Last month we talked about the different types of nursing homes and long-term care facilities available in Hawaii. We covered ARCH, Adult Foster Homes, and Nursing Homes. There are also assisted-living facilities, which we did not discuss, but which are an important component of elderly care. Assisted-living facilities are especially helpful for those who don’t have family members who can help them to stay at home while they need some assistance, but before they need full-time nursing care. One question that some clients come to me with is: Which is the Best Nursing Home?

Obviously this is a difficult question to answer as there are so many factors that go into evaluating what makes a nursing home great.  Before I tell you the answer—which is The Best!—let’s talk about some of the things to consider when choosing a nursing home.

First, you have to determine the level of care that you will need and whether that facility provides the type of care you require. In some cases, we have to consider specialized care such as memory care (or the ability to handle patients with dementia or Alzheimer’s or those who wander); ventilator machines or other sophisticated medical equipment; or rehabilitation for those transitioning from a stroke, fall, broken hip, or other injury or illness. Aside from the level of care, you will want to evaluate the quality of care that this facility provides. This can be hard to ascertain unless you or a loved one can visit the facility, see what it’s like, and perhaps even ask residents about their experience.

Maybe you’ve heard the old adage about the three factors that affect the value of real estate: Location, location, and location. That “value” is not just financial in buying and selling, but also applies to identifying the best nursing home as well. Is it close to family members so they can visit? Is it easily accessible for a spouse who might still be living at home and wants to visit, but is unable to drive? If you’re still ambulatory and able to walk about outside, is it in an area or neighborhood that you like and are familiar with?

Another important consideration is comfort. This is a broad category. Are you comfortable with the ambience and environment? (i.e., is it beautiful or depressing to you?) Are you comfortable with the living situation? (e.g., is it a shared room or private?) Are you comfortable with the caregiver, nurses, and/or staff? Do you feel safe and secure both physically and with regard to your personal belongings?

Food can be another critical factor. If you are used to a certain diet, you may find it difficult to adapt to something totally different from what you’re used to. Are you vegetarian or vegan? Have you always eaten within your cultural cuisine (Japanese, Chinese, Filipino, etc.)? What food is served can make things a lot more comfortable or unpleasant for many long-term care patients.

Is there a language issue, a religious preference, or cultural practice that is important to consider? Some of these miscellaneous points tend to get pushed down on the priority list, but they may be important for some people, and in those cases, they are worth considering.

Finally, cost is a big factor for most people. Unfortunately, it will often be the factor that ultimately drives the decision of where to go. Adult Foster Homes tend to be less expensive than full nursing homes. However, some patients thrive better in the institutional environment where there are many other people to interact with, and lots of scheduled activities to participate in. Thankfully, most of these facilities can and do accept Medicaid to pay for the cost of long-term care. And even for those patients who start off paying privately, eventually, they tend to run out of money and need to get qualified for Medicaid to pay for their nursing home costs. Because of this, most people shouldn’t use cost as a determining factor. They can pick the best facility for themselves otherwise, and plan ahead to prepare to qualify for Medicaid once they have run out of money, whether at an expensive nursing home or a more affordable one.

After reading through all these considerations in choosing a nursing home, I hope you came to the same realization that I did: There is not one BEST Nursing Home in Hawaii. It really does depend. The best nursing home is different for each person, based on his or her individual needs and circumstances. Although we can’t tell you which nursing home is best for you, if you or a family member is considering going to a nursing home, Okura & Associates can help point you to the right resources to make that decision and we can provide advice on how to structure your assets so that you will be able to qualify for Medicaid when that time comes.


Honolulu Office  (808) 593-8885

Hilo Office          (808) 935-3344


Ethan R. Okura received his Doctor of Jurisprudence Degree from Columbia University in 2002.  He specializes in Estate Planning to protect assets from nursing home costs, probate, estate taxes, and creditors.

This written advice was not intended or written to be used, and it cannot be used by any taxpayer, for the purpose of avoiding penalties that may be imposed on the taxpayer.  (The foregoing legend has been affixed pursuant to U.S. Treasury Regulations governing tax practice.)

This column is for general information only.  The facts of your case may change the advice given.  Do not rely on the information in this column without consulting an estate planning specialist.