Hawaii adult residential care home (ARCH) license: Type I, Type II and the expanded ARCH

Three Hawaii questions decide which credential you need

Hawaii’s small-home care model is the adult residential care home. The rule defines an ARCH as any facility giving 24-hour living accommodations, for a fee, to adults unrelated to the family who need at least minimal help with activities of daily living, personal care, protection and health care, but who do not need the professional services of an intermediate care, skilled nursing or acute care facility.⁠¹ Federally operated facilities are excluded.⁠¹ The statute requires every ARCH to be licensed and directs the Department of Health (DOH) to run it on a “social model” of care that provides for aging in place.⁠²

Before you look at houses, settle three things:

• How many residents? A Type I ARCH is licensed for five or fewer; the statute lets DOH allow up to six in a Type I home.⁠²⁠¹ A Type II ARCH is licensed for six or more, and brings an administrator, a registered nurse, shift staffing and commercial-style building rules with it.⁠¹
• Will residents need nursing-home-level care? A regular ARCH serves people who do not need intermediate or skilled nursing care. Serving them requires an expanded ARCH license, which you cannot apply for until your ARCH has operated satisfactorily for at least six months.⁠¹
• Will you care for just two or three adults in your own family home? That may be a different credential: a Community Care Foster Family Home (CCFFH) certificate of approval under HAR 11-800, limited to two unrelated adults (three if certified for three beds), with one bed (two in a three-bed home) reserved for Medicaid recipients unless the two-private-pay rules are met.⁠⁷ The CCFFH certificate costs $200 initially and $125 to renew, against $350 and $225 for an ARCH (as published on 2026-10-12).⁠⁴

Hawaii has no separate small-home license below the ARCH. If you want private apartments of your own design with 24-hour staff, look at the Hawaii assisted living facility license. If you want daytime care only, see the adult day care center certificate of approval; an ARCH itself may take no more than three day care clients at a time, under HAR 17-1424.⁠¹

The primary care giver is the license’s center of gravity

Every ARCH must have a primary care giver who is present in the home at all times unless a qualified substitute is covering, and who has no outside job or responsibilities demanding enough to interfere with resident care.⁠¹ For a Type I home, HAR 11-100.1-8 requires the licensee acting as primary care giver, or the person the licensee designates, to:⁠¹

• be a resident of the State of Hawaii and at least 21;
• be at least a nurse aide;
• live in the Type I ARCH, or be employed or contracted by a licensee who does not live there;
• have completed the ARCH teaching modules approved annually by the department;
• have one year of full-time (or equivalent) direct nurse aide work as an employee of a state-licensed intermediate care facility, skilled nursing facility, home health agency or hospital, or complete a department-approved competency-equivalence program;
• show enough English to meet the program’s objectives and the rule’s requirements;
• have acceptable skill in first aid, nutrition, CPR, nursing and behavior management for the residents admitted; and
• complete six hours of documented training every year in topics such as personal care, infection control, pharmacology and chronic illness.

The department may also require a physician or mental health examination of the primary care giver as a condition of continued licensure.⁠¹

So an investor can own a Type I ARCH without living in it, but only by hiring a qualified primary care giver who meets every item above.⁠¹ If you want more than one Type I ARCH, you must also show the department you can run multiple homes, keep a written 24-hour staffing plan for each, and have at least one year of compliant operation of a licensed Type I ARCH.⁠¹

ARCH teaching modules

OHCA’s minimum-qualifications sheet (revised March 20, 2019) lists Kapiolani Community College for nurse aides (Module 11, ARCH activities; Module 12, diseases, diet and medications; Module 13, helping therapies and behavior management; Module 14, regulations, accounts and community resources), plus Leeward (when enrollment allows), Hawaii and Kauai community colleges.⁠³ If you took the modules more than five years ago, you must retake all of them.⁠³ OHCA gives out the license application only after you complete the modules.⁠³ The sheet is dated 2019 and the guide could not confirm that each college still offers the modules; ask the State Licensing Section at (808) 692-7400 which campuses are enrolling before you plan around one.

