More residential care homes for the elderly are opening up in dense, urban neighborhoods, spurring frictions as residents deal with delivery vans coming and going, family members visiting and workers parking their cars on the street.

And the tensions aren't expected to go away anytime soon, with an aging population in the Islands likely to need hundreds more care home beds over the next several decades.

Since 2000, state figures show, the number of residential care homes in the Islands has increased by nearly 19 percent, from 405 to 480.

Much of the recent growth of care homes is in Honolulu communities — and the disagreements are there, too.

In Manoa, residents are working to stop a care home operator from opening a third facility next to two she already owns. In Nu'uanu, residents fought a care home operator trying to open two facilities — opposing that even before he applied for the required state and city permits. And in Makiki Heights, neighbors sued the city after a care home operator was granted a permit to open a 16-bed facility in her home on two acres of land.

The scuffles have come to the attention of the state Health Department, which oversees licensing for care homes, and the city Department of Planning and Permitting, along with City Council members and legislators. The council is debating a resolution that would urge the city to consider traffic and other impacts in their care home permitting process. State policymakers are trying to decide whether there should be restrictions on the number of care homes in a given area.

The implications of the talks are widespread, and care home operators say the changes could restrict their ability to do business at a time when more residents are aging and need their services.

RESIDENTIAL IMPACT

But those who are fighting care homes in their neighborhoods say there should be a greater balance between the need for care home beds and the needs of the community. Care homes are considered "homes" — but they are anything but, they say, bringing plenty of traffic and parking headaches.

"In all cases, an ARCH (adult residential care home) is more than a single-family home. If you have nine people, they have to have Handi-vans come. They have to have deliveries come. It puts a burden on the facilities," said Gene Vricella, a Manoa resident who opposes the construction of a third care home in his neighborhood, the College Hill district. He said he is not opposed to care homes, but to "clusterings" of care homes — and wants restrictions on how many of the facilities can operate within a given area.

More than 100 people in Manoa signed a petition to stop more care homes from moving in until a study of the regulations could be completed. But a state House resolution calling for a review failed to pass through committee hearings earlier this month. Two City Council resolutions on care homes are still alive, however.

One would ask the city planning department to review existing permits for care homes, said permitting director Henry Eng, and a second asks the planning department to review all new applications for care homes.

Linda LeGrande, of Mohala Way in Manoa, said the impact of care homes should be just as well studied as vacation rentals and hostels. "These facilities, by nature of their purpose, impact our neighborhoods tremendously," LeGrande said, in testimony to the City Council. "Careful planning and sensible distancing between them in our residential neighborhoods will certainly resolve many of the issues that are bound to arise."

The care home industry in Hawai'i serves more than 2,500 elderly people, and charges from $2,500 to upward of $8,000 a month to give seniors a sense of quasi-independence, keeping them out of a nursing facility and in a home-like setting with 24-hour assistance. Care homes here tend to be run by small operators, not corporations. Most operators own one to two facilities.

AGING IN PLACE

The highest numbers of care homes can be found in Waipahu and Kalihi, where land is cheaper and turning a property into a care home makes more financial sense. But more care home operators are looking elsewhere on the island to set up facilities, saying many seniors like to "age in place" in their own communities.

"There's a great need for care homes, and there's a lot of elderly in Manoa," said Sandra Shim, who operates the two care homes near Vricella's home on McKinley Street and is working to open a third by the end of the year. Shim said though the homes are next to each other, they operate independently — as city rules dictate. She also said she is willing to work with her neighbors to iron out an equitable solution for everyone.

All of the permits for her third care home have been approved.

In all, there are eight care homes in Manoa. Five are permitted to service up to eight seniors, and three can have five at any one time.

Manoa Senior Care operates five homes in Manoa and two in Kaimuki. Paul Dold, Senior Care president, said the arguments over care homes in urban neighborhoods are similar to the disagreements over vacation rentals: Residents don't like the home next door converted into a business. But, he said, vacation rentals for tourists and care homes for longtime, elderly residents shouldn't be equated.

"I don't know that the traffic we generate is noticeably different than other single-family homes," he added. "It may be more, but I certainly do not see it as a problem. And our parking is prescribed by the city Department of Planning and Permitting."

Dold said he has never had a complaint about his homes in Manoa. But when he tried to set up two care homes in Nu'uanu in 2003, he was quickly bombarded with complaints. He never opened the facilities.

Regulations for residential care homes were set up in the 1960s, and revised in the 1980s, to address concerns over how the facilities were overseen.

Care home operators are quick to point out that though the number of care home facilities has grown statewide since 2000, there are actually fewer homes than in the 1980s. In 1986, for example, there were 550 care homes in Hawai'i.

Officials attribute the decline to a variety of reasons, but say the market was ripe at the time for people to buy homes relatively cheaply and convert them. Once the homes were converted, however, people lost money over time when operating facilities with five or fewer seniors and got out of the business.

STATE BACKING

From the state's perspective, care homes are a better option than nursing homes for many elderly residents who can largely take care of themselves but need some assistance.

The state Department of Human Services, which oversees Medicaid payments to the elderly, instituted a program in 2003 to get more people into care homes. The program allows Medicaid patients to go into residential care, rather than hospitals, and saves the state about $70,000 per patient each year.

In addition to the cost savings, health advocates for the elderly say many seniors don't like the idea of living in a large nursing home.

"What is unique about adult residential care homes is that they operate as a family unit," said Terri Byers, acting chief of the Office of Health Care Assurance at the Health Department. "People seem to prefer that their family members live in community-based residential family homes, versus in institutional-type settings."

Tim Lyons, legislative liaison for the Hawai'i Coalition of Care Home Administrators, said he expects the number of care homes to continue to grow as more and more Hawai'i residents enter retirement and need assistance.

"Overall, we're looking at a community that by 2020, one out of four of us will be over 60," Lyon said. "There's got to be some acceptance of these care homes going into this. To me, Manoa is being selfish."

The disagreements over care homes also extend to Makiki Heights, where neighbors of a planned care home at 2615 Tantalus Drive sued the city, saying the 16-bed facility should not be allowed in a residential area and its permit should be revoked.

The neighbors lost their suit last year, said John Steelquist, chairman of the Makiki Heights /Punchbowl/Tantalus Neighborhood Board, which opposed the care home. Meanwhile, the operator of the care home said she will move ahead with her plan — just not right away.

Reach Mary Vorsino at mvorsino@honoluluadvertiser.com.