Honolulu, Hawaii's Honolulu County seat, has 18 Medicare-certified nursing homes with approximately 1,990 beds. Families should research carefully—quality varies significantly from one facility to the next.

Honolulu vs. Hawaii: A Concerning Gap

Honolulu nursing homes fall below the state average on key quality metrics. The city's average CMS rating of 3.00 stars trails Hawaii's statewide average of 3.44 stars by nearly 0.4 stars—a significant gap that families should take seriously. The below-average performance is somewhat surprising for a major urban area, where competition and workforce availability typically drive higher quality.

Federal inspection data reveals 6 facilities classified as high-risk based on patterns of serious deficiencies, complaints, or CMS enforcement actions. Only 3 of 18 facilities earn a B grade or better, meaning families should be prepared to look beyond the closest option to find quality care.

Understanding Our Trust Score System

The Trust Score is a 0-100 rating calculated from CMS's official nursing home database. The score combines five data categories:

• Health Inspection Results — Recent deficiencies, their severity, and patterns over time
• Staffing Levels — RN hours, total nursing hours, and weekend staffing
• Quality Measures — Clinical outcomes like falls, pressure ulcers, and rehospitalizations
• Penalties — Fines, payment denials, and enforcement actions
• Complaints — Substantiated complaints and their severity

In Honolulu, 3 facilities score a B grade or better, indicating they meet quality benchmarks across these categories. We recommend families prioritize these facilities and carefully research any facility rated C or below before visiting.

Staffing: Meeting Standards in Honolulu

Staffing levels are among the most important predictors of nursing home quality. Research consistently shows that facilities with more nursing staff—especially registered nurses—have better outcomes for residents.

Honolulu facilities average 1.56 RN hours per resident day, which meets the CMS-recommended threshold of 0.75 hours. The typical Honolulu resident receives approximately 94 minutes of RN attention daily—compared to the 45 minutes experts recommend.

12 Honolulu facilities exceed CMS staffing recommendations. Families prioritizing staffing should look for facilities with the "Top Staffing" badge and ask specifically about RN hours during facility visits.

Ownership: Mix of For-Profit and Non-Profit

Honolulu has 5 non-profit nursing homes and 11 for-profit facilities. 5 of 18 facilities are chain-owned, with the remainder independently operated.

Research suggests non-profit facilities often have higher staffing levels and fewer deficiencies on average, though ownership type alone does not guarantee quality. Families should evaluate each facility individually using inspection data, staffing levels, and recent deficiency reports.

Nearby Alternatives Worth Considering

Honolulu's below-average ratings mean families may benefit from expanding their search to nearby cities. The following Hawaii cities offer multiple nursing home options:

• Hilo — 5 facilities
• Kaneohe — 3 facilities
• Waimea — 2 facilities
• Kahului — 1 facilities
• Honokaa — 1 facilities
• Kapaa — 1 facilities