in assisted living communities, while memory care provides specialized services for those with dementia. Active elders may appreciate the social aspect of independent living. Seniors who need skilled nursing care and around-the-clock monitoring may be best suited to a nursing home.

Because independent living is for individuals who don’t have any care needs, it is the cheapest long-term care option in Hawaii. Average rates are $3,494 per month. Seniors who need the support provided by assisted living facilities can expect to pay around $5,375 each month. Although usually provided in assisted living communities, memory care has higher costs due to stricter regulations and staff training requirements. On average, memory care costs $6,719 a month in Hawaii. Nursing home care is the costliest care option, with average monthly fees of $12,501.  

The Cost of Assisted Living in Hawaii

With a monthly median of $5,375, the cost of assisted living in Hawaii is higher than the nationwide average of $4,500. However, average rates are lower than in the other non-mainland state of Alaska, where seniors typically pay around $6,830 per month. Compared with mainland states along the Pacific coast, California is a little more affordable, at $5,250 per month. Prices decreased further in Oregon to $5,045. Assisted living costs more in Washington, with a median monthly price of $6,000.  

The Cost of In-Home Care in Hawaii

Costing an average of $12,501 per month, Hawaii’s nursing homes charge almost $4,600 each month more than the national average of $7,908. Seniors along the west coast also pay more than the national median, albeit costs are generally lower than in Hawaii. Monthly nursing home care costs around $10,342 in Oregon, $9,794 in California and $9,429 in Washington. There’s a substantial price increase in Alaska, where average monthly rates are $31,512.      

The Cost of Nursing Home Care in Hawaii

Seniors in need of nursing home care in Hawaii will pay a premium to receive this type of care in The Aloha State. At $11,650, the average monthly cost for nursing home care in Hawaii far surpasses the U.S. average of $7,513 by $4,137 per month.

Can You Use Medicaid to Pay for Senior Living in Hawaii?

Hawaii Medicaid, called Med-QUEST, combines medical care and long-term services and supports under the QUEST Integration demonstration waiver. Services are administered using a managed care model.

For eligible seniors, Med-QUEST covers nursing home care, assisted living and memory care.

Similar to most other states, Hawaii Medicaid doesn’t provide funding for independent living, as this option is for seniors who don’t need personal or medical care services.  

	Medicaid Coverage Level	Type of Medicaid Coverage	Entitlement?*
Assisted Living	Partial	Medicaid Waiver	Yes
Independent Living	None	N/A	N/A
Memory Care	Partial	Medicaid Waiver	Yes
Nursing Home Care	Full	Medicaid Waiver	Yes

*Note: Entitlement programs mean that everyone who qualifies will receive coverage and be accepted into the programs. If the program is not “entitlement,” then participant caps could be in place, and there may be a waiting list. 

Medicaid’s Coverage of Assisted Living & Memory Care in Hawaii

Under the Quest Integration waiver, Hawaii’s Med-QUEST program provides assisted living and memory care for eligible seniors via its Long Term Services Supports program. Unlike seniors in many other states who must apply for home- and community-based services under a Section 1915(c) waiver, qualifying elders in Hawaii don’t need to go on a waiting list for services.

Provided by managed care organizations (MCOs), services may include:

• Help with personal care and daily living activities
• Housekeeping and laundry
• Meal preparation
• Case management
• Emergency response systems
• Medical equipment and supplies
• Transportation

Hawaii Medicaid does not pay for room or meal costs for residents of assisted living or memory care communities.

Eligibility depends on seniors meeting functional needs criteria, as determined by a doctor’s assessment. There are also income and asset limits, and seniors must be aged 65 or above, blind or disabled.  

Applications can be made online through the Med-QUEST portal or by calling (800) 316-8005. Alternatively, individuals can download an application form and return it by fax or mail to their local Eligibility Branch Office.    

Medicaid’s Coverage of Nursing Home Care in Hawaii

In Hawaii, three in five nursing home residents use Medicaid to pay for their care. For eligible individuals, Medicaid funding covers a range of health care services, such as skilled nursing, medication management, medical equipment and supplies, physical, speech and occupational therapy, 24-hour nursing oversight and assistive devices. It also covers the costs of room and board, personal care services, homemaker chores, laundry and transportation.

