What Home Care Costs in Hawaii

What does home care cost in Hawaii?

Hawaii does not publish a price for home care, and neither does anyone else. Two numbers exist, and they measure different things. The first is a wage: Hawaii's home health and personal care aides earn a median of $18.32 an hour, a mean of $18.83, and there are about 6,150 of them working statewide 1Ref 1U.S. Bureau of Labor Statistics (2025).Occupational Employment and Wage Statistics: 31-1120 Home Health and Personal Care Aides.Hawaii state-level estimates for home health and personal care aides: employment of about 6,150, mean hourly wage $18.83, median hourly wage $18.32, and the percentile spread from $15.00 at the 10th percentile to $21.98 at the 90th. Used for the state's aide wage level and the compression of its wage distribution; these are worker wages, not agency charge rates.. The second is a national consumer median, and it is roughly double.

The 2024 Genworth Cost of Care Survey put the national median cost of a home health aide at $77,792 a year and homemaker services at $75,504, both figured on 44 hours a week for 52 weeks 2Ref 2Genworth Financial / CareScout (2025).Genworth and CareScout Release Cost of Care Survey Results for 2024.The 2024 national median consumer cost of in-home care: home health aide $77,792/year and homemaker services $75,504/year, both computed on 44 hours a week for 52 weeks, which yields the $34 and $33 hourly bill rates used in this page's schedule table; and the finding that two-thirds of home care agencies now charge the same rate for both service types.. Divide either by 2,288 hours and the hourly bill rate falls out: $34 an hour for an aide, $33 for homemaker help. The same survey found that two-thirds of home care agencies now charge the same rate for both service types 2Ref 2Genworth Financial / CareScout (2025).Genworth and CareScout Release Cost of Care Survey Results for 2024.The 2024 national median consumer cost of in-home care: home health aide $77,792/year and homemaker services $75,504/year, both computed on 44 hours a week for 52 weeks, which yields the $34 and $33 hourly bill rates used in this page's schedule table; and the finding that two-thirds of home care agencies now charge the same rate for both service types., which means the old habit of asking for "just light housekeeping" to save money mostly no longer works.

Now set that against the worker's side of the ledger. The national median wage for this occupation was $34,900 a year in May 2024, about $16.76 an hour 3Ref 3U.S. Bureau of Labor Statistics (2025).Home Health and Personal Care Aides — Occupational Outlook Handbook.The national median annual wage of $34,900 for home health and personal care aides in May 2024, about $16.76 an hour, used as the national worker-wage benchmark against which Hawaii's aide wage and the national consumer bill rate are compared.. So a family nationally pays close to two dollars for every dollar that reaches the aide.

That gap is not markup in the retail sense. It is payroll taxes, workers' compensation, unemployment insurance, supervision, scheduling, and the promise that somebody arrives when your regular aide has the flu.

Hawaii's aide wage sits above the national median wage. The bill rate is built on top of it.

Why Hawaii's minimum wage keeps moving the floor

Hawaii legislated a wage escalator, and home care sits directly in its path. Act 114, signed in 2022, set a four-step climb: $12.00 an hour from October 2022, $14.00 from January 2024, $16.00 from January 2026, and $18.00 from January 2028. The state is at $16.00 now, and the Wage Standards Division of the Department of Labor and Industrial Relations enforces it.

Look at what that has already done to the distribution. When the federal wage survey was taken in May 2025, the lowest-paid tenth of Hawaii's aides earned $15.00 an hour 1Ref 1U.S. Bureau of Labor Statistics (2025).Occupational Employment and Wage Statistics: 31-1120 Home Health and Personal Care Aides.Hawaii state-level estimates for home health and personal care aides: employment of about 6,150, mean hourly wage $18.83, median hourly wage $18.32, and the percentile spread from $15.00 at the 10th percentile to $21.98 at the 90th. Used for the state's aide wage level and the compression of its wage distribution; these are worker wages, not agency charge rates.. Seven months later the legal floor moved above that number. The bottom of Hawaii's home care wage distribution was lifted by statute rather than by the market, and every agency employing those aides had to re-price or absorb it.

