Ethan R. Okura
Hawai‘i Herald Columnist

In last month’s column, I discussed the different types of nursing homes and long-term care facilities available in Hawai‘i. We covered ARCH, adult foster homes and nursing homes. Although we did not discuss them, there are also assisted living facilities, which are an important component of elder care. Assisted living facilities are especially helpful for those who do not have family members who can help them to stay at home while they need some assistance, but before they need full-time nursing care.

A commonly asked question from our clients is: Which is the best nursing home? This is obviously a difficult question to answer, as there are so many factors involved in evaluating “the best” nursing home. Before I tell you which nursing home I consider the best, let’s talk about some of the factors one should consider when selecting a nursing home.

First, you need to determine the level of care you will need and whether a facility provides the type of care you require. In some cases, one must consider specialized care such as memory care (the ability to care for patients with dementia or Alzheimer’s or those who wander); ventilator machines or other sophisticated medical equipment; or rehabilitation for those transitioning from a stroke, fall, broken hip, or other injury or illness. Aside from the level of care, you will want to evaluate the quality of care this facility provides. This can be hard to ascertain unless you or a loved one can visit the facility and see what it’s like and perhaps even talk with current residents about their experience.

You’ve probably heard the old adage about the three factors that affect the value of real estate: location, location and location. That “value” is not just financial in buying and selling — it also applies to identifying the best nursing home. Is it close to family members so they can visit? Is it easily accessible for a spouse who might still be living at home and wants to visit, but is unable to drive? If you’re still ambulatory and able to walk about outside, is it in an area or neighborhood that you like and are familiar?

Another important consideration is comfort. This is a broad category. Are you comfortable with the facility and environment (i.e., is it beautiful or depressing to you?)? Are you comfortable with the living situation (e.g., is it a shared room or private)? Are you comfortable with the caregiver, nurses and/or staff? Do you feel safe and secure both physically and with regard to your personal belongings?

Food can be another critical factor. If you are accustomed to a certain type of diet, you may find it difficult to adapt to something new and totally different. Are you a vegetarian or a vegan? Have you always eaten within your cultural cuisine (Japanese, Chinese, Filipino, etc.)? The type of food served can make things a lot more comfortable — or unpleasant — for many long-term care patients.

Is there a language issue? A religious preference? A cultural practice that is important to consider? Some of these miscellaneous points tend to get pushed down the priority list, but they may be important to some people and in those cases are worth considering.

Finally, cost is a big factor for most people. Unfortunately, it often becomes the deciding factor of where to go. Adult foster homes tend to be less expensive than full nursing homes. However, some patients thrive better in an institutional environment where they can interact with other people and there are lots of scheduled activities in which to participate.

Thankfully, most of these facilities accept Medicaid to pay for long-term care, even for those patients who start off paying privately, but run out of money and need to get qualified for Medicaid to pay for their nursing home costs. Because of this, most people should not use cost as a determining factor. They can then pick the best facility for themselves and plan ahead to prepare to qualify for Medicaid once they have run out of money, whether at an expensive nursing home or a more affordable one.

After reading through all these considerations in choosing a nursing home, you probably came to the same realization I did — that there isn’t any one best nursing home in Hawai‘i. It really depends, as the “best” nursing home is different for each person based on his or her individual needs and circumstances. We can’t tell you which nursing home is best for you, but if you or a family member are considering entering a nursing home, we can help by pointing you to the right resources to make that decision and provide advice on how to structure your assets so that you will be able to qualify for Medicaid when the time comes.

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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