While there’s no set income limit to qualify for Med-QUEST, beneficiaries must use all of their income to pay for care. The only exceptions are a monthly personal allowance of $50, Medicare premiums and, if applicable, a spousal allowance. Eligibility also depends on a physician’s assessment to determine if a senior satisfies nursing home level of care needs.  

Eligibility for Medicaid in Hawaii

While there’s no hard income limit for seniors applying for Medicaid to cover nursing home care, those who require assistance via home- and community-based services are subject to financial requirements.

2022 Hawaii Medicaid Income Limits 

	Income Limits*	Asset Limits
Single Person	Nursing home: No set limitHCBS: $15,636 **	$2,000
Two-Person Household(Only one applicant)	Nursing home: No set limitHCBS: $15,636 for applicant **	$2,000 for applicant$137,400 for non-applicant
Two-Person Household(Two applicants)	Nursing Home: No set limitHCBS: $31,272 **	$4,000

*per year

** Note: Different income limits apply for those who receive SSI and wish to receive HCBS services in an adult foster care home or community foster family home

Further eligibility requirements also apply for seniors applying for Med-QUEST:

• Applicants must be U.S. citizens or have qualifying non-citizenship status
• Applicants must be permanent residents of Hawaii
• Applicants must meet clinical needs criteria as determined by a physician

Applying for Medicaid in Hawaii

Seniors have several convenient options for applying for Medicaid in Hawaii. Online applications can be made through the Med-QUEST portal. Those who prefer to complete a paper form can download the relevant application documents and return them by mail or fax to their nearest Med-QUEST Eligibility Branch Office. Alternatively, seniors can call Med-QUEST Customer Service at (800) 316-8005 to apply over the telephone.   

Before You Apply

Applicants must supply in-depth information and verification documents when applying for Medicaid. Individuals should ensure they have the following information handy:

• Social Security number
• Proof of identification, citizenship and residence in Hawaii
• Details of all assets and income
• Up-to-date bank statements
• Insurance policies
• Medical bills

How To Get Help

Although applying for Medicaid can feel intimidating, Hawaii seniors can obtain advice and assistance from various organizations. Advisors can help with understanding eligibility, completing applications, understanding benefits and filing appeals.

Resource	Contact	What You Should Know
Med-QUEST Eligibility Branch Offices	Location Dependent	Individuals can obtain advice by calling or visiting their local Eligibility Branch Office. Advisors can help people enroll in Medicaid, find contact details for health plan providers, check the status of pending applications and check eligibility. Seniors can also report any change in circumstances and order replacement Medicaid cards.
Medicaid Ombudsman	(888) 488-7988	Hawaii’s Medicaid Ombudsman can help consumers resolve issues surrounding access to health care benefits, denied claims, quality of service and limitations of coverage and service provision.
American Council on Aging	Online Form	The American Council on Aging provides comprehensive information about Medicaid, including requirements for each state. Individuals can contact the organization via the online form to obtain a free eligibility check and be connected with low-cost Medicaid planners in their local area.

Can You Use Medicare to Pay for Senior Living in Hawaii?

Unfortunately, Medicare does not cover the cost of assisted living, independent living, or memory care. Unlike nursing homes, these care types are not considered to be “clinical settings” and so are not eligible for Medicare coverage. That being said, those who live in these communities can still use Medicare to cover the cost of approved medications, doctor visits, medical equipment, etc.

When it comes to nursing home care, it gets much more complicated. Medicare does provide limited coverage for a qualified stay in a nursing home,but there are strict rules and requirements of which you should be aware. This benefit is available to seniors who have been hospitalized for at least three days, excluding the date of discharge.

Once you’ve met the hospitalization requirement, Medicare will pay for up to 100 days in a skilled nursing facility (per benefit period). While the first 20 days are covered in full, there is a daily coinsurance rate that must be paid starting on day 21. After day 100, seniors are responsible for the entire cost.

