How Hawaii licenses adult residential care homes

What is an adult residential care home (ARCH) in Hawaii?

An adult residential care home is a home licensed by the Hawaii Department of Health to give 24-hour living accommodations, for a fee, to adults unrelated to the family who need at least minimal help with daily activities, personal care, protection and health care, but who do not need the professional services of a nursing facility or hospital.

That definition comes from Hawaii Administrative Rules (HAR) section 11-100.1-2, and it is the key to the whole Hawaii model. On the mainland, the default answer to a parent who can no longer live alone is an assisted living building. On Oahu, the default answer has long been a care home: a house in Waipahu, Kalihi or Pearl City where a licensed primary care giver lives with up to five residents, cooks for them, gives medications and keeps watch around the clock.

The Office of Health Care Assurance (OHCA), State Licensing Section, licenses and inspects every one of them. The City and County of Honolulu does not license care homes, although building, zoning and fire rules still apply to the house.

What is the difference between a Type I and a Type II ARCH?

A Type I ARCH is licensed for five or fewer residents and a Type II ARCH for six or more; the same split applies to expanded ARCHs (HAR 11-100.1-2).

In practice almost every Type I home is a single-family house, often with the licensee's own family living upstairs or next door. Type II homes are larger, sometimes purpose-built, and on Oahu a handful hold 20 or more beds. The licensed capacity printed on the roster includes up to three day care clients the home may also serve (HAR 11-100.1-3), so a five-bed home may not have five overnight residents.

Source: OHCA Combined ARCH / Expanded ARCH report, April 2026.

Type matters to families because it predicts the feel of the place. A Type I home is quiet and domestic, with one main caregiver who knows every resident's habits. A Type II home has more staff and more company, but less of the one-family feel.

Who is allowed to be the primary care giver in a Hawaii care home?

The primary care giver in a Type I ARCH must live in Hawaii, be at least 21, be at least a nurse aide, live in the home (or the licensee must hire a qualified primary care giver who does), complete the department's ARCH teaching modules, and have at least a year of full-time nurse aide work in a licensed facility, home health agency or hospital (HAR 11-100.1-8).

The same section requires first aid and CPR skills, enough English to meet the rules and to communicate with residents, and at least six hours of training every year in areas such as personal care, infection control, medications and behavior management. A primary care giver must be present at all times unless a qualified substitute care giver is covering (HAR 11-100.1-3), and must not have outside work demanding enough to interfere with care.

Ask every home you visit who the primary care giver is, whether that person actually lives there, who the substitute care givers are and how often they cover. The answers tell you more than the furniture.

What can and can't a regular ARCH do for a resident?

A regular (non-expanded) ARCH may care only for residents who need minimal to moderate help and do not need the professional health services of a nursing facility; once a resident's physician certifies nursing-facility level of care, the home must either hold an expanded ARCH license or the resident must move.

Within that limit an ARCH provides room, meals, supervision, help with bathing, dressing and toileting, medication assistance, laundry, planned activities and transportation to medical appointments, all of which the rules list as basic services. What it does not provide is skilled nursing: wound care beyond the simple, injections, tube feeding or close nursing monitoring. Those are the reason expanded ARCHs exist.

Read how expanded ARCHs work before choosing a regular ARCH for someone whose health is declining, because a second move is hard on a frail resident.

How long is a Hawaii care home license good for?

An ARCH license is in force for one year or for another period the department sets (HAR 11-100.1-3), and it is issued to a named licensee for a specific house, so it cannot be transferred if the home is sold or the operator changes.

The license has to be posted where visitors can see it. OHCA's roster prints each license's expiration date, and the department's inspection index shows which years an inspection report was required. Some homes are licensed for two years, so a year marked “Not Required” is normal rather than a red flag. Here is how to check a license.