Hawaii home care programs

Home health: the medical benefit

In Hawaii, skilled home health is Home Health Services (Hawaii Medicaid) (HHA). It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.

Only a licensed home health agency enrolled with Hawaii Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating, toileting and household tasks is "home care" or personal care. In Hawaii the agency route is Personal assistance, chore and respite through QI plan agencies. No skilled need is required; the person qualifies on functional need, usually measured by an assessment of daily activities.

The agency recruits, trains, schedules and pays the aides, and it is the employer. The aide is agency staff rather than a relative.

Consumer-directed care: the person hires their own aide

Hawaii's consumer-directed option is Self-direction option for QUEST Integration personal assistance and respite. The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.

This is the route most families use to be paid: Self-direction option for QUEST Integration personal assistance and respite allows a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.

Structured family caregiving: a paid live-in family caregiver

Hawaii has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (Self-direction option for QUEST Integration personal assistance and respite), by the hour, as the participant's chosen aide.

Other ways Hawaii pays for care at home

Waiver in-home services: Home and Community-Based Services Waiver for People with Intellectual and Developmental Disabilities (PAB). These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.

State-funded: Kupuna Care (KC) and Kupuna Caregivers Program. Paid from state funds outside Medicaid, for people who do not qualify for Medicaid or are waiting for it.

Which one fits

• Needs nursing, wound care, injections or therapy at home: home health (Home Health Services (Hawaii Medicaid) (HHA)).
• Needs daily help and wants an agency to supply and manage the aide: Personal assistance, chore and respite through QI plan agencies.
• Wants to choose the aide, including a relative where allowed: Self-direction option for QUEST Integration personal assistance and respite.
• Meets nursing-home level of care and needs more than personal care: Home and Community-Based Services Waiver for People with Intellectual and Developmental Disabilities (PAB).