	Medicare Coverage	Medicare Coverage Duration	Coinsurance Requirement?
Assisted Living	None	N/A	N/A
Independent Living	None	N/A	N/A
Memory Care	None	N/A	N/A
Nursing Home Care	Limited	100 Days Per Benefit Period	Yes – After 20 Days

What Nursing Home Care Services Does Medicare Cover?

Medicare covers a number of specific services, including:

• Meals
• A semiprivate room
• Medications
• Skilled nursing services
• Physical therapy
• Occupational therapy
• Speech therapy
• Audiologist care
• Medical supplies
• Medical social services
• Nutritional counseling
• Ambulance transportation

What Nursing Home Care Services Aren’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.

Medicare Support & Resources in Hawaii

Several organizations empower Hawaii’s seniors to make educated choices regarding their health insurance options. Advisors can help older adults understand coverage, compare plans, find ways to save money and enroll in health insurance coverage.

Resource	Contact	What You Should Know
Hawaii State Health Insurance Assistance Program	(888) 875-9229	Using a network of statewide volunteers, Hawaii State Health Insurance Assistance Program (SHIP) provides free individualized counseling to help seniors understand their Medicare options. Counselors explain different programs, such as Medicare Advantage, Medigap and prescription drug coverage, as well as details about funding assistance to pay for Medicare costs. Active seniors may also wish to train as a volunteer SHIP advisor.
Social Security Administration	(800) 772-1213	Seniors can visit their local Hawaii Social Security office to check eligibility and enroll in Medicare. For common inquiries, individuals may talk to an experienced advisor via the toll-free helpline.
Senior Medicare Patrol	(800) 296-9422	The Senior Medicare Patrol aims to reduce fraud and abuse within the Medicare system by educating older adults about common scams that target vulnerable members of society. Seniors can also learn how to spot potential mistakes in their medical bills and report any suspected fraud or errors.

Are There Other Financial Assistance Options for Senior Living in Hawaii?

Depending on your unique situation, there may be other financial assistance options to partially or fully cover the cost of senior living in Hawaii. Below, we cover some of the common ways that seniors can make senior living options such as assisted living or memory care more affordable.

	How to Get Started	What You Should Know
Aid and Attendance	Apply online at va.gov.	If you are a veteran and you receive a VA pension, you may also be eligible for the Aid and Attendance benefit. This benefit takes the form of a monthly cash allowance that you receive in addition to your standard pension. This benefit is used by veterans who need long-term care services, including care received at an assisted living facility.
Reverse Mortgages	Research and learn about the different types at ftc.gov.	If you own a home, you may be able to use a reverse mortgage to access some of the equity in your home. Like traditional loans, reverse mortgages do need to be repaid with interest, typically within 12 months, so seniors should carefully weigh this option alongside other financing methods.
Long-Term Care (LTC) Insurance	Learn about how to receive LTC insurance benefits at acl.gov.	While those who currently need assisted living will typically not be eligible, if you purchased an LTC insurance policy in the past, you may be able to use it to help pay for assisted living. While most policies cover at least a portion of the cost, you still need to check the specific terms of your policy.

Free Senior Living Resources for Seniors in Hawaii

Hawaii has diverse programs and benefits to help the older population enjoy a good quality of life. Services include meal programs, practical advice on aging-related matters, social activities and wellness classes. Provided by nonprofit and government agencies, services are free or low cost, regardless of an individual’s financial circumstances.

