Adult Residential Care Home Hawaii: ARCH, E-ARCH, and CCFFH Explained

The hospital case manager says your parent cannot safely return to their apartment — the stairs are too steep, they live alone, and there is no family nearby to supervise during the day. She recommends looking into "care homes," but the options sound nothing like the mainland nursing homes you have heard about. ARCH, E-ARCH, CCFFH — the acronyms blur together while the discharge clock ticks.

Hawaii has a distinctive care home system built around small, family-style residential settings that are fundamentally different from large institutional nursing facilities. Understanding the differences determines whether your parent receives appropriate care at a manageable cost.

Type I and Type II ARCH

An Adult Residential Care Home (ARCH) provides 24-hour personal care, meals, and lodging in a residential setting. Under Hawaii Administrative Rules Chapter 11-100.1, ARCHs are divided into two categories:

• Type I ARCH: A private family home licensed for up to five residents. The home operator typically lives on-site and provides direct personal care
• Type II ARCH: A larger, commercial-style facility licensed for six or more residents, managed by an administrator overseeing professional caregivers

ARCHs serve residents who need help with daily activities — bathing, dressing, meal preparation, medication reminders — but do not require continuous skilled nursing care. They are licensed and inspected by the Department of Health, Office of Health Care Assurance (OHCA).

Expanded ARCH (E-ARCH)

An E-ARCH is a specialized care home licensed to accept residents who meet the state's Nursing Home Level of Care (NHLOC) criteria — the same clinical threshold used for Med-QUEST long-term care eligibility.

• Type I E-ARCH: Licensed for up to five residents, with a maximum of three residents meeting NHLOC criteria at any time
• Type II E-ARCH: Licensed for six or more residents with specific capacity limits for expanded-care residents

E-ARCHs must arrange physician evaluations of expanded-care residents every four months. A Registered Nurse or case manager must be available to train and supervise caregivers. Staff undergo annual training covering personal care, pharmacology, infection control, and behavioral management.

The E-ARCH fills a critical niche: it provides a more personal, home-like alternative to a nursing facility for parents who technically qualify for nursing home care but would benefit from a smaller setting.

Community Care Foster Family Home (CCFFH)

CCFFHs are private family homes licensed for up to three adult residents. To live in a CCFFH, your parent must:

• Meet the Nursing Home Level of Care criteria (certified via the DHS 1147 evaluation)
• Be enrolled in a licensed Case Management Agency (CMA) that provides ongoing RN oversight and care coordination

CCFFHs are licensed, certified, and inspected by Community Ties of America (CTA), a third-party regulatory contractor designated by the Department of Health. This is different from ARCHs, which are inspected directly by OHCA.

The CCFFH model is particularly common in Hawaii because it allows families to provide paid caregiving in their own homes while meeting state licensing standards.

How These Compare to Nursing Homes

Finding the Right Placement

When evaluating care homes after a hospital discharge:

1. Confirm Med-QUEST acceptance — If your parent will transition from private pay to Med-QUEST once their assets are spent down, verify the home accepts Medicaid payments before signing admission paperwork
2. Check licensing status — Verify the home's current license through OHCA or CTA. Ask about the most recent inspection results
3. Visit in person — Look at cleanliness, staff interaction with current residents, medication management procedures, and the physical safety of the environment
4. Read admission agreements carefully — Watch for "responsible party" clauses that make you personally liable for unpaid bills

For a complete guide to Hawaii's care home system, discharge planning, and how to protect yourself from financial liability during placement, the Hospital-to-Home Hawaii guide covers every facility type with the specific questions to ask and contract clauses to watch for.

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