Substitute care givers

Hawaii grades substitute requirements by how long the substitute is in charge:⁠¹

If the primary care giver will be away more than three days, residents and their families must get at least a week’s notice (except in emergencies), and the home must have a written, department-approved plan for care during absences.⁠¹ Everyone who lives in or works in a Type I home needs a physician’s exam before first contact with residents and every year after, and initial and annual tuberculosis clearance.⁠¹

Type II homes add an administrator, a nurse and shift staff

A Type II ARCH’s licensee or designated administrator must meet the Type I qualifications and also have at least two years of management experience in housing, health care or personal care services, knowledge of accounting principles, supervisory training or experience, and knowledge of large-volume food purchasing, infection control and laundry.⁠¹ The home must also have:⁠¹

• an administrator available for overall management;
• a registered nurse available to assess residents and oversee direct care staff;
• enough qualified staff on duty 24 hours a day, as the department determines, with at least one nurse aide on every shift;
• a trained person to make medications available under a licensed nurse’s general supervision;
• no staff member working more than two consecutive eight-hour shifts in 24 hours;
• six hours of annual training for the administrator, primary and substitute care givers; and
• a registered dietitian to help plan menus and assess residents at nutritional risk or on special diets, with compliance with HAR chapter 11-12 food sanitation rules.

Type II homes also need written policies on nursing delegation and staffing ratios, medication administration, drug storage, medical emergencies, restraints, resident funds, meal planning, abuse reporting, resident assessment, and hazardous and infectious waste.⁠¹

The house: Hawaii’s Type I physical rules

DOH weighs the site’s quietness, sanitation, accessibility and nearness to the community served; the home must be reachable by emergency medical services and near public transportation.⁠¹ The main numbers from HAR 11-100.1-23:⁠¹

Day care clients, relatives and visitors who regularly use resident areas count as residents when the department calculates dining and living room space.⁠¹ Each bedroom must be reachable without passing through another bedroom, and residents of a room must be the same sex unless a couple and the primary care giver agree to a shared semi-private room.⁠¹ Signaling devices approved by the department are required at bedsides and in bathrooms; if you and the residents sleep on different levels, you need an electronic signaling system.⁠¹

Type II homes must meet Group I occupancy requirements of the Uniform Building Code and the NFPA 101 Life Safety Code as adopted by the state and county fire codes, with exit lighting, night lighting and a secondary power source for emergency exit lights.⁠¹ Bedrooms may hold up to four residents, and the home needs one toilet per eight occupants, one tub or shower per fourteen and one lavatory per ten.⁠¹

Fire safety and the self-preservation rule

A Type I home must pass a fire inspection before licensing and at least once a year after, and the licensee pays any fire inspection fees.⁠¹ Smoke detectors must follow the current NFPA 101 for one- and two-family dwellings; existing homes may keep battery units only until ownership or the primary care giver changes, when a hard-wired UL-approved system is required.⁠¹ Hold and record fire drills at least four times a year, at least three months apart, at varying times of day and night, and post a written evacuation plan with diagrams.⁠¹

Each Type I resident must be certified by a physician as ambulatory and able to follow directions and get out in an emergency. No more than two residents without that certification may live in a Type I home, and only if either a responsible adult is in the home whenever they are, with no stairway to negotiate in an evacuation, or the home has an NFPA 13-D sprinkler system throughout.⁠¹ This rule shapes which houses work: a two-story home without sprinklers limits you to residents who can self-evacuate, except on the ground floor with constant adult presence.

Plan review before you build

Send drawings for any new construction, addition or alteration to DOH before work starts; the counties and fire marshals keep final authority over construction and fire safety.⁠¹ Before you apply, OHCA offers a free courtesy plan review: submit a Request for Plan Review form with one 11 by 17 inch scaled floor plan, and a second review is available on request.⁠³

Zoning: the eight-resident group living rule

HRS §46-4(d) says no law, county ordinance or rule may prohibit group living in state-licensed, certified, registered or monitored facilities with eight or fewer residents, not counting a resident manager or supervisor and that person’s family.⁠⁶ Those homes must still meet county requirements on building height, setback, lot coverage, parking and floor area.⁠⁶ Your application must document compliance with county building and zoning codes either way.⁠¹