Resource	Contact	What You Should Know
Area Agencies on Aging	Location Dependent	Hawaii has four Area Agencies on Aging (AAA) that offer diverse services for older adults, including benefits and health insurance advice, nutrition and transportation programs, legal assistance, caregiver support, respite care and enrichment activities. There’s an agency in each of the state’s counties.
Kupuna Legal Aid Services	Oahu: (808) 536-0011 Other Islands: (888-536-0011)	Part of the Legal Aid Society of Hawaii, Kapuna Legal Aid Services provides free, confidential advice to seniors aged 60 and above. Legal professionals can advise on matters such as powers of attorney, wills and advance health care directives, as well as support older adults who have been victims of crime.
Hawaii Aging and Disability Resource Center	(808) 643-2372	Hawaii Aging and Disability Resource Center (ADRC) is a valuable first point of contact for seniors and disabled people searching for information and assistance. Advisors signpost and refer to relevant organizations and can help with benefit and health insurance claims.
Hawaii Healthy Aging Partnership	(808) 643-2372	Operated jointly by Hawaii’s Executive Office on Aging and the Community Health Division of the Hawaii Department of Health, the Hawaii Healthy Aging Partnership encourages seniors to follow healthy lifestyles. Evidence-based programs include fitness classes and workshops on topics such as fall prevention, managing chronic conditions, pain management, living with cancer and coping with feelings of isolation.
Long-Term Care Ombudsman Program	(888) 229-2231	Hawaii’s Long-Term Care Ombudsman Program safeguards the rights, well-being and health of older adults who live in residential long-term care communities, including nursing homes and assisted living residences. Ombudsmen work with residents and their loved ones to investigate and resolve complaints and provide advice on topics such as long-term care options, how to pay for long-term care and how to choose a nursing home.
Alzheimer’s Association Aloha Chapter	(800) 272-3900	The national Alzheimer’s Association provides education, information and support for people with dementia and their loved ones. The nonprofit organization operates a 24/7 hotline for anyone affected by Alzheimer’s. The local Aloha Chapter advocates for policy changes, facilitates events to raise awareness and hosts fundraisers, support groups and social engagement activities.

Covid-19 Rules and Restrictions for Hawaii Senior Living Facilities

The following information is based on research done on several government websites, including health.hawaii.gov/coronavirusdisease2019 and cdc.gov/coronavirus. These rules apply to nursing homes 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.

Visiting Loved Ones

Can I visit my relative in person if he/she wants emotional support from me?	Yes (Conditions Apply)
Can I visit my relative in person for end-of-life compassion care?	Yes
Will my loved one be required to self-quarantine after I visit him or her?	No
Do I need to wear PPE and/or a cloth mask if I do visit my relative in person?	Yes
Are hairdressers and other non-medical contractors still allowed in senior living facilities?	No
Does the state recommend or require that senior living facilities assist families with setting up virtual visit alternatives?	Not Available*
Are visitors being screened for elevated temperatures?	Yes
Are visitors being asked questions about health, travel, and potential virus contact?	Yes

Outings and Group Activities

Are residents allowed to leave the facility for non-medical reasons?	Yes
Are residents of senior living facilities who leave and return required to self-quarantine?	No (Conditions Apply)
Are senior living facilities required to cancel all group outings?	No
Are residents still eating together in the dining hall?	Yes (Conditions Apply)
Are facilities still allowed to host group activities within the community?	Yes (Conditions Apply)

Safety Measures for Staff & Contractors 

Are staff members and contractors being screened for elevated temperatures?	Yes
Are staff members and contractors being tested for Coronavirus?	Yes
Are staff members and contractors being asked questions about health, travel, and potential virus contact?	Yes

Safety Measures for Residents 

Are staff members required to regularly screen residents for coronavirus symptoms?	Yes
Are residents relied on to screen themselves and self-report potential coronavirus symptoms?	No
Are staff members required to take residents’ temperatures?	Yes
Are residents being tested for coronavirus?	Yes (Conditions Apply)

Senior Living Laws and Regulations in Hawaii

Note: All these rules typically apply to non-clinical senior living facilities, such as independent living, assisted living, and memory care facilities. Nursing homes and other senior living facilities with a clinical setting may have additional or slightly different requirements and regulations.

Senior living facilities in Hawaii are regulated by state law in order to ensure all senior living residents are treated with care, respect and the appropriate level of support. The Department of Health, State Licensing Section overseas licensing and inspection of ALFs, and all facilities must comply with state regulations regarding service delivery, staffing and accommodations. These are some of the rules that apply to all licensed ALFs in Hawaii.

Admissions Requirements

In Hawaii, there are no clear limitations on resident admissions to senior living facilities. Individual ALFs have the discretion to admit or decline any resident who has medical needs or behaviors that might not be safely managed at the facility.