The 2028 step is the one worth watching. Hawaii's median aide wage today is $18.32 1Ref 1U.S. Bureau of Labor Statistics (2025).Occupational Employment and Wage Statistics: 31-1120 Home Health and Personal Care Aides.Hawaii state-level estimates for home health and personal care aides: employment of about 6,150, mean hourly wage $18.83, median hourly wage $18.32, and the percentile spread from $15.00 at the 10th percentile to $21.98 at the 90th. Used for the state's aide wage level and the compression of its wage distribution; these are worker wages, not agency charge rates.. An $18.00 floor arrives within thirty-two cents of it. When a legal minimum reaches an occupation's median, it stops behaving like a floor and starts behaving like the wage, and the compression tends to push the rungs above it upward too.

Federal law is the backstop here, not the constraint. Home care workers employed by an agency are entitled to federal minimum wage and overtime 4Ref 4U.S. Department of Labor, Wage and Hour Division (2016).Fact Sheet #25: Home Health Care and the Companionship Services Exemption Under the FLSA.That agency-employed home care workers are entitled to federal minimum wage and overtime; that the companionship services exemption does not apply where a third-party employer such as an agency is involved; and that live-in domestic service employees may be exempt from overtime, though not minimum wage, when employed directly by the household. Used to explain why round-the-clock hourly shifts cost more than live-in arrangements., but at $7.25 the federal minimum has not been the binding number in Hawaii for many years. The state's own floor governs.

A caregiver scheduled 44 hours a week at Hawaii's $16.00 minimum costs $736 in wages alone once the four overtime hours are paid at time and a half, before a dollar of payroll tax.

What a 6,150-aide workforce does to price and availability

Hawaii employs roughly 6,150 home health and personal care aides across the entire state 1Ref 1U.S. Bureau of Labor Statistics (2025).Occupational Employment and Wage Statistics: 31-1120 Home Health and Personal Care Aides.Hawaii state-level estimates for home health and personal care aides: employment of about 6,150, mean hourly wage $18.83, median hourly wage $18.32, and the percentile spread from $15.00 at the 10th percentile to $21.98 at the 90th. Used for the state's aide wage level and the compression of its wage distribution; these are worker wages, not agency charge rates.. That is a small pool by any measure, and it is spread across six inhabited islands with no road between them. Scarcity of this kind shows up in a home care bill in ways that never appear on the invoice.

An agency that cannot fill a shift has two options: pay overtime to somebody already working, or decline the case. Overtime is time and a half 4Ref 4U.S. Department of Labor, Wage and Hour Division (2016).Fact Sheet #25: Home Health Care and the Companionship Services Exemption Under the FLSA.That agency-employed home care workers are entitled to federal minimum wage and overtime; that the companionship services exemption does not apply where a third-party employer such as an agency is involved; and that live-in domestic service employees may be exempt from overtime, though not minimum wage, when employed directly by the household. Used to explain why round-the-clock hourly shifts cost more than live-in arrangements., and at Hawaii wages that premium is real money. Four-hour shift minimums exist partly because a two-hour visit cannot absorb an aide's travel time, and travel time in Hawaii can mean a ferry or a plane.

The wage distribution is unusually tight. Hawaii's aides earn $15.00 an hour at the tenth percentile and $21.98 at the ninetieth 1Ref 1U.S. Bureau of Labor Statistics (2025).Occupational Employment and Wage Statistics: 31-1120 Home Health and Personal Care Aides.Hawaii state-level estimates for home health and personal care aides: employment of about 6,150, mean hourly wage $18.83, median hourly wage $18.32, and the percentile spread from $15.00 at the 10th percentile to $21.98 at the 90th. Used for the state's aide wage level and the compression of its wage distribution; these are worker wages, not agency charge rates.. Under seven dollars separates the bottom of the market from the top. In a compressed market an agency cannot simply buy scarce weekend or overnight availability by paying meaningfully more, because there is little headroom to pay into. It rations instead. That is why families here so often find the binding constraint on a care plan is not the budget but the schedule.

Cost is one honest reason Hawaii families think about the mainland, and the comparison deserves care. What home care costs in Oregon or what home care costs in Nevada is only half the equation, because a move also spends down the network of neighbours, church, and cousins who currently check in for free.

