In California, Residential Care Facilities for the Elderly offer a place to live with different levels of full-time care. These residences must:
– Have adequate supervision
– Have a structured activity program
– Have enhanced safety including locks and alert devices
That means, in California a residence cannot safely care for someone with dementia unless it has a formal program in place to meet the needs of dementia patients. There are about 1,300 memory care communities in California. In addition, there are also more than 6,000 board and care homes. These are smaller home-like residences that can offer personal and healthcare options for your loved one. Given the vast number of options, there is free assistance to help families choose among them.
California’s Community Care Licensing Division, run by the Department of Social Services, governs all assisted living facilities in the state.
The average cost of memory care in California is $6,368 per month. This includes room, board and general care. Residential care facilities are prohibited from changing pricing without 60 days advance notice.
With the expensive average monthly price, you may be able to find more affordable memory care in a neighboring state. For example, if you live to the east in the San Joaquin Valley both Nevada and Arizona are less expensive. In Nevada, memory care costs about $4,527 per month and in Arizona it is $4,859 monthly. The difference in prices can be huge, so be sure to assess all your options for assisted living before agreeing to move your loved one into a memory care residence. Northern Californians will be interested to know that Oregon’s memory care costs are similar to California’s running $6,110 monthly.
California is the country’s most populated state, so of course the pricing varies depending where you live, coastal or inland. The most expensive place for memory care is in Santa Rosa, costing $8,540 monthly. The least expensive is Visalia, charging $4,159 per month. Other major cities include:
|California Memory Care / Assisted Living Costs (updated June 2022)|
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In California, there are a number of conditions one must meet before being admitted to a residential care facility. Residents must be assessed for functional capacity, mental condition, and social factors before admission. This assessment can be performed by staff at the residence. While there is not a standard form, a Functional Capability Assessment is available here. Whatever form is used, an assessment must be updated yearly or whenever there’s a major change in your loved one’s condition. The cost of this assessment should not be an additional fee; it’s part of moving in, and should be covered under the basic rate.
Admission also requires a separate, detailed medical report. A good way to begin the process of moving into memory care in California is to make an appointment with your loved one’s doctor and ask for this report. The doctor can guide you on what to look for, including helping to know what level of care is required. Paying for this doctor’s evaluation is probably the responsibility of the person moving in. If your loved one is on Medicare, an annual free “wellness visit” (also called a “cognitive assessment”) that screens for dementia symptoms is covered.
Residents who need help with all activities of daily living (even people with dementia can usually perform some ADLs without assistance) cannot be admitted unless they’ve submitted a written exception request to the Department of Social Services, and been approved. A residence cannot admit someone who needs 24-hour skilled nursing care or has a mental disorder that disrupts a group unless all guidelines are met. In addition, people with the following conditions also cannot be admitted:
– Stage 3 or 4 dermal ulcers
– Gastrostomy care
– Naso-gastric tubes
– Staph infection or other serious infection
The signed admissions agreement must list all services, rates, payment provisions, and conditions that would allow for refunds. It must explain billing and payment procedures and the conditions that could cause rates to increase. Any factors that could lead to eviction (see below) must also be listed.
Because it can take months between picking a residence and actually moving in, you’ll want to start looking as soon as possible. Your loved one will also be able to provide more input the sooner you start your search. It is possible to move into memory care on short notice, but the longer you spend investigating options, the more likely you are to find a home that’s a good fit. This is especially true because some residences have extended wait lists for admissions.
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.” 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. There must be one toilet and sink for every six residents, and a bathtub or shower for every 10.
In memory care homes for people with dementia, doors with outdoor access require special locks to prevent people from wandering outside and getting lost. Unlike in other states, California memory care homes are not required by regulations to be designed with dementia-friendly features like clear layouts and circular hallways. This is another reason to carefully inspect a residence before moving in; keep an eye on whether you think your loved one could get lost or confused by the buildings’ designs.
There is no specific staffing ratio that must be met in California, though staffing “must be sufficient” for the number of residents throughout the 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 in residential care facilities must be at least 18 years old, with on-the-job training. Additionally:
–Initial training in the first month of hiring is 40 hours total. 20 hours must be done before they can work with patients and 12 hours must be focused 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.
