
How To Start a Home Care Business in Hawaii
Anton FonsekaAre you passionate about making a difference in Hawaii’s aging community? Dreaming of launching a business that’s both rewarding and in high demand? Starting a home care agency in Hawaii is one of the most impactful ways to serve the islands’ kupuna (elders) while building a sustainable, future-proof business. But where do you begin? Hawaii’s regulatory landscape, unique demographics, and cultural expectations can feel overwhelming. That’s why we’ve created this in-depth, step-by-step guide—so you can launch your agency with clarity, confidence, and compliance.
Why Hawaii is the Perfect Place for Home Care
The Silver Tsunami is Here
Hawaii’s population is aging faster than almost anywhere else in the United States. By 2035, nearly 30% of Hawaiians will be 65 or older—and the number of residents aged 85+ is expected to triple by 2040. With a significant number of seniors today (according to recent data, 21.5% of the population was over 65 in 2024) and more than 70% preferring to age at home, the demand for compassionate, reliable home care is skyrocketing.
Cultural Expectations and Family Needs
In Hawaii, family is everything. Multigenerational households are common, and many families want to care for their elders at home. But with rising costs of living, workforce shortages, and more dual-income households, families often need outside help. Home care agencies that understand and respect Hawaii’s diverse cultures—from Native Hawaiian to Filipino, Japanese, and beyond—are in especially high demand.
The Market Opportunity
- Home care industry growth: Projected at significant rates nationally over the next decade.
- Average hourly rates: Often range from $30–$40 for private pay clients in Hawaii.
- Medicaid/Med-QUEST: Hawaii's Medicaid program (Med-QUEST) covers eligible seniors, with specific reimbursement rates.
- Veterans: Over 87,000 in Hawaii, many eligible for VA home care benefits.
Step 1: Understand the Home Care Industry Landscape
Before you register your business, take time to research:
- Types of services: Non-medical (personal care, companionship, homemaking) vs. medical (skilled nursing, therapy).
- Competitors: Who’s serving your area? What services are missing?
- Target clients: Seniors, veterans, individuals with disabilities, and their families.
- Referral sources: Hospitals, clinics, senior centers, and community organizations.
Pro Tip: Agencies that offer culturally sensitive care and bilingual staff have a clear edge in Hawaii’s diverse communities.
Step 2: Decide on a Business Structure
Your business structure affects your liability, taxes, and day-to-day operations. The two most popular options for home care agencies are:
LLC (Limited Liability Company)
Pros:
- Flexible management
- Pass-through taxation (no double tax)
- Personal asset protection
Cons:
- Can be harder to raise investment capital
Corporation (C-Corp or S-Corp)
Pros:
- Easier to raise funds
- Strong liability protection
Cons:
- More formalities (board meetings, annual reports)
- Potential for double taxation (C-Corp)
Most Hawaii agencies choose LLCs for their simplicity and protection, but consult with a business attorney or CPA to decide what’s best for you. For more guidance, check out our article on how to form an LLC and obtain an EIN for home care startups.
Step 3: Register Your Business Entity
- Choose a unique name and check availability with the Hawaii Department of Commerce and Consumer Affairs (DCCA) Business Registration Division (BREG).
- File Articles of Organization (LLC) or Articles of Incorporation (Corporation) with DCCA BREG.
- Register a trade name (DBA) if you’ll be operating under a different name (also via DCCA BREG).
- Apply for a General Excise Tax (GET) license with the Hawaii Department of Taxation.
Step 4: Obtain an Employer Identification Number (EIN)
Apply for an EIN with the IRS online. You’ll need it to open a business bank account, hire employees, and handle taxes.
Step 5: Draft a Comprehensive Business Plan
A strong business plan is your roadmap to success—and essential for investors, lenders, and licensing bodies. Consider resources from the U.S. Small Business Administration (SBA).
Your plan should include:
- Executive summary
- Market analysis (including Hawaii’s unique demographics)
- Services offered
- Marketing strategy
- Financial projections and budgeting
- Operational plan
Need a shortcut? Our Home Care Business Plan Template is designed for Hawaii’s market and ready for SBA loans and licensing applications.
Step 6: Define Your Services and Target Market
- Personal care: Bathing, dressing, grooming
- Homemaking: Meal prep, laundry, errands
- Companionship: Social activities, transportation
- Specialized care: Dementia, diabetes, post-hospital recovery
- Telehealth: Virtual check-ins and medication reminders (especially valuable for rural and inter-island clients)
Identify your ideal clients and tailor your services to their needs. Consider offering bilingual staff or culturally specific programs.