Hawaii licenses home care agencies, and the list is public

Hawaii is one of the states that licenses non-medical home care, which is not true of every state and matters more than it sounds. Section 321-14.8 of the Hawaii Revised Statutes gives the Department of Health authority to license home care agencies, and Chapter 11-700 of the Hawaii Administrative Rules sets what a licensed agency must do: written service plans, policies and procedures, administrative standards, a defined scope of services. The Office of Health Care Assurance runs the licensing section, conducts unannounced inspections in clients' homes, and publishes a list of licensed agencies together with those pending approval.

Read the scope carefully, because it defines your bill. A Hawaii home care agency license covers personal care, homemaker assistance, and respite: help with dressing, feeding, bathing, personal hygiene, household tasks. It expressly excludes nursing services and financial management. If a parent needs a wound dressed or an injection given, that is outside what a home care agency's license permits. It belongs to a Medicare-certified home health agency, which is a different organisation, a different visit, and usually a different bill. Families routinely discover this halfway through a hospital discharge.

A license is a floor, not a rating. It tells you an agency is inside the state's system and subject to unannounced inspection. It tells you nothing about whether the aide who arrives at your door is any good. The public list is where a conversation starts, not a ranking.

The Kupuna Caregivers Program is not available anywhere else

Hawaii built something no other state has: a care benefit paid on account of the caregiver's job rather than the elder's poverty. The Kupuna Caregivers Program, created in 2017, provides up to $210 a week toward care for an older adult so that the working family member caring for them can stay employed. There are currently no income or asset limits, which is close to unheard of in American long-term care policy.

The eligibility rules are unusual and reward literal reading:

• The caregiver must work at least 30 hours a week outside the home, and may not be self-employed.
• The caregiver does not have to live with the person they care for.
• The care recipient must be a Hawaii resident aged 60 or older.
• The care recipient must not live in a long-term care facility, which here means not assisted living, not an adult residential care home, not a community care foster family home, and not a nursing facility.

The money can go to adult day care or adult day health, transportation to and from it, respite, home-delivered meals, chore and homemaker services, and personal care such as bathing, grooming, dressing, and help with mobility. Applications run through the county Aging and Disability Resource Centers.

Now the arithmetic, honestly. Two hundred and ten dollars a week set against a national homemaker median of $33 an hour 2Ref 2Genworth Financial / CareScout (2025).Genworth and CareScout Release Cost of Care Survey Results for 2024.The 2024 national median consumer cost of in-home care: home health aide $77,792/year and homemaker services $75,504/year, both computed on 44 hours a week for 52 weeks, which yields the $34 and $33 hourly bill rates used in this page's schedule table; and the finding that two-thirds of home care agencies now charge the same rate for both service types. buys about six hours. That is one weekly morning, not a care plan. The program was built to keep a working caregiver in their job, and judged against that goal it is well aimed. Judged as a funding source, it is a partial offset and worth having, but it will not carry a schedule.

Hawaii separately runs Kupuna Care, a state and county funded program of long-term services and supports for residents 60 and older who are not eligible for Medicaid.

When the money runs out: QUEST Integration and who else pays

Most home care in the United States is paid out of pocket, by Medicaid for those who qualify, or by a long-term care insurance policy, because Medicare does not cover ongoing custodial or personal care 5Ref 5Administration for Community Living (2025).Costs of Care.That home care is generally paid out of pocket, by Medicaid for those who qualify, or by long-term care insurance, because Medicare does not pay for ongoing custodial or personal care. Used for the 'who pays' framing and the three-doors structure of the funding section.. Hawaii does not change that rule. It changes the door you walk through.

Medicaid can cover home and community based services through several distinct legal authorities: 1915(c) waivers, the 1915(i), (j), and (k) state plan options, and Section 1115 demonstrations 6Ref 6Centers for Medicare & Medicaid Services (2025).Home & Community Based Services Authorities.That Medicaid covers home and community based services through several distinct authorities — 1915(c) waivers, the 1915(i)/(j)/(k) state plan options, and Section 1115 demonstrations — which supports the distinction drawn between waiver states and Hawaii's 1115 managed-care route, and what that difference means for who authorises hours.. Hawaii runs its Medicaid program, long-term services and supports included, through QUEST Integration, which is an 1115 demonstration delivered as managed care.

That structural choice has a consequence families feel directly. In a 1915(c) waiver state, home care hours are authorised through a waiver program with its own enrolment slots and frequently its own waiting list. In Hawaii, the elder is enrolled in a health plan, and the plan's care coordinator is the person who assesses need and authorises hours. When hours are cut, the appeal goes through the plan first. Establishing which of those two worlds you are in tells you who to call and what to ask, and it is the most useful thing to nail down early.

