Hawaii assisted living rules: what you must document about each resident

Who these rules cover

Chapter 11-90 covers licensed assisted living facilities: building complexes offering dwelling units, meals, 24-hour staff, where "services are based on the individual needs of each resident".¹ Hawaii also licenses adult residential care homes and expanded ARCHs under a separate chapter, 11-100.1, which this page does not cover.

The chapter opens with three principles: aging in place, a negotiated plan of care, and managed risk. Its definitions add "individuality", which it describes as "recognizing variability in residents' needs and preferences and having flexibility to organize services in response to such needs and preferences."

The assessment

Hawaii's assessment requirement is one sentence, and it is broad:

"The assisted living facility staff shall conduct a comprehensive assessment of each resident's needs, plan and implement responsive services, maintain and update resident records as needed, and periodically evaluate results of the plan."HAR § 11-90-8(a)(1)

The rule does not prescribe a state form, a list of domains or a separate deadline. Because the service plan must exist before move-in, the assessment it rests on has to happen before move-in too. The same paragraph says the plan "shall reflect the assessed needs of the resident and resident choices", support "dignity, privacy, choice, individuality, independence, and home-like environment", and include significant others who help deliver services.

The service plan

The service plan is the center of Hawaii's rule:

"A service plan shall be developed and followed for each resident consistent with the resident's unique physical, psychological, and social needs, along with recognition of that resident's capabilities and preferences."HAR § 11-90-8(a)(2)

The plan must say what services will be provided, by whom, when, how often, and the expected outcome. The resident takes part "to the extent possible". The admission process includes a service plan "developed by facility staff with the resident and significant others ... based on resident needs and choices", and the resident record must hold it.¹

"The initial service plan shall be developed prior to the time the resident moves into the facility and shall be revised if needed within 30 days. The service plan shall be reviewed and updated by the facility, the resident, and others as designated by the resident at least annually or more often as needed;"HAR § 11-90-8(a)(3)

A named staff member must be designated to review, monitor, implement and modify each resident's plan.

Activities and socialization

Every facility must provide "opportunities for individual and group socialization" and be able to provide or arrange "social or recreational opportunities" and social work services. The activities rule itself is brief:

"Recreational or social activities are to be made available to residents on a daily basis."HAR § 11-90-8(b)(4)

There is no required hour count, calendar format or interest survey. The link to preferences comes through the service plan and the "individuality" principle, not through the activities rule.

Memory care

Chapter 11-90 has no separate dementia or memory-care unit section. It mentions cognitive impairment only in the emergency-planning rules. If you run a memory care neighborhood, the general service-plan rule still applies, and you should check with the Office of Health Care Assurance about any other expectations.

What surveyors tend to look for

Going only by what Chapter 11-90 says to document:

• A service plan dated before move-in, with any revision within 30 days.
• A plan that addresses physical, psychological and social needs and shows the resident's preferences and choices.
• What, who, when, how often and expected outcome for each service.
• Evidence of resident participation and an annual review.
• Daily recreational or social activities.

Gathering preferences well

A thin rule leaves room to do this properly. Some habits that help:

• Ask open questions before and after move-in. "Tell me about a typical day at home." "What do you do when you want to relax?" Use the 30-day revision window for what you learn in the first weeks.
• Include the significant others the resident names, as the rule already expects.
• Record what brings comfort and what to avoid, since psychological and social needs include both.
• Link interests to the daily activity offer, so preferences show up in more than one document.
• Revisit at the annual review or sooner when something changes.

How Porchlight can help

Porchlight helps you gather preferences, routines and life-story material in the resident's own words. A resident taps one large button on a tablet, a life question is read aloud and shown in large type, and the answer is recorded and transcribed. There are 800+ human-written questions by life chapter; any can be skipped, and nothing is scored. Staff can record profile facts, including topics to avoid, and get a "Know Your Resident" briefing. Family get a private page to listen, reply, and add questions and photos. The assessment, service plan and compliance remain your facility's responsibility.

Frequently asked questions

What does Hawaii require in an assisted living resident assessment?

HAR 11-90-8 requires facility staff to conduct a comprehensive assessment of each resident's needs and to periodically evaluate the results of the plan. The rule does not prescribe a state form or a separate deadline for the assessment.

When is the Hawaii assisted living service plan due?

The initial service plan must be developed before the resident moves in and revised if needed within 30 days. It is reviewed and updated at least annually or more often as needed.

Does Hawaii require resident preferences in the service plan?

Yes. The service plan must be consistent with the resident's unique physical, psychological and social needs, along with recognition of the resident's capabilities and preferences. The rule does not specifically require a life history.

Does Hawaii have memory care rules for assisted living?

Chapter 11-90 has no separate dementia or memory-care unit section. Check with the Department of Health's Office of Health Care Assurance for current expectations.

How often must activities be offered in Hawaii assisted living?

Recreational or social activities must be made available to residents on a daily basis, along with opportunities for individual and group socialization.