Hawaii is clamping down on unlicensed care homes

State officials have grown increasingly concerned about the facility, with 89 investigations already underway.

The Hawaii Department of Health issued a $51,000 fine to an unlicensed adult residential care home run by Bella Ariota on Maui.

Among the concerns, state officials found that 11 unrelated senior residents were paying an illicit fee to the home to receive 24-hour unlicensed housing.

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Health department inspectors conducted an investigation at the Kahului home in November. The violation notice was issued in April and the fine was based on $100 for each day the unlicensed facility was in operation, according to the DOH.

Ariota said he was unaware his actions were illegal and would have appreciated the government giving him time to register and authorize his home care.

“Not everyone can afford to pay $7,000 to $8,000 a month on licensed facilities, and I do it for $3,000,” Ariota said.

State lawmakers and Gov. Josh Green have grown increasingly concerned about these unlicensed nursing homes and their operations, with 89 investigations of such facilities already underway. The DOH said it cannot comment on cases under investigation.

But there are several cases where initial inspections into suspected nursing homes were denied and investigators had to wait for search warrants. One cited example occurred last year at an alleged unlicensed adult residential home in Pearl City on Oahu.

Those problems are compounded, lawmakers declared in Senate Bill 1378, by licensed nursing homes that continue to transfer overflow patients to these facilities.

The Legislature passed that bill this year and it is pending consideration by the governor. It prohibits all new referrals or transfers of patients to unlicensed nursing homes and repeals owner exclusions, which have been used to hamper investigations.

Elderly man walks with a cane along Hotel Street in the Honolulu metropolitan area.
The problem of unlicensed nursing homes is becoming more acute as more seniors need care that can be prohibitively expensive. (Cory Lum/Civil Beat/2022)

An owner exclusion in this case allows homes to deny entry to inspectors on the grounds that the rooms are rented out to tenants. DOH cannot enter and search private property until it receives court-issued search warrants.

SB 1378 “expands the Department’s ability to protect our kupuna by making it easier to investigate and take appropriate enforcement action as needed if someone is operating an unlicensed nursing home,” said Bureau Chief Keith Ridley. State Medical Care Guarantee.

The US Department of Health and Human Services and other federal agencies have been tracking the rise of these unlicensed nursing homes and documenting the demand for them, including more patients lacking the funds to cover the facility’s expenses. Licensed as well as Licensed Care Homes exclusion policies have against admitting residents who exhibit substance use and behavior problems.

In turn, the report notes, conditions in many unlicensed nursing homes are “abusive, financially exploitative, and neglectful of residents’ basic needs.”


Critics of SB 1378 raised another concern, saying the bill would restrict nursing home placement permits and not allow relatives to care for relatives in their own homes.

DOH did not respond to a request to address what older patients should do if they cannot afford a licensed facility but still need help.

Ridley said non-family members paying a fee for 24-hour accommodation help create health management problems. This bill, she added, “does not restrict anyone from receiving health care or other services in their own home or from family members caring for a relative.”