Honolulu Senior AdvisorHow is a foster family home different from a care home?
A community care foster family home cares for two adults (three with approval) who are at nursing facility level of care and works through a licensed case management agency, with at least one resident on Medicaid; an adult residential care home is licensed for five or fewer (Type I) or six or more (Type II) residents and can serve people needing less care.
On Oahu there are 1,111 certified foster family homes and 455 licensed care homes, so foster family homes outnumber care homes by more than two to one; Waipahu alone has 524 of them.
Which one is easier to get into?
For a Med-QUEST member at nursing facility level of care, a foster family home is often the easiest community placement, because most homes keep at least one bed for Medicaid residents; for private-pay families, a care home is usually easier, because foster family homes can take private-pay residents only in limited cases.
Foster family home placements are arranged through a case management agency or a QUEST Integration service coordinator, not by calling around. Care homes can be contacted directly.
Which gives more individual attention?
A foster family home has the smallest ratio of residents to caregiver in Hawaii's system, two or three people, so it often gives the most individual attention; a Type I care home has up to five, and a Type II home more.
That small size also means less company. Some residents thrive with a quiet household; others do better with more people around.
How are they overseen?
Care homes are licensed and inspected by OHCA under HAR 11-100.1, and foster family homes are certified under HAR 11-800 through Community Ties of America, OHCA's designee, with a case manager visiting each resident; inspection reports for both are posted on OHCA's website.
Which costs less?
For Med-QUEST members, both a foster family home and an expanded care home are paid through long-term care, with the resident contributing income toward room and board; for private-pay families, care homes are the more common option, each with its own rate.
Ask each option for the resident's monthly contribution in writing.
At a glance
| A foster family home | A care home (ARCH) | |
|---|---|---|
| Residents | Two, or three with approval | Up to five (Type I) or six or more (Type II) |
| Level of care | Nursing facility level | From light help to nursing level (if expanded) |
| Payment | Built around Med-QUEST | Mostly private pay, Med-QUEST in E-ARCHs |
| How to find one | Through a case management agency | Directly, from the OHCA roster |
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.