Long-term care insurance is the third door 5Ref 5Administration for Community Living (2025).Costs of Care.That home care is generally paid out of pocket, by Medicaid for those who qualify, or by long-term care insurance, because Medicare does not pay for ongoing custodial or personal care. Used for the 'who pays' framing and the three-doors structure of the funding section.. Policies bought decades ago carry an elimination period before benefits start and a daily benefit cap once they do, and both are worth reading closely before assuming the policy will cover an island rate.

The arithmetic: hours, months, and round-the-clock coverage

Home care is priced by the hour, which means the monthly number a family is quoted is a schedule decision far more than it is a rate decision. Doubling the hours doubles the bill; shaving a dollar off the rate does almost nothing by comparison. At the national median home health aide rate of $34 an hour 2Ref 2Genworth Financial / CareScout (2025).Genworth and CareScout Release Cost of Care Survey Results for 2024.The 2024 national median consumer cost of in-home care: home health aide $77,792/year and homemaker services $75,504/year, both computed on 44 hours a week for 52 weeks, which yields the $34 and $33 hourly bill rates used in this page's schedule table; and the finding that two-thirds of home care agencies now charge the same rate for both service types., the arithmetic runs like this:

The bottom row is why live-in arrangements exist at all. Almost nobody pays close to $300,000 a year for round-the-clock hourly shifts if an alternative exists, and the alternative is written into federal wage law. Live-in domestic service employees can be exempt from overtime, though never from minimum wage, when the household employs them directly, while the companionship services exemption does not apply where a third-party employer such as an agency is involved 4Ref 4U.S. Department of Labor, Wage and Hour Division (2016).Fact Sheet #25: Home Health Care and the Companionship Services Exemption Under the FLSA.That agency-employed home care workers are entitled to federal minimum wage and overtime; that the companionship services exemption does not apply where a third-party employer such as an agency is involved; and that live-in domestic service employees may be exempt from overtime, though not minimum wage, when employed directly by the household. Used to explain why round-the-clock hourly shifts cost more than live-in arrangements.. That single distinction, who signs the paycheck, is what separates a live-in cost from an 8,736-hour cost.

The crossover with assisted living is the same arithmetic run backwards. There is no published Hawaii facility price in the federal data, so the honest instruction is a method rather than a number: take one local all-in monthly quote, divide it by the hourly rate you have been offered, and the answer is how many home care hours a month buys the same thing. Divide that by 4.3 for a weekly figure. Below that line home is cheaper; above it, it is not, and the gap widens quickly.

The variable that decides the crossover is hours, not the hourly rate. Negotiating two dollars an hour off a rate moves the line far less than adding a second daily shift moves it.

What the neighbor islands change

Statewide averages hide the thing that actually decides a Hawaii care plan. Those 6,150 aides 1Ref 1U.S. Bureau of Labor Statistics (2025).Occupational Employment and Wage Statistics: 31-1120 Home Health and Personal Care Aides.Hawaii state-level estimates for home health and personal care aides: employment of about 6,150, mean hourly wage $18.83, median hourly wage $18.32, and the percentile spread from $15.00 at the 10th percentile to $21.98 at the 90th. Used for the state's aide wage level and the compression of its wage distribution; these are worker wages, not agency charge rates. are not spread evenly across six inhabited islands, and there is no road between them. On Molokai, on Lanai, and across the rural districts of Hawaii Island, the binding constraint is not the hourly rate at all. It is whether anyone is free on the day and at the hour you need.

A license is not a service area. The Department of Health's list tells you which agencies are licensed to operate in Hawaii. It does not tell you which of them staffs your island, your side of that island, or your overnight. That is a separate question, and asking it plainly, which of these specific hours can you cover this month with a named person, is the most useful question a family can put to an agency anywhere and the most important one here.

Travel is the hidden driver. An aide covering a rural route absorbs driving time between clients that is unpaid or only partly paid, which raises the wage an agency must offer to fill that route and shrinks the number of people willing to work it. Neither effect appears on your invoice as a line item. Both appear as a four-hour minimum, a narrower window of offered times, or a quiet no.