Applying to OHCA, in order

1. Complete the ARCH teaching modules and confirm the primary care giver’s nurse aide status and one year of qualifying experience.⁠¹⁠³
2. Get a courtesy plan review of the scaled floor plan from OHCA, before you commit to renovations.⁠³
3. Request the application from the State Licensing Section, 601 Kamokila Boulevard, Room 361, Kapolei, HI 96707, (808) 692-7400; in-person service is in Room 337. OHCA says applications are free.⁠³⁠⁵
4. Collect the clearances and documents that must accompany the application:⁠¹
   • documented compliance with county building and zoning codes;
   • documented compliance with fire code requirements;
   • clearance from the DOH sanitation branch and the DOH wastewater branch;
   • building plans with accurate measurements to scale of the entire home;
   • written approval from the property owner if the home is rented, leased or on leased land;
   • disclosure of ownership or control, and a projected annual budget of income and expenses based on 60% occupancy, with evidence of financial resources on request;
   • written policies on staffing, visiting hours, emergency plans and access to records, and the general operational policies listed in HAR 11-100.1-7 (admission, services, responsibilities, abuse and neglect reporting, infection control, incident review, transfer and discharge); and
   • documented evidence that the licensee, primary care giver, household members with access to the home and substitute care givers have no prior felony or abuse convictions.
5. Wait for the decision. DOH must grant or deny within 60 days of a complete application; incomplete applications are returned. If DOH misses the deadline, the application is deemed approved on the 61st day and the license is issued within a month.⁠¹
6. Pass the initial survey and pay. DOH surveys every home before an initial license. If you are in full compliance, you deliver the initial fee within 10 days of the department’s notice; otherwise you answer deficiencies with a written plan of correction.⁠⁴

DOH may deny a license for noncompliance, lack of financial capability, misrepresentation, or failure to provide a satisfactory work history of patient care confirming that the applicant never abused, neglected or exploited a resident.⁠¹

Fees as published on 2026-10-12

Fees are non-refundable and payable to “State of Hawaii OHCA SF” by corporate check, bank check or money order, or electronically where available; personal checks and cash are refused.⁠⁴ A bounced check counts as an incomplete application.⁠⁴ OHCA’s 2019 sheet also lists a $15 charge for a printed copy of the rule chapter; it is free online.⁠³

Admissions, medications and residents’ money

A resident’s physician or APRN must determine and document the level of care before admission, and that information must be available to the department.⁠¹ You may refuse someone your home cannot care for, but you must admit without regard to age, disability, race, color, national origin (including language), sexual orientation, religion or gender.⁠¹ Before admission, explain your approved policies and sign a written agreement setting out the resident’s rights, the services you will provide and each side’s responsibilities.⁠¹ A resident who comes to need a higher level of care may stay in a Type I or Type II home while awaiting transfer only if the department finds the primary care giver capable of that interim care.⁠¹

Medications must stay in their pharmacy-labeled containers and be kept in a staff-controlled cabinet away from residents’ bedrooms and bathrooms, with refrigerated drugs in a separate locked container.⁠¹

Inspections, renewal, waivers and closing

A license runs one year or another interval set by the department, is issued by name for one specific home, and cannot be transferred under any circumstances; each home needs its own license, and a change of licensee goes to the department to decide whether a new license is needed.⁠¹ The rule sets no fixed term, so ask OHCA what interval it assigns to a new ARCH license.

DOH makes at least one unannounced visit to every ARCH each year in addition to the relicensing inspection, which is normally announced and held during business hours (OHCA’s office hours are 7:45 a.m. to 4:30 p.m. weekdays⁠³). Complaint and follow-up visits are unannounced and may come at any hour.⁠¹ You have 10 working days to return a plan of correction after an inspection. The department may refuse renewal if deficiencies are not corrected, or issue a provisional license; no home gets more than two provisional licenses in a row.⁠¹ The renewal fee is due at least 30 days before the renewal date, and failing to pay forfeits the license on that date.⁠⁴

You may request a written waiver of a rule for up to one year; it is deemed approved if DOH does not act within 60 days of a complete request, but no waiver may touch the licensing or primary care giver requirements.⁠¹ Violations can bring administrative penalties under HRS §321-20 and suspension or revocation; you have 20 days after receiving an order by certified mail to request a hearing.⁠¹ To close, give DOH and residents, guardians and agencies at least 30 days’ written notice and move every resident to an appropriate licensed setting first.⁠¹

The expanded ARCH: nursing-home-level residents

An expanded ARCH may admit residents who need intermediate or skilled nursing facility care, as determined and certified by the resident’s physician or APRN.⁠¹ The statute, as reproduced in a 2025 bill, ties eligibility to certification by DHS, a physician, APRN or registered nurse case manager, for residents with no financial relationship with the home.⁠¹⁰ Limits:⁠¹

• Type I expanded ARCH: no more than two nursing-facility-level residents at a time.
• Type II expanded ARCH: nursing-facility-level residents may not exceed 20% of licensed capacity.
• In both cases the department may allow more, including letting a current resident stay as an extra one when that is in the resident’s best interest.

