Honolulu Senior AdvisorWhat is the difference between an ARCH and an expanded ARCH?
A regular ARCH may care only for residents who do not need the professional health services of a nursing facility, while an expanded ARCH may also care for residents certified at nursing facility level of care, up to two in a Type I home or 20% of capacity in a Type II home unless the department allows more (HAR 11-100.1-2 and 11-100.1-84).
On Oahu, 285 of 455 licensed care homes (62%) are expanded, so most families can find an expanded home in their area if they ask for one specifically.
What extra oversight does an expanded ARCH resident get?
Each expanded ARCH resident has a registered nurse case manager who assesses them before placement, writes an interim care plan within 48 hours and a full plan within seven days, and monitors care, with a licensed social worker available when needed (HAR 11-100.1-88).
The home must also arrange physician visits at least every four months, annual physical and dental exams and recommended vaccines (HAR 11-100.1-87). That structure is what makes it safe to keep a nursing-level resident in a house.
Why choose an expanded ARCH even if your parent doesn't need nursing care yet?
Choosing an expanded ARCH now can avoid a second move later, because if your parent declines to nursing facility level of care, an expanded home can keep them (within its limits) while a regular ARCH cannot.
Ask the expanded home how many nursing-level slots it has and how many are filled. A home already at its limit may not be able to keep a resident whose needs rise, unless the department approves an exception.
How does payment differ?
Regular ARCH residents are usually private pay because they are below nursing facility level of care, while expanded ARCH residents at nursing level can be eligible for Med-QUEST long-term care through a QUEST Integration plan if they meet the financial rules.
At a glance
| A regular ARCH | An expanded ARCH | |
|---|---|---|
| Residents | Need minimal to moderate help | May include nursing-level residents within limits |
| Nursing oversight | No required RN case manager | An RN case manager for each expanded resident |
| Payment | Mostly private pay | Private pay or Med-QUEST at nursing level |
| On the roster | Type I / Type II Adult Residential Care Home | Type I / Type II Expanded ARCH |
Sources include Hawaii Administrative Rules chapters 11-100.1, 11-90 and 11-800, HRS 321-481 and 321-1.8, Office of Health Care Assurance rosters and pages, the 2026 HHS poverty guidelines, CMS, CareScout and VA rate tables as cited above; see our editorial standards.
