Aging in place and multigenerational ohana in Hawaii
Hawaii has the highest rate of multigenerational households in the United States. The cultural value placed on caring for kupuna at home — within the ohana — shapes how Medicare, Med-QUEST, Kupuna Care, and senior services work together here.
The Hawaii ohana approach to aging
About 1 in 4 Hawaii households is multigenerational, compared to about 1 in 8 nationally. Across Hawaii's communities — Native Hawaiian, Filipino, Japanese, Samoan, Korean, Chinese, and others — multiple generations living together with adult children caring for aging parents is far more common than on the mainland.
Hawaii's high cost of housing makes multigenerational living an economic necessity for many families as well as a cultural preference.
What aging in place looks like here
For Hawaii kupuna and their families, "aging in place" usually means staying with family — not staying alone in their own home:
- The primary caregiver is often a working adult child or grandchild, not a paid professional
- Family caregivers are usually unpaid; their hours are invisible in healthcare data
- The "facility" is the family home, often shared with grandchildren
- Services come into the home rather than the kupuna going to a facility
- Decisions are typically family decisions, not individual kupuna decisions
Medicare benefits that support aging in place
- Home health care — Part A covers part-time skilled nursing, PT/OT/speech therapy, and home health aide services for homebound patients with a physician order
- Durable medical equipment (DME) — wheelchairs, walkers, hospital beds, oxygen, CPAP, glucose monitors
- Telehealth — virtual primary and specialty visits without leaving home
- Chronic Care Management — monthly care coordination for kupuna with two or more chronic conditions
- Hospice — comprehensive end-of-life care at home
- Skilled nursing facility (SNF) — short-term rehabilitation after a qualifying hospital stay
Medicare Advantage supplemental benefits
Many 2026 Hawaii Medicare Advantage plans include benefits that directly support aging in place:
- Home meal delivery (typically post-hospital)
- Non-emergency medical transportation
- Personal emergency response systems (fall-detection pendants)
- OTC and grocery allowances
- Limited in-home support services
- Caregiver support and respite
Med-QUEST Home and Community-Based Services (HCBS)
For income-eligible kupuna, Med-QUEST's QUEST Integration program is one of the largest payers of in-home support in Hawaii:
- Personal care assistance
- Adult day care and adult day health
- Home-delivered meals
- Homemaker / chore services
- Respite care
- Case management
- Community Care Foster Family Home placement
- Assisted Living Facility services
HCBS requires both functional eligibility (nursing-home level of care assessment) and financial eligibility (~$1,530/month for ABD applicants).
Kupuna Care for those above Medicaid limits
For kupuna who don't qualify for Med-QUEST, Hawaii's state-funded Kupuna Care program offers similar in-home services. Kupuna Care fills the gap for older adults too well-off for Medicaid but unable to afford private services.
Kupuna Caregivers Program — first of its kind in the nation
The Kupuna Caregivers Program gives stipends to working family caregivers — up to $210/week, $10,500/year — to help pay for adult day care, home health, transportation, or other supports for an aging relative.
Eligibility:
- Caregiver must be employed at least 30 hours per week
- Care recipient must be 60 or older
- Care recipient must need help with at least two activities of daily living
- Care recipient must not be eligible for similar Med-QUEST services
Apply through the Hawaii Department of Labor and Industrial Relations.
Where to start
The Hawaii Aging and Disability Resource Center (ADRC) at 643-ADRC (643-2372) is the single best starting point for any family caring for a kupuna at home. They can help map the available resources — Medicare home health, Med-QUEST HCBS, Kupuna Care, Kupuna Caregivers Program, Native Hawaiian Health Care System programs, and community resources — into a coordinated plan.
Frequently asked questions
Generally no. Original Medicare covers short-term skilled care (home health, hospice, SNF rehab), but not long-term custodial care — bathing, dressing, supervision. That's where Med-QUEST HCBS, Kupuna Care, and Kupuna Caregivers come in.
Through Med-QUEST's QI program, family members (other than spouses) may be paid as personal care assistants under specific arrangements. Kupuna Caregivers stipends pay the caregiver to purchase outside services rather than paying the caregiver for caregiving itself.
Med-QUEST HCBS is for income-eligible kupuna who would otherwise need nursing home care. Kupuna Care is state-funded and serves older adults who aren't Medicaid-eligible. Similar services, different populations.
Start with 643-ADRC. They'll do an intake assessment and help you map together Medicare home health, Med-QUEST or Kupuna Care services, the Kupuna Caregivers Program, and community resources into a workable plan.