In California, “Residential Care Facilities for the Elderly” (RCFEs) offer a place to live with different levels of full-time care, including options for people who have dementia. Generally, care and supervision in RCFEs includes assistance with activities of daily living (ADLs) like cleaning, dressing, and eating. RCFEs with residents who have Alzheimer’s disease or a related dementia (including vascular dementia, Lewy body dementia, and frontotemporal dementia) are often called Alzheimer’s care homes, 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, in California a residence cannot safely care for someone with dementia unless it has a formal program in place to meet needs specific to that disease. Fortunately, many do: There are about 1,300 memory care communities in California. There are also more than 6,000 board and care homes, which are smaller house-like residences that can likewise offer personal and healthcare options for people with dementia. Given the vast number of options, it is fortunate there is free assistance to help families choose among them.
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 and retirement homes.
The average cost of memory care per month in California is $5,380, which equals $64,560 annually. Services covered includes room, board and general care. RCFEs are prohibited from changing pricing without 60 days advance notice.
If you live near the state’s eastern border (in the San Joaquin valley, for instance), you may be able to find more affordable memory care in a neighboring state. Nevada and Arizona are both less expensive. In Nevada, memory care costs about $4,070 per month and $48,840 annually, and in Arizona those figures are $4,470 per month and $53,640 annually. 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. (North-north Californians will be interested to know that Oregon’s memory care costs are, on average, the same as California’s.)
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 $6,970 per month and $83,640 annually. The least expensive is Merced County, for $3,780 per month and $45,360 annually. Other notable cities include: .
|California Memory Care / Assisted Living Costs (updated Oct. 2020)|
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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 (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.
In addition, residents must be assessed for functional capacity, mental condition, and social factors before admission. This assessment can be performed by staff at the residence itself, and while there is not a standard form, a “Functional Capability Assessment” is available here. Whatever form is used, the appraisal must be updated once per year, 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 report from your loved one’s doctor, to be updated if, again, there’s any major change in condition. 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.
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 scouting locations. 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 perfect. This is especially true because some residence 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.” 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.
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 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.
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, and in California the program that provides long-term care and support is called Medi-Cal. For financially qualified persons, Medi-Cal will help cover the cost of nursing homes for persons 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 personal care in assisted living / memory care, 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. 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.
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 cash payments received through these programs is a little less than $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. 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 eight veterans’ homes in California, which are residential care facilities that provide long-term care for veterans. These are located in Barstow (north of San Bernardino), Chula Vista (near San Diego), Yountville (north of Napa), Lancaster (in northern Los Angeles county), Fresno, Ventura (on the coast, northwest of LA), Redding (in northern California), and Los Angeles. Given that California has almost two million veterans, more than any other state, it’s possible that none of these locations will be helpful for some people who need these services. For help finding the right residence for a loved one who served, contact the VA. Folks who live near Nevada, Arizona, or Oregon might also consider looking across the state border.
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.