Growing Older at Home

Hawaiian culture has always revered people who are older, known as kupuna. However, as the years go on, it might become difficult for kupuna to grow older at home.

Hawaii has a significant kupuna population, and it's expected to increase in the upcoming years. As of 2020, there were an estimated 277,200 people aged 65 years and older living in Hawaii. That's about 20 percent of the state’s total population, according to the U.S. Census. It's estimated that by 2030 one in every five Hawaii residents will be older than age 65, representing 23 percent of the population. Additionally, Hawaii has the highest life expectancy in the U.S., at an average of 80 years old in 2020.

As kupuna in Hawaii age, their housing and care needs may vary. Family members may wonder how to best support their loved ones. Who will be the primary caregiver? Will the elder person be able to stay at home or will they need to move to live with family, to another home, or to a care home? How much will this care or housing cost? What types of housing are available in Hawaii for older people?

Many kupuna choose to stay in their homes as they grow older or "age in place."

What is aging in place?

The U.S. Centers for Disease Control and Prevention defines aging in place as “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.” Most people who are older would prefer to remain in their homes for as long as possible, as this is economical and often more comfortable.

What are some important considerations for aging in place?

• Consider modifications to make home safer and more accessible. Modifications, such as a lift for the stairs, an accessible bathroom, plenty of lighting and lower kitchen counters are just a few of the many helpful additions to make the home safer for seniors. Certified Aging-in-Place Specialists (CAPS) can assist homeowners by recommending modifications to their home to optimize safety, functionality and design.
• Have a support plan in case of injury or illness. As we age our physical and cognitive capabilities inevitably decrease. Chronic conditions can often increase the likelihood of injury or illness. Therefore, it is important to have clear plans in place for communication and monitoring. If a kupuna falls, how will anyone know? If dementia onset occurs, how will family members notice and support? Personal emergency response systems (PERS) can assist with fall detection, and home sensors can assist with monitoring abnormal behavior, including dementia.
• Manage chronic conditions. Primary care physicians and medical specialists can help to create a medical care plan that considers chronic illnesses management. A health journal or online healthcare management system can assist a kupuna or caregiver with keeping track of medication and appointments.

What other housing options or health services are available for older people in Hawaii?

Other housing options in Hawaii for kupuna are often expensive or limited. Nursing homes in Hawaii can cost almost 50 percent more than nursing home accommodations on the U.S. Mainland, and in-home health care, like a home health aide, caan cost thousands more than the U.S. average. Hawaii only has about 4,400 beds in nursing home and 7,000 spaces in residential facilities for people of retirement age—not nearly enough to meet the housing and care needs of kupuna.

The following is a list of the terms used to describe housing and care options for seniors living in Hawaii:

• A Skilled Nursing Facility (SNF) is a nursing home that has a registered nurse (RN) available for at least 8 hours per day. Someone who suffered from a fall might need additional support in an SNF.
• An Intermediate Care Facility (ICF) is a nursing home service that provides custodial care. This type of service is not typically covered by Medicare and would be for someone who needs significant care. 
• Adult Residential Care Homes (ARCH) must be licensed by the Hawaii Department of Health. These are found in both smaller family homes as well as larger institutional facilities. Elderly people who live in residential care homes do not typically need high levels of medical care. Also, Medicare or Medicaid do not typically reimburse for this type of care but supplemental security income (SSI) does. All the islands, especially Oahu, have a number of adult residential care homes.
• Assisted Living Facilities often provide a full community of services to retired people, including housing, medication management, meals, health services, private apartments, housekeeping and a variety of recreational activities. Assisted Living Facilities are usually paid through private money.
• Adult Day Care is for kupuna who live at home but require socialization, supervision or rehabilitation during the day.
• Home Care includes services for taking care of needs while older people stay at home. These services may include health care, meals, cleaning and assistance with personal hygiene. Home Care services may allow older people to successfully age in place.
• Senior Housing is a building or community with certain minimum age requirements. Residents are independent and often enjoy community amenities, such as pools and group exercise classes. 

For a list of senior housing options on Oahu, please contact your Locations agent.

While many housing options exist for kupuna as they age, aging in place remains one of the most popular options in Hawaii. Aging in place takes the right home, proper care plans, and a lot of love, often from family members. Locations agents are happy to offer their expertise to find a comfortable home for kupuna as they age.