How Hawaii licenses assisted living

What counts as assisted living in Hawaii?

In Hawaii, assisted living means a facility licensed under HAR chapter 11-90: a building complex offering private dwelling units and services so residents can keep an independent lifestyle, with meals, staff available 24 hours a day and services based on each resident's assessed needs.

The word is used loosely in advertising, but only a licensed facility may call itself an assisted living facility, and the designation appears on its license (HAR 11-90-3). Independent living, retirement apartments and care homes are not assisted living in the legal sense.

What must a Hawaii assisted living unit include?

Each resident gets an apartment of at least 220 square feet not counting the bathroom, with a full bathroom (sink, shower and toilet), a refrigerator and cooking capacity that can be disconnected if it becomes unsafe, a call system monitored 24 hours a day and wiring for telephone and television (HAR 11-90-4).

That is the clearest physical difference from a care home, where a resident usually has a bedroom, often shared, in a family house. The rules also require access to common areas such as dining and activity rooms, and a private mailbox.

What services does Hawaii require assisted living to provide?

Hawaii requires 24-hour on-site direct-care staff, three meals a day with modified diets reviewed by a dietitian twice a year, laundry, socialization, help with all activities of daily living, nursing assessment and health monitoring, routine nursing tasks that an RN may delegate, and housekeeping (HAR 11-90-8).

The facility must also be able to provide or arrange transportation to appointments, ancillary medical services such as podiatry or therapy, support for residents with behavior problems, social work and a resident fund account. A service plan is written before move-in, revised within 30 days if needed and reviewed at least once a year.

The rules describe aging in place as remaining at home despite decline, with services added “within the ability of the facility” (HAR 11-90-2). That last phrase is where families should push: ask each building exactly where its ability ends.

How often does the state inspect assisted living in Hawaii?

The Department of Health inspects each assisted living facility at least every two years for relicensing, may enter without notice, and requires a plan of correction within 10 days of any deficiency list (HAR 11-90-3); licenses run at least two years.

In practice OHCA's public inspection index shows most Oahu assisted living facilities with a report in each recent year, and every report is posted under HRS 321-1.8. Our facility pages link each one. See how to read an OHCA report.

Why is assisted living so expensive in Hawaii?

CareScout's 2025 survey put Hawaii's median assisted living cost at $145,065 a year, about $12,089 a month and the highest of any state, reflecting a small number of mostly large, amenity-rich Honolulu buildings, Hawaii's land and labor costs, and the fact that care homes absorb much of the lower-cost demand.

That median describes the licensed buildings CareScout surveyed, not care homes, which it does not survey. Many families who start out looking for assisted living end up comparing it with an ARCH. Read what care costs in Hawaii.