In California, “Residential Care Facilities for the Elderly” (RCFEs) offer varying levels of full-time care, mostly for people over 60. How much care your loved one receives is based on an agreement made at the time of admission, or determined upon formal follow-up assessments. Generally, care and supervision in RCFEs includes assistance with activities of daily living (ADLs), like cleaning, dressing, and getting around from place to place. Residents who need specialized help with things like catheters, oxygen, and regular injections can be admitted to RCFEs so long as all regulations are followed and staff is appropriately skilled.
Two residents per bedroom is the maximum amount allowed by California law.
RCFEs with residents who have Alzheimer’s disease or a related dementia are often called Alzheimer’s care home, dementia care, or memory care. An RCFE cannot admit people with dementia unless a number of boxes get checked, among them:
– An annual medical assessment
– Adequate supervision
– A structured activity program
– Enhanced safety (including locks and alert devices)
In other words, a residence cannot safely care for someone with dementia unless it has a program in place to meet needs specific to that disease. Fortunately, many do.
RCFEs are governed by California’s Community Care Licensing Division, under the Department of Social Services. Other terms for RCFEs in California include assisted living facilities, retirement homes, and board and care homes.
The average cost of memory care per month in California is $5,903, which breaks down to about $194 per day and $70,836 annually. The services covered by these payments should include room and board and general care, but it’s important to note that California RCFEs must complete an admission agreement before admitting any resident. That agreement details all services, rates, payment provisions (see below), and conditions that would allow for refunds.
Assisted living, without the additional services required for memory care, costs California residents about and $4,511 per month and $54,132.
California is the country’s most populated state, so of course the pricing varies depending where you live. The most expensive place for memory care is San Jose, running $7,658 per month and $91,896 annually. The least expensive is Merced County, for $4,148 per month and $49,776 annually. Other notable cities include Los Angeles (where memory care costs $5,903 per month and $70,836 annually), San Francisco ($6,222 per month and $74,664 annually), and San Diego (same as San Francisco: $6,222 per month and $74,664 annually).
In California, there are a number of conditions one must meet before being admitted to an RCFE. A residence cannot admit someone who needs 24-hour skilled nursing care. A resident cannot be admitted with a mental disorder that disrupts a group, including dementia, unless other guidelines (see below) are followed.
People with the following conditions cannot be admitted to an RCFE:
– Stage 3 or 4 dermal ulcers
– Gastrostomy care
– Naso-gastric tubes
– Staph infection or other serious infection
Residents who need help with all activities of daily living cannot be admitted unless they’ve submitted a written exception request to the Department of Social Services, and been approved.
In addition, residents must be assessed for functional capacity, mental condition, and social factors before admission. That appraisal must be updated once per year, or whenever there’s a major change in your loved one’s condition. Admission also requires a detailed report from your loved one’s doctor, to be updated if, again, there’s any major change in condition.
Because it can take months between picking a residence and actually moving in, you’ll want to begin the process as soon as possible. Your loved one will also be able to provide more input the sooner you start scouting locations.
Residents’ rooms don’t need to be a specific size, except that they must “be of sufficient size to allow for mobility of the resident and equipment.” Lots of wiggle room there, so be sure to see exactly where your loved one will sleep before you sign an agreement, to assess whether there’s enough space. Bedrooms may have two residents at most. And there must be one toilet and sink for every six residents, and a bathtub or shower for every 10.
There is no specific staffing ratio that must be met in California, though staffing “must be sufficient” for the number of residents throughout both day and night. An administrator or manager who is certified and at least 21 years old must be on the premises 24 hours per day. All other staff at a California RCFE must be at least 18 years old, with on-the-job training or relevant experience. More specifically, an employee needs 40 hours of initial training: 20 hours of training before working solo with any residents, and then 20 more hours completed within the first four weeks of employment. Importantly, 12 of those initial 40 training hours must be specifically on dementia care.
– Staff who work directly with residents need 20 hours of training annually, including eight hours of dementia-care training.
– First aid training is also required. Someone trained to do CPR must be working at the residence at all times.
– All training for every employee must be documented by the facility.
– Residences must train staff to recognize elder abuse.
– Residents with specialized health conditions, like diabetes, must be cared for by staff with training from a licensed professional that meets the specific need.
– Staff who handle medications must meet training requirements that vary depending on the number of residents.
Medicaid is a jointly funded federal and state program, and in California the program that provides long-term care and support is called Medi-Cal. Medi-Cal will help cover the cost of nursing homes for residents with specific health needs that require round-the-clock nurse care, but Medi-Cal generally does not pay for assisted living or memory care except through a program called the Assisted Living Waiver (ALW). ALW is a Home and Community-Based Services (HCBS) program that pays for expenses in assisted living, though your loved one will still need to pay toward room and board. ALW can cover some home healthcare costs as well.
To qualify for ALW’s help with assisted living or memory care, your loved one must live in a residence licensed by the state. These residences are only in the following counties: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, and Sonoma. Approved residences in these counties are called Residential Care Facilities for the Elderly (RCFEs). More on Medicaid eligibility.
A person in assisted living who needs additional help covering costs may be eligible for combined federal and state assistance through the SSI and SSP programs, often in addition to Medi-Cal benefits. The monthly payments received through these programs is a little less than $1,200 per month for someone in assisted living.
Veterans are statistically more likely to develop dementia. Relevant in all states including California is the VA’s Aid & Attendance pension program for veterans and surviving spouses, which is an amount of money added to veterans’ and survivors’ basic pension. Applicants must be at least 65 years old (or disabled) and require assistance with activities of daily living (ADLs) like eating, bathing, and mobility. The cash assistance from these pensions can be used as the recipient wishes, meaning it can go toward the cost of memory care. In addition, the cost of residential care can be deducted from one’s income, effectively reducing the amount of calculable income used to determine the benefit amount. The latest (2020) maximum amount a veteran can receive through A&A is $27,194 per year, and surviving spouses can receive as much as $14,761. Learn more here.
There are also Veterans homes in California, which are residential care facilities that provide long-term care for veterans. In addition to nursing home care, assisted living and memory care may be provided. Payment is made directly from the VA to the facility. State veterans homes are typically reserved for veterans whose need for care stems at least 70 percent from their military service. Because there is often a waiting list, contact a home before visiting to see if your loved one is eligible to live there.
Other ways to help pay for assisted living with memory care include tax credits and deductions like the Credit for the Elderly and the Disabled, or the Child and Dependent Care Credit (if you can claim your elderly loved one as a dependent). California also has a state version of the Dependent Care Credit. Remember also that medical and dental expenses can be deducted, and that may include some assisted living costs.
A reverse mortgage may be a good option for a married person moving into memory care, if their spouse continues to live in the home. Should their spouse move from their home, the reverse mortgage would become due.
Elder care loans are for families to cover initial costs of moving into memory care, if you need a little help at first but can afford costs after the initial payments. For example, if one is waiting for a VA pension to be approved or waiting to sell a home.