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Hawaii Residential Alzheimer’s Care (Memory Care): Rules, Costs & Financial Help

Last Updated: October 26, 2020

 

An assisted living residence in Hawaii offers apartment-style living for people who cannot live independently, including those with dementia. Regulations require these communities have the following:

– Staff on duty 24 hours per day
– Assistance with activities of daily living (ADLs) like eating and bathing
– Three meals daily, including modified meals (approved by a dietician) for people with special dietary needs
– Laundry services
– Activities that encourage socialization
– Housekeeping
– Nurses who monitor health and perform routine nursing tasks
– Transportation to medical and social appointments
– Recreational opportunities
– Social work services
– Maintenance of personal funds for residents

Unlike in other states, there are not additional requirements for services or staffing at homes —often called “memory care,” “dementia care,” or “Alzheimer’s units”—that admit people with Alzheimer’s disease or a related dementia like vascular, frontotemporal, or Lewy body dementia.

There are approximately 30 residences with memory care. Hawaii also has 11 board and care homes, which are smaller house-like residences that offer the same types of services as assisted living, including dementia care in some cases. For free help finding a home in Hawaii to meet your loved one’s needs and budget, click here.

The Hawaii Department of Health’s Office of Health Care Assurance regulates assisted living and memory care in the state.

 Did You Know? Hawaii is, on average, one of the oldest states in America, with more than 17% of its residents over the age of 65. The number of people with Alzheimer’s disease is expected to increase there to about 35,000 by 2025.

 

The average cost of assisted living with memory care in Hawaii is $5,230 per month, which is about $62,760 annually. This is roughly $1,000 more than the average cost of assisted living, because of the additional training for staff and care required when providing a home for people with dementia. Hawaii memory care is slightly more expensive than the average for mainland states.

To know exactly where your money’s going, a breakdown in costs should be provided; if you are considering moving into any assisted living home in Hawaii, ask for an itemized list of costs including base rates and any additional fees, including for optional services. Many states require this list be provided to anyone considering moving into an assisted living home, but Hawaii does not.

Urban Honolulu is also its most expensive place for memory care. The average cost of memory care there is $5,380 per month and $64,560 annually. Homes are less expensive across the other six islands. On Maui, in Kahului, the monthly average for memory care is slightly less expensive, at about $5,120 per month and $61,440 annually. Costs vary widely across the state, from The Big Island to Kauai, running as little as about $3,000 to more than $10,000 per month.

 

Hawaii Assisted Living Laws & Regulations

Admissions Process & Requirements

A full assessment of residents’ needs is required before they may move into assisted living homes in Hawaii. The assessment is to be conducted by a medical professional who works for the residence. The cost of this assessment may be included in the base rate or may be an up-front extra payment often called a “community” fee or “move-in” fee that covers the assessment, the creation of a personal care plan, and any other initial details like preparing your loved one’s apartment. These fees are usually equal to between one-half and two months’ rent.
There is no standard form for the assessment, but it must be periodically updated and include the following:

– Ability to be involved in residence functions
– Support necessary to preserve dignity, privacy, choice, individuality and independence
– Family members who may help with delivering services

You do not need to have a diagnosis of Alzheimer’s disease, or related dementia, to move into memory care in the Islands. Dementias are difficult to accurately diagnose, as different diseases can seem similar depending on the stage of illness, and finding the right home is more about linking symptoms to care. The assessment will reveal which activities of daily living (ADLs), like eating and bathing, your loved one needs the most help with, and it is more important to find a residence that can help your loved one with symptoms than with a specific disease.

It is possible to move into Hawaiian memory care on short notice. This will depend on the specific residence. Unlike other states, there is no regulation requiring the assessment to take place within a certain time frame of moving in, meaning you could move into a memory care community without getting assessed first. This is not a good idea, however, and you should begin the process of finding a memory care community as soon as possible. Get an assessment before agreeing to move in so you’re certain the home is a good fit. If your loved one moves into a residence, and then finds that specific needs cannot be met there, then an eviction is required and the difficult process of finding a home will begin again. (For more on eviction, see below.)

 

Facility / Residence

Every bedroom must be at least 220 square feet and include a bathroom with a sink, shower, and toilet, and a kitchen with a refrigerator, sink, and cooking space. There are no rules about how many residents may live in a single room.

