Honolulu Senior AdvisorWhat is a community care foster family home (CCFFH)?
A community care foster family home is a private home certified by the Hawaii Department of Health to give 24-hour care, including personal care and homemaker services, to no more than two adults at a time who are at nursing facility level of care, unrelated to the family and receiving services from a licensed case management agency, with at least one of them a Medicaid recipient (HRS 321-481).
Foster family homes are certified rather than licensed, and the day-to-day certification work is done by Community Ties of America, the organization OHCA has designated for foster family homes, case management agencies and adult day care centers. The detailed rules are in HAR chapter 11-800.
The Department of Health's March 2026 roster lists 1,111 certified community care foster family homes on Oahu with 2,800 certified beds; 580 are certified for three residents. The homes cluster in Waipahu (524), Ewa Beach (199), Honolulu (166).Can a foster family home take a third resident or private-pay residents?
Yes, in limited cases: the department may certify a home for a third adult who is at nursing facility level of care and a Medicaid recipient, once the home has operated at least a year and its primary and substitute caregivers meet nurse aide training requirements (HRS 321-481, as amended by Act 30 of 2017).
Act 30 also lets the department allow two private-pay residents in the same three-bed home when they are a married couple or in a civil union, among other conditions, such as the home having had a vacant Medicaid bed for at least six months. The roster shows most Oahu homes certified for two or three beds.
The practical result: foster family homes are built around Med-QUEST. A family paying privately should ask early whether a home can take a private-pay resident at all.
Who are the caregivers in a foster family home?
The primary caregiver must live in the home, be a nurse aide, LPN or RN with at least a year of experience in a home setting, and have a department-approved substitute caregiver who takes over during absences (HAR 11-800-41).
The primary caregiver must be at least 21 and the substitute at least 18; both need tuberculosis clearance, background checks, CPR, first aid and infection-control training, and a way to drive residents to appointments or an approved transportation plan. The primary caregiver completes 12 hours of in-service training a year and the substitute 8. Any substitute who gives three or more hours of care a day must be at least a nurse aide.
Why do we not list individual foster family homes by name?
We publish foster family homes only as counts by town because each one is a private family residence, and the state's roster lists them by the caregiver's personal name and home address.
When a family is ready, a case management agency or a QUEST Integration service coordinator matches the resident with a specific home, and that is the safer route: the case manager knows which homes have an open Medicaid or private-pay bed and which caregivers handle which care needs. Our foster family home page shows where on Oahu the homes are concentrated.
How is a foster family home different from a care home?
A foster family home is smaller (two or three residents), certified through a case management agency for people at nursing facility level of care and built around Medicaid, while an ARCH is a licensed home of up to five (Type I) or more (Type II) residents that also serves people needing less care.
Both sit in ordinary neighborhoods and both rely on a live-in primary care giver. See the side-by-side comparison.
At a glance
| A CCFFH is | A CCFFH is not | |
|---|---|---|
| Size | Two adults, or three with department approval | A five-bed care home |
| Residents | Adults at nursing facility level of care | A setting for people who need only light help |
| Payment | Built around Med-QUEST, with limited private-pay exceptions | Open to any private-pay resident by default |
| Oversight | Certified via CTA, with a licensed case management agency | Inspected only when a complaint is filed |
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.