Step 7: Financial Projections and Budgeting
Typical startup costs in Hawaii:
Expense | Estimated Cost |
---|---|
Licensing fees | $1,200+ (Check current OHCA fees) |
Insurance | $3,500+/year (Varies widely) |
Office space (Oahu example) | $1,200+/month (Varies widely by location) |
Marketing | $2,000+ (Initial setup) |
Staff recruitment/training | $5,000+ |
Revenue streams:
- Private pay clients
- Medicaid/Med-QUEST
- Long-term care insurance
- VA benefits
Tip: Build a buffer for Hawaii’s higher wages and cost of living.
Our business plan template includes Hawaii-specific financial models.
Step 8: Apply for Necessary Licenses
Home Care Agency License
Apply through the Hawaii Department of Health's Office of Health Care Assurance (OHCA).
Submit a detailed application with:
- Policies and procedures manual
- Staff credentials and background checks
- Emergency preparedness plan
Pay the application fee (confirm current fee with OHCA). Prepare for an onsite survey and inspection.
Tax Identifications and Healthcare Accreditations
Register for Hawaii state taxes (GET, withholding if applicable) via Hawaii Tax Online and unemployment insurance via the Department of Labor and Industrial Relations. Consider accreditation from organizations like ACHC, CHAP, or The Joint Commission for Medicare/Medicaid billing and demonstrating quality.
Don’t risk costly delays! Our End-to-End State Licensing Guidance walks you through every step, ensuring you’re compliant from day one.
Step 9: Develop Policies and Procedures
Your policies and procedures are the backbone of your agency. They must comply with Hawaii (HAR Chapter 11-700) and federal standards, covering:
- Client intake and care planning
- Staff training and supervision
- Infection control and safety
- Abuse prevention and reporting
- Emergency preparedness
Most licensing delays are due to incomplete or non-compliant policies.
Our Hawaii Customized Policies and Procedures are audit-ready and tailored to local regulations.
Step 10: Understand Healthcare Licensing Processes
- State requirements: Home care and home health agencies have different licensing paths via OHCA. If you plan to offer skilled nursing or therapy (home health), you’ll need a separate license.
- Federal requirements: If you want to accept Medicare/Medicaid, additional certifications and surveys are required through the Centers for Medicare & Medicaid Services (CMS) process, often facilitated by OHCA or an accrediting body.
- Renewal and compliance: Licenses must be renewed regularly; maintain meticulous records and stay up to date with regulatory changes.
Step 11: Staff Your Agency with Qualified Professionals
- Recruitment: Advertise locally, partner with training schools, and tap into Hawaii’s diverse workforce.
- Training: While Hawaii doesn’t mandate specific hours for non-medical aides under HAR 11-700, best practice includes training in dementia care, infection control, emergency procedures, and cultural sensitivity.
- Background checks: Required for all staff per state regulations.
- Certifications: Ensure nurses and therapists (if providing home health services) hold valid Hawaii licenses.
Pro Tip: Offering continuing education and cultural competency training helps retain staff and improves client satisfaction.
Step 12: Obtain Suitable Business Insurance
- General liability insurance
- Professional liability (malpractice) insurance
- Workers’ compensation (required for employees in Hawaii)
- Property insurance (for your office)
Work with a local insurance agent familiar with Hawaii’s healthcare sector.
Step 13: Consider Innovative Programs
- Telehealth services: Remote monitoring, medication reminders, and virtual visits are especially valuable for clients on neighbor islands or in rural areas.
- Fall prevention: Implement evidence-based programs to reduce hospitalizations.
- Respite care: Support family caregivers and prevent burnout.
Step 14: Market Your Home Care Services
- Branding: Choose a name and logo that reflect Hawaiian values.
- Online presence: Build a user-friendly website optimized for keywords like “home care Oahu” and “kupuna care Hawaii.”
- Community networking: Partner with hospitals, senior centers, churches, and cultural organizations.
- Client testimonials: Showcase your commitment to compassionate, culturally sensitive care.
Step 15: Leverage Resources from Consultants
Launching a home care agency is complex, but you don’t have to do it alone. Consultants can help with:
- Operations and compliance
- Licensing and policy development
- Strategic growth planning
Our team at CarePolicy.US specializes in Hawaii’s market and can guide you every step of the way.
Step 16: Set Up an Equipped Office
- Location: Choose a space that’s accessible and professional.
- Technology: Invest in secure record-keeping, scheduling software, and telehealth platforms.
- Supplies: Stock up on PPE, medical equipment (if applicable), and office essentials.
Step 17: Adhere to Local Regulations
- Business laws: Stay current with Hawaii’s business and employment regulations.
- Environmental and safety standards: Ensure your office and services meet all requirements.
- Non-discrimination and accessibility: Serve all clients equitably.
Conclusion: Your Next Steps to Success
Starting a home care business in Hawaii is a powerful way to serve your community and build a legacy. The key is preparation: understand the market, comply with regulations, and deliver culturally attuned, high-quality care.
Ready to turn your vision into reality?