State Assisted Living Policy: 1998. Hawaii



Assisted living facilities. (Draft) Hawaii Administrative Rules §11-90-1 et seq.

Adult residential care homes (Draft) Hawaii Administrative Rules §11-101-1 et seq.

General Approach

The Department of Health has developed proposed rules for a new assisted living category and revised rules for adult residential care homes. In 1994, a multi-member task force was created by House Concurrent Resolution 377 to make recommendations concerning assisted living and to explore the use of Medicaid waivers to support low income residents in assisted living. The report was issued in December 1994 and recommended that the Department of Health be authorized to develop regulations to establish an assisted living program. Members of the task force made site visits to facilities in Oregon and Washington. Legislation authorizing the development of assisted living regulations was passed in April, 1995. The draft regulations are expected to be finalized in 1998.


Assisted living facility means a facility as defined in §321-15.1, HRS. The facility is a building complex offering dwelling units to individuals and services to allow residents to maintain an independent assisted living lifestyle. The environment of assisted living is one in which meals are provided, staff are available on a 24-hour basis and services are based on the individual needs of each resident. Each resident, family member, and others work together with the facility staff to assess what is needed to support the resident in his or her greatest capacity for living independently. The facility is designed to maximize the independence and self-esteem of limited-mobility persons who feel that they are no longer able to live on their own.

Assisted living means encouraging and supporting individuals to live independently and receive services and assistance to maintain independence. All individuals have the right to live independently with respect for their privacy and dignity, fee from restraints.

Adult residential care facility means any facility providing 24-hourliving accommodations, for a fee, to adults unrelated to the family, who require at least minimal assistance in ADLs, but who do not need the services of an intermediate care facility. There are two types of homes. Type I homes serve five or fewer residents and Type II serve six or more residents. Adult residential care homes may obtain an extended care license to serve a limited number of residents who meet the nursing home level of care.


Assisted living The draft rules require apartment units with a bathroom, refrigerator and cooking capacity, including a sink and a minimum of 220 square feet, not including the bathroom (sink, shower and toilet). The cooking capacity may be removed or disconnected depending on the needs of the resident. Other requirements include wiring for phone and television, a private accessible mail box and a call system monitored 24 hours by staff.

Adult residential care homes The current rules require that single rooms have 90 square feet and multiple occupancy rooms 70 square feet per occupant. One toilet is required for every eight residents, one shower for every 14 residents and one lavatory for every 10 residents.

Tenant Policy

Assisted living facility Each facility must develop admission policies and procedures which support the principles of dignity and choice. The policies include a listing of services available, the base rates, services included in the base rates, services not provided but which may be coordinated and a service plan and contract. Facilities must also develop discharge policies and procedures which allow 14 days notice for behavior, other needs that exceed the facility's ability to meet or the resident's established pattern of non-compliance. The rules do not specify who may be admitted and retained. Rather, each facility may use its professional judgement and the capacity and expertise of the staff in determining who may be served.

Adult residential care homes Homes without an extended care license may not serve residents needing nursing home care. Type I extended care homes may serve no more than two residents qualifying for nursing home care and Type II homes may serve no more than 10% of its residents needing this level of care.


Assisted living facilities shall provide awake, 24-hour on-site staff, three dietician approved meals a day, laundry services, opportunities for individual and group socialization, services to assist with ADLs, nursing assessment and health monitoring, housekeeping, medication administration and services for residents with behavior problems (staff support, intervention and supervision), and recreational and social activities. Facilities must also arrange or provide transportation, ancillary services for medically related care (physician, pharmacist, therapy, podiatry), barber/beauty care, hospice, home health and other services.

Service agreements are developed using negotiated risk principles.


The report suggested that land policies should be reviewed and modification of zoning requirements made to allow existing housing stock to be used. State loans and bonds would be made available to at favorable interest rates to stimulate development. The report recommended consideration of providing a higher level of service in residential care facilities as a means of maximizing existing buildings to meet new needs. A resolution passed the legislature directing the Medicaid Agency to study the feasibility of using a Medicaid Home and Community Based Services Waiver to finance services.


Assisted living facilities The draft rules allow assistance with self-administration and administration of medication as allowed under the nurse practice act.


Assisted living facilities must have licensed nursing staff available seven days a week to meet care management and monitoring needs of residents.

Adult residential care homes Licensees must submit a plan showing how they will obtain a registered nurse and case manager. Sufficient staff must be on duty 24-hours a day to meet resident needs.


Assisted living facilities

Administrators The administrator/director must have two years experience in the health and social services field and show evidence of having completed an assisted living facility administrator's course acceptable to the Department.

All staff shall be trained in CPR and first aid. The facility shall have written policies and procedures which incorporate the assisted living principles of individuality, independence, dignity, privacy, choice and home-like environment. In-service education consists of an orientation for all new employees to acquaint them with the philosophy, organization, practice and goals of assisted living; and ongoing in-service training on a regularly scheduled basis (minimum of six hours annually).

Adult residential care homes A registered nurse must train and monitor primary caregivers.

Background Check

Assisted living facilities Licensure may be denied for convictions in a court of law or substantiated findings of abuse, neglect or misappropriation of resident funds or property.

Adult residential care homes All staff, including the licensee must have no history of confirmed abuse, neglect or misappropriation of funds.


Assisted living facilities The rules require biannual inspection and license renewal.


Fees will be established by the Department of Health.


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