Honolulu Senior AdvisorCan someone who qualifies for a nursing home live in a care home in Hawaii?
Yes: Hawaii's expanded ARCHs and community care foster family homes are licensed or certified to care for people at nursing facility level of care in a home setting, with a registered nurse case manager overseeing each resident's care plan.
Oahu has 285 expanded ARCHs and 1,111 foster family homes, together far more nursing-level placements by count than its 27 certified nursing homes, though each home holds only a few residents. That is a deliberate state policy: Hawaii has long favored community settings over institutional beds.
When is a nursing home the better choice?
A nursing home is usually the better choice when someone needs skilled nursing several times a day, short-term rehab therapy after a hospital stay, two-person transfers around the clock, complex wound care, or secure care for dementia with persistent wandering.
Nursing homes have licensed nurses on every shift and therapy staff on site; a care home relies on one primary care giver and visiting professionals. For short-term rehab, a skilled nursing stay covered by Medicare after a hospital admission is often the first step, with a care home afterwards.
How do the costs compare?
Hawaii's 2025 nursing home medians are $185,679 a year for a semi-private room and $196,735 for a private room (about $15,473 and $16,395 a month); care homes publish no median, but their rates are generally well below a nursing home's for long-term care.
For Med-QUEST members, both are covered at nursing facility level of care, but in a care home the resident pays room and board from income while Medicaid pays the care.
How do we compare quality?
Compare nursing homes with CMS Care Compare star ratings, inspection results and staffing data, and compare care homes by reading their OHCA inspection reports, meeting the primary care giver and talking with the RN case manager.
Our nursing home directory shows CMS ratings; our care home roster links each home's latest OHCA report.
At a glance
| An expanded care home | A nursing home | |
|---|---|---|
| Setting | A family house with a few residents | A facility with dozens or hundreds of beds |
| Nursing | RN case manager visits; care giver delivers daily care | Licensed nurses on every shift |
| Rehab | Outpatient or visiting therapy | On-site therapy, Medicare-covered short stays |
| Ratings | OHCA inspection reports | CMS star ratings and inspection data |
Sources include Hawaii Administrative Rules chapters 11-100.1, 11-90 and 11-800, HRS 321-481 and 321-1.8, Office of Health Care Assurance rosters and pages, the 2026 HHS poverty guidelines, CMS, CareScout and VA rate tables as cited above; see our editorial standards.
