Honolulu Senior AdvisorWhat is an expanded ARCH (E-ARCH)?
An expanded adult residential care home is an ARCH licensed to also care for residents who need the professional health services of an intermediate care or skilled nursing facility, as certified by the resident's physician or APRN (HAR 11-100.1-2 and 11-100.1-84).
It is the single most distinctive piece of Hawaii's long-term care system. Instead of a nursing home bed, a person at nursing facility level of care can live in a licensed home in their own neighborhood, with a primary care giver in the house and a registered nurse case manager overseeing the care plan.
On Oahu, 285 of the 455 licensed ARCHs on OHCA's April 2026 roster are expanded homes, with 1,818 licensed beds between them; 34 are Type II expanded homes of six or more residents.On the roster an expanded home appears as “Type I Expanded Adult Residential Care Home” or “Type II Expanded”. In our directory it is labelled E-ARCH.
How many nursing-level residents can an expanded ARCH have?
A Type I expanded ARCH (five or fewer residents) may have no more than two nursing-facility-level residents at a time, and a Type II expanded ARCH (six or more) no more than 20% of its licensed capacity, unless the Department of Health allows more (HAR 11-100.1-84).
The department must also consider letting a current resident who declines to nursing level stay on as an additional nursing-level resident, based on the resident's best interest after talking with the resident, family, physician, case manager, care giver and operator. That provision is what makes aging in place possible in a care home.
For families, the practical question is whether the home has an open nursing-level slot, not just an open bed. A five-bed E-ARCH with two nursing-level residents already may only be able to take someone at a lower level of care.
Who is the case manager in an expanded ARCH, and what do they do?
Every expanded ARCH resident must have a case manager who is a registered nurse with a bachelor's degree in nursing and at least two years of care coordination experience, with a licensed social worker available when the care plan needs one (HAR 11-100.1-88).
The resident or family chooses the case management agency together with the care giver and physician. The case manager assesses the resident before placement, writes an interim care plan within 48 hours of admission and a full care plan within seven days, then monitors it. Case management agencies are licensed separately; OHCA's designee, Community Ties of America, licenses them.
The primary care giver arranges annual physical and dental exams, recommended vaccines and physician visits at least every four months, and has round-the-clock access to a physician or APRN and the case manager (HAR 11-100.1-87). Injections are given by a licensed nurse unless the physician allows self-injection; the RN case manager may delegate the task under Board of Nursing rules (HAR 11-100.1-89).
Who pays for an expanded ARCH?
Residents pay privately or, if they qualify, through Med-QUEST's long-term services and supports in a QUEST Integration health plan, which can pay for care in an expanded ARCH for members who meet nursing facility level of care; the resident's own income still goes toward room and board.
Ask each home whether it accepts Med-QUEST members and which health plans it works with, and ask the plan's service coordinator the same question from the other side. Private rates are set by each home and are not published by the state. Read paying for a care home for how the money usually works.
When is an expanded ARCH the wrong choice?
An expanded ARCH is the wrong choice when a resident needs more skilled care than one care giver and a visiting nurse can safely provide, such as frequent suctioning, complex IV therapy, two-person transfers around the clock or close post-surgical rehab; those needs usually point to a nursing facility.
It can also be wrong for someone who wanders persistently, because a family home is rarely built with secured exits, or for a person who wants the privacy of an apartment. Discuss the case manager's assessment honestly with the care giver before move-in; a placement that fails after two weeks is worse than a nursing home stay that was planned.
At a glance
| An expanded ARCH can | An expanded ARCH cannot | |
|---|---|---|
| Level of care | Care for residents certified at nursing facility level | Exceed two nursing-level residents (Type I) without department approval |
| Oversight | Rely on an RN case manager chosen by the family | Operate without a case manager for each expanded resident |
| Medications | Have injections given by a licensed nurse or delegated by the RN | Let an unlicensed care giver inject without delegation |
| Payment | Be paid through Med-QUEST long-term care for eligible members | Bill Medicare for room, board or personal care |
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.
