Ethan R. Okura
Hawai‘i Herald Columnist

Over the years, we have had hundreds of clients who have gone to nursing homes to provide for their care as they aged. Some lived full, rich, engaged lives in the nursing home until the very end. Others suffered from severe physical disabilities or dementia that prevented them from actively interacting with the world as meaningfully as they would have liked. Oftentimes, clients are confused about the different types of long-term care options available to them. In this column, we’ll describe the differences between the main types of long-term care facilities available in Hawai‘i.

The three main categories of long-term care facilities that you can go to are: 1) ARCH, 2) adult foster home and 3) nursing home. Each is distinct and serves a slightly different purpose.

ARCH is the acronym for Adult Residential Care Home. These homes are licensed and regulated by the Hawai‘i state Department of Health, Office of Health Care Assurance. ARCH Type I homes are limited to no more than five long-term residents, while ARCH Type II homes can have six or more residents. Both ARCH I and ARCH II homes could be regular — serving residents requiring minimal assistance with the activities of daily living, such as bathing, changing, walking, eating and getting out of bed; or they could be expanded and able to accept residents who require 24-hour assistance or skilled nursing services. Only Expanded ARCH homes (either Type I or Type II) may choose to accept Medicaid patients, although it is not required.

Adult Foster Homes are licensed and regulated by the Hawai‘i state Department of Human Services. Although commonly referred to as adult foster homes, the official name of the program that they fall under is the Community Care Foster Family Homes Program. Foster homes are designed to be a less expensive, family-home setting alternative to an institutional nursing home. They are licensed for up to three long-term residents. Residents in foster homes must be at the intermediate care facility, or ICF, level of care or at the skilled nursing facility, or SNF, level of care, which is equivalent to Expanded ARCH. Foster homes must have at least one Medicaid resident. Homes licensed for two or three residents may have one private-pay, non-eligible resident. All residents in a foster home must have a case management agency licensed by the Department of Human Services to coordinate their health care requirements.

Finally, full-fledged nursing homes are generally licensed under the Hawai‘i state Department of Health, Office of Health Care Assurance as intermediate care facilities and/or skilled nursing facilities. These are what most people think of as typical nursing home institutions. They may have as few as a handful of beds or a few dozen beds — some even have the capacity for several hundred residents. Most or all ICF and SNF nursing homes beds are Medicaid-eligible, although some institutions have a limited number of Medicaid-eligible beds, with the remainder reserved for private pay patients only.

Contrary to popular myth, Medicaid does not tell you where to go. Rather, Medicaid recipients can choose which long-term care facility they would like to live in, as long as there is an available bed and the resident is accepted into the facility. The quality of care the resident receives will depend primarily on other factors, such as how much the nursing staff cares and how often family members visit and are involved in monitoring the resident’s care.

Next month, we’ll discuss selecting the right facility for you.

Honolulu Office (808) 593-8885
Hilo Office          (808) 935-3344

Ethan R. Okura received his doctor of jurisprudence degree from Columbia University in 2002. He specializes in estate planning to protect assets from nursing home costs, probate, estate taxes and creditors.

This written advice was not intended or written to be used, and it cannot be used by any taxpayer, for the purpose of avoiding penalties that may be imposed on the taxpayer. (The foregoing legend has been affixed pursuant to U.S. Treasury Regulations governing tax practice.)

This column is for general information only. The facts of your case may change the advice given. Do not rely on the information in this column without consulting an estate planning specialist.

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