Adult Residential Care Homes (ARCH)

The State of Hawaii Department of Health, Office of Health Care Assurance, licenses two residential care settings: assisted living facilities (ALFs) and adult residential care homes (ARCHs). Type I ARCHs are licensed for five or fewer residents and Type II for six or more residents. In addition, the state has provisions for licensure of expanded adult residential care homes (E-ARCHs) that provide professional health services similar to those provided by nursing facilities.

Adult Residential Care Home Definition

a facility providing 24-hour living accommodations to adults, unrelated to the provider, who require at least minimal assistance in activities of daily living (ADLs). E-ARCH are licensed to serve a limited number of residents who need an intermediate level of nursing facility care.

Resident Agreements

es must have a written agreement that explains the resident’s rights, the provider’s responsibilities, and services to be provided based on the resident’s care plan.

Admission and Retention Policy

Adult residential care homes are for individuals who need assistance with personal care below an intermediate level of nursing facility care. Homes must develop admission and discharge policies and procedures. E-ARCHs may admit individuals who meet nursing facility level of care criteria as determined and certified by a physician or an advanced practice registered nurse (RN). No more than 20 percent of residents in Type II E-ARCHs may need a nursing facility level of care, though exceptions are possible.


Adult residential care homes provide personal care services, medication services, assistance with self-administration of medications, laundry and housekeeping, transportation to health care appointments, supervision, and social activities. E-ARCHs provide additional health-related services needed by residents who meet nursing facility level of care criteria; the facility must make arrangements for such residents to visit a medical doctor every 4 months for a medical evaluation.

Service Planning

Adult residential care homes must conduct a comprehensive assessment of each resident’s needs and develop a schedule of activities that describes the services to be provided. For E-ARCHs, a care plan is developed by the resident’s case management agency and–at a minimum.

Third Party Providers

Residents who require therapeutic services prescribed by a physician may receive these services provided by an outside agency at the facility.

Medication Provisions

Adult residential care homes may make medications available unless the resident is capable of and prefers to self-administer. E-ARCHs require licensed nurses to administer medications by injection unless the resident is capable of self-administration. In addition, this task may be delegated to unlicensed assistive personnel according to state administrative rules and the state’s Nursing Model Act.

Food Service and Dietary Provisions

Adult residential care homes provide three meals a day, snacks, and may offer meals recommended or prescribed by a physician.

Staffing Requirements

Type of Staff. An administrator of a Type II ARCH manages and oversees all staff and residents. Facilities must make arrangements for an registered nurse to conduct resident assessments. E-ARCHs must have an RN or case manager available to train and supervise caregivers. A case manager is a person who is licensed by the state as an RN or social worker. Other staff include nurse aides and direct care staff who assist residents with personal care needs and some nursing tasks. Staff Ratios. No minimum ratios. Sufficient staff must be on-duty 24 hours a day to meet residents’ needs. At least one nurse aide must be on each shift.

Training Requirements

For E-ARCHs, an RN must train and monitor primary caregivers. All Type II ARCH staff must have 6 hours of annual training on specified topics, including personal care; infection control; pharmacology; medical and behavioral management of residents; diseases and chronic illnesses; and community services and resources.

Provisions for Apartments and Private Units

Adult residential care homes may have up to four residents sharing a room. One toilet is required for every eight residents, one sink for every ten residents, and one shower for every 14 residents.

Background Checks

All staff, including the licensee, must have no hiistory of confirmed abuse, neglect, or misappropriation of funds.

Inspection and Monitoring

Adult residential care homes are inspected annually or based on requests or complaints. Inspections are unannounced except for the annual re-licensing inspection.



How Much Does Residential Care Cost?

Between $3,000 to $7,000 per month.


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