Residents who exhibit behaviors that pose a threat to themselves, other residents or ALF staff may be discharged upon receiving written notice from the ALF administrator.

Scope of Care

Senior living facilities are geared toward seniors and people with disabilities who are unable to live independently but who don’t need around-the-clock skilled nursing care.

Every licensed ALF in Hawaii must provide, or arrange for:

• 24-hour on-site direct care staff
• Three meals daily plus snacks, including dietary modifications to accommodate medical needs and personal preferences as determined by a licensed dietitian
• Laundry services for residents who can’t do their own laundry
• Assistance with activities of daily living such as grooming, toileting, bathing, eating and dressing
• Routine health monitoring by a licensed registered nurse or delegated unlicensed staff
• Opportunities for individual and group socialization, including age-appropriate recreational programming
• Transpiration to local medical appointments
• Barber or beauty care services
• Ancillary medical services such as dental care, occupational and physical therapy, and podiatry
• Social work services
• A personal fund account for each resident
• Behavioral support and intervention
• A private apartment unit measuring at least 220 square feet plus a bathroom with a sink, shower and toilet
• Resident apartments must have a refrigerator and at least one appliance to cook food

Medication Management

Every licensed ALF in Hawaii must have written policies regarding self-management and medication administration. Facilities can help residents take prescription medications under the direct or indirect supervision of a registered nurse. Any medications administered by facility staff or self-administered by residents must be reviewed by a registered nurse or physician every 90 days or less.

Staffing

Although there are no state regulations regarding staffing ratios in Hawaii’s senior living facilities, ALFs are required to employ direct care staff who have complied with current tuberculosis clearance standards. Staff must also be trained in basic first aid and CPR and complete at least six hours of in-service training each year. A registered nurse must be available to train and supervise staff and conduct resident assessments.

Facility administrators are required to have a minimum of two years of experience as a manager of a health care, personal care or housing organization. Administrators also need to complete the ALF administrator’s course or equivalent training.

Frequently Asked Questions

How much does assisted living cost in Hawaii?

The statewide median cost of assisted living in Hawaii is $4,375. Actual costs may be higher or lower than the state median, depending on the location, services and amenities offered.

Are there financial assistance programs for assisted living in Hawaii?

Yes. Seniors in Hawaii who meet the financial criteria for Medicaid enrollment and who need assisted living services may be eligible for Med-QUEST, Hawaii’s Medicaid managed care program. Vets, dependents and survivors may also qualify for one of two VA pension top-up programs, Aid and Attendance, and Housebound.

What are “Activities of Daily Living”?

Activities of Daily Living are fundamental daily self-care tasks. These tasks generally include eating, bathing, getting dressed, grooming, taking prescription medications, keeping up with basic housekeeping and moving around. As people age, they may experience physical and cognitive deterioration that makes performing ADLs independently difficult.

What types of amenities are commonly in Assisted Living Communities?

In addition to providing seniors with room and board, 24-hour on-site staff and nonmedical support, assisted living communities often offer a variety of amenities. Communal dining rooms, living rooms and access to outdoor space such as a patio, gardens or terrace is common, and many facilities also have exercise rooms, guest suites and private dining rooms that can be reserved for family celebrations. Some large assisted living communities also feature swimming pools, off-leash dog areas, resident gardens, games rooms and movie theaters.

What is the difference between assisted living and independent living?

Independent living is a type of senior care geared toward those who don’t require help with activities of daily living, and who want to live a carefree lifestyle. Independent living communities usually provide housekeeping, laundry and recreational amenities, and some communities offer meal programs.

By comparison, assisted living is suitable for seniors who need daily assistance with tasks such as getting dressed, grooming and transferring, but who don’t need the level of medical care offered in a nursing home. While independent living is the least restrictive type of senior care, assisted living is generally seen as the level of care between independent living and nursing home care.

Learn More About Senior Living in Hawaii

For more information about specific types of senior living in Hawaii read our Guide to Assisted Living and Independent Living.

The Top Cities for Senior Living in Hawaii

Learn more about the cost of senior living in the top Hawaii cities. Additionally, find reviews and information about assisted living facilities and other senior living communities across the state.