To qualify, you must already hold an ARCH license and have operated satisfactorily for at least six months; the home is inspected for its ability to care for residents who cannot self-evacuate; existing waivers are reviewed; and total beds can never exceed the original ARCH capacity.⁠¹ You must submit a department-approved plan for arranging a registered nurse and case manager, and name trained substitute care givers.⁠¹ A registered nurse other than the licensee or primary care giver must train and monitor caregivers, and primary and substitute care givers need 12 hours of continuing education a year.⁠¹ Each resident gets a case manager (a Hawaii-licensed RN with a bachelor’s degree in nursing and two years of care coordination experience) who sets an interim care plan within 48 hours of admission and a full care plan within seven days.⁠¹

Type I expanded ARCHs add monthly fire drills, self-closing bedroom doors, locks that open from inside without a key, and hard-wired smoke detectors tested monthly in specified locations; Type II expanded ARCHs follow Group I occupancy rules.⁠¹ A pool needs a locking solid cover or a 6-foot fence.⁠¹ You must give 30 days’ written notice to move a resident out, except in emergencies; residents give you 14 days.⁠¹

How ARCH residents pay, and pending changes

Many ARCH residents rely on federal Supplemental Security Income plus a Hawaii state supplement for domiciliary care. In Med-QUEST’s SPA 24-0013, the state supplement for an individual was $784 a month at Level I and $892 at Level II, on top of the 2024 SSI rate of $943, for totals of $1,727 and $1,835.⁠⁸ Med-QUEST’s distribution memo says CMS approved the amendment on November 15, 2024, effective October 1, 2024, raising the Level I and II amounts from $651.90 and $759.90.⁠¹¹ Ask OHCA or the Department of Human Services for the amounts in force when you open.

Two 2025 House bills, both shown in the 2026 session files, would change the picture:

• H.B. 551 would raise the HRS §346-53 state supplemental payment ceilings from $784 to $1,440 for Type I ARCHs and from $892 to $1,530 for Type II ARCHs.⁠⁹
• H.B. 185 would bar licensing any ARCH or expanded ARCH financed, managed, supervised, directed or owned in whole or in part by someone convicted of a gambling offense under HRS chapter 712, part III.⁠¹⁰

Both bills were carried over to the 2026 session on December 8, 2025, and the legislature’s status page, checked 2026-10-12, showed no action beyond committee referral; confirm before relying on either.

OHCA keeps a registry of licensed ARCHs and their vacancies and publishes combined ARCH and expanded ARCH vacancy reports by area and alphabetically; the statute requires DOH to keep a current vacancy inventory.⁠⁵⁠² If you also plan to send caregivers into clients’ homes, that needs a separate Hawaii home care agency license, and skilled nursing at home needs a home health agency license.

Sources

1. 1
   Hawaii State Department of Health, Hawaii Administrative Rules, Title 11, Chapter 100.1: Adult Residential Care Homes Checked 12 Oct 2026 · Back to text ↑
2. 2
   Hawaii State Legislature, Hawaii Revised Statutes §321-15.6: Adult residential care homes; licensing Checked 12 Oct 2026 · Back to text ↑
3. 3
   Hawaii Department of Health, Office of Health Care Assurance, Minimum Qualifications for an Adult Residential Care Home (ARCH) License (rev. 3/20/19) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Hawaii State Department of Health, Hawaii Administrative Rules, Title 11, Chapter 103.1: Fees for Licensure and Certification Checked 12 Oct 2026 · Back to text ↑
5. 5
   Hawaii Department of Health, Office of Health Care Assurance, State Licensing Section Checked 12 Oct 2026 · Back to text ↑
6. 6
   Hawaii State Legislature, Hawaii Revised Statutes §46-4: County zoning Checked 12 Oct 2026 · Back to text ↑
7. 7
   Hawaii State Department of Health, Hawaii Administrative Rules, Title 11, Chapter 800: Home and Community-Based Case Management Agencies and Community Care Foster Family Homes Checked 12 Oct 2026 · Back to text ↑
8. 8
   Hawaii Department of Human Services, Med-QUEST Division, SPA 24-0013, Optional State Supplemental Program Increase Checked 12 Oct 2026 · Back to text ↑
9. 9
   Hawaii State Legislature, H.B. No. 551, Relating to Care Homes (2025, Thirty-Third Legislature) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Hawaii State Legislature, H.B. No. 185, Relating to Care Homes (2025, Thirty-Third Legislature) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Hawaii Department of Human Services, Med-QUEST Division, Approval of SPA 24-0013, Optional State Supplemental Increase (distribution memo) Checked 12 Oct 2026 · Back to text ↑

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