The admission agreement signed when moving in must include information about evictions, including all the reasons a person can be asked to leave the residence. An eviction notice can be issued that gives someone 30 days to move out, for the following reasons:
– Nonpayment within 10 days of the due date
– Illegal behavior
– Not following the residence’s policies
– Resident’s health needs have changed and the residence can no longer safely provide care
If a resident’s behavior is considered threatening to anyone in the residence, it’s possible that the state’s Department of Social Services would approve a three-day eviction notice, rather than the usual 30 days. A judge’s order is required to remove someone who doesn’t leave voluntarily after receiving an eviction notice. Help with relocation must be made available to someone being evicted. For general information on what to do if you receive an eviction notice in memory care, click here.
Medicaid is a jointly funded federal and state program. In California the program that provides long-term care and support is called Medi-Cal. For financially qualified people, Medi-Cal will help cover the cost of nursing homes for patients that require round-the-clock nursing care. 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 personal care in assisted living and memory care, though your loved one will still need to pay toward their room and board.
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.
California residents who do not currently reside in one of those counties can gain admission by moving to an assisted living / memory care home located in one of those counties.
For additional information on the program, including how to enroll, click here. Medi-Cal eligibility details are here and a Medi-Cal Spend-Down Calculator here.
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 the form of addition to Medi-Cal benefits. The monthly cash payments received through these programs can average around $1,200 per month for someone in assisted living. The Social Security Administration determines whether your loved one is eligible based on federal rules. For more on eligibility and how to apply, click here.
Veterans are statistically more likely to develop dementia. Among the reasons for this is that traumatic brain injuries and posttraumatic stress disorder lead to a higher probability of developing the condition. The VA offers many benefits for Alzheimer’s and dementia as well as different pension types.
There are three types of VA Pensions available. The benefits change annually and are valid from December 2022 to December 2023. The benefits (and their maximum allowance) are as follows:
1) Basic Pension – This benefit is also known as a death pension. It is for veterans and surviving spouses who are aged or disabled. The qualifying disability does not need to be related to their military service. On an annual basis, the Basic Pension pays:
– Veterans without spouses or children up to $16,073
– Veterans with dependent spouses or children up to $21,001
– Surviving spouses without dependent children up to $10,756
2) Aid & Attendance – Abbreviated as A&A, this is an important program for veterans and their surviving spouses who require assistance with activities of daily living. This means they need assistance with activities like bathing, dressing, and eating. A&A is particularly helpful for people with dementia, especially in the middle and later stages of the disease, when the need for more assistance becomes necessary. A&A is intended to help with the long-term care costs of adult day care, in-home care, assisted living, memory care, and skilled nursing. Based on an individual’s need and the progression of the disease, most of these additional services that support your loved one will become necessary. Annually, the A&A pays:
– Veterans without spouses or children a maximum of $26,751
– Veterans with dependent spouses or children a maximum of $31,713
– Surviving spouses without dependent children a maximum of $17,191
3) Housebound – For veterans and surviving spouses who are permanently disabled and unable to leave their homes, making them require additional assistance. The definition of “home” can include assisted living, memory care, and nursing home. The Housebound pension, like the A&A pension, is meant to help cover long-term care costs. Annually, the Housebound pays:
– Veterans without spouses or children a maximum of $19,598
– Veterans with dependent spouses or children a maximum of $24,562
– Surviving spouses without dependent children a maximum of $13,145
There are eight veterans’ homes in California, which are residential care facilities that provide long-term care for veterans. They are scattered throughout the state and located in Barstow, Chula Vista, Yountville, Lancaster, Fresno, Ventura, Redding, and Los Angeles. Given that California has almost two million veterans, more than any other state, services are impacted. For help finding the right residence for a loved one who served, contact the VA. Patients who live near Nevada, Arizona, or Oregon might also consider looking across the state border. More info.
1) Elder care loans exist for families to cover the costs of moving into memory care while waiting for other financial resources to become available. For example, if one is waiting for a VA pension to be approved or waiting to sell a home. More on bridge loans for memory care.
2) 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). Remember also that medical and dental expenses can be deducted, and that can include assisted living costs.
3) A reverse mortgage can be an option for a married person moving into memory care, if their spouse continues to live in the home. However, if the spouse moves from their home, the reverse mortgage becomes due.