Unlike other states, there are also no rules distinguishing Hawaiian memory care residence designs from regular assisted living. People with dementia benefit from certain special architectural features in their home communities, like outdoor spaces that are secure to prevent wandering and circular hallways that don’t come to a dead end. Before entering into a contract with a memory care residence, inspect the facilities with an eye on whether your loved one can be comfortable in the spaces. Freedom of movement without concern for confusion or safety are most important.

 Covid 19-Related Visitor Rules
The state of Hawaii has advised assisted living homes to severely restrict visitors during the pandemic, except in end-of-life situations. Check with your loved one’s specific residence, but the general rule in Hawaii has been to limit residents to only one visitor per day, outside or in a designated area.

 

Staff & Training

There are no required staff-to-resident ratios in Hawaiian assisted living homes. All staff must be trained in CPR, and a nurse must be available seven days per week. Nurses must also make resident assessments and train staff. Administrators must be licensed by the state after acquiring adequate educational and work experience. All staff must have an orientation upon hiring that covers philosophy, organization, practice, and general goals in assisted living. Six hours of in-service training is also required annually.

 Covid 19-Related Rules for Staff
During the pandemic, Hawaii’s Department of Health has said all staff should be screened for symptoms at the beginning of every shift, specifically fever, shortness of breath, and cough. Employees are discouraged from working in multiple assisted living homes.

 

Evictions

Residents must receive at least 14 days notice before being discharged or evicted from Hawaiian memory care. These are the reasons a person can be asked to leave:

– Behavior poses a threat to self or others
– There is a documented pattern of breaking residence rules
Someone may also be evicted if their care needs cannot be met at the residence. Because Alzheimer’s disease and related dementias are progressive, meaning they get worse over the course of stages, your loved one’s new home should anticipate changes to the type of care needed, making an eviction for this reason unlikely.

If you have received a notice of eviction in assisted living and need to know what to do next, click here.

 

Financial Assistance for Residential Alzheimer’s Memory Care

Med QUEST Integration Program

Hawaii’s Medicaid Program Med QUEST covers services including the costs of care in assisted living residences. Eligibility requirements in 2020 include monthly income under $1,224, but Hawaii has multiple pathways to receiving benefits and if someone doesn’t meet certain requirements they may still be able to work with the state to sign up. Special medical equipment, transportation, and assisted living expenses (that are not room and board) are among the services covered under this plan. There is no waiting list or cap on enrollment. For more information, click here. To apply, visit the state’s MyBenefits webpage here. Alternatively, read Med QUEST eligibility criteria here or take a Medicaid eligibility test.

 

Veterans Affairs (VA)

Veterans are statistically more likely to develop dementia. Relevant in all states including Hawaii is the VA’s Aid & Attendance pension program for veterans and surviving spouses, which is money added to veterans’ and survivors’ basic pensions. Applicants must be at least 65 years old (or disabled) and require assistance with activities of daily living (ADLs) like eating, bathing, and mobility. The cash assistance from these pensions can be used as the recipient wishes, meaning it can go toward the cost of memory care. In addition, the cost of residential care can be deducted from income, effectively reducing the amount of calculable income used to determine the benefit amount. The latest (2020) maximum amount a veteran can receive through A&A is $27,194 per year, and surviving spouses can receive $14,761. Learn more here.

There is also a State Veterans Home in Hilo (Yukio Okutsu), on the Big Island, that provides long-term residential care for veterans. In addition to nursing home care, assisted living and memory care may be provided. Payment is made directly from the VA to the facility. State veterans’ homes are typically reserved for veterans whose need for care stems at least 70 percent from their service. Because there is often a waiting list, contact the home before visiting to see if your loved one is eligible to live there.

 Hilo Veterans Home & Covid-19
The Yukio Okutsu State Veterans Home was hit hard during the pandemic, with many residents and staff there contracting the virus. Administration has been turned over to the state, and new admissions may be suspended. For the latest, contact the state’s Office of Veterans’ Services.

 

Other Options

Other ways to help pay for memory care include tax credits and deductions like the Credit for the Elderly and the Disabled, or the Child and Dependent Care Credit (if you claim your elderly loved one as a dependent). Remember also that medical and dental expenses can be deducted, and that might include some assisted living costs.

A reverse mortgage may be a good option for a married person moving into memory care, if their spouse continues to live in the home. Should the spouse move, the reverse mortgage would become due.

Elder care loans are for families to cover costs of moving into memory care, if you need a little help at first but can afford costs after the initial payments. For example, if one is waiting for a VA pension to be approved or waiting to sell a home.