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According to the 2012 Genworth Financial cost of care survey, the average cost of assisted living in California is $3,500 per month.
The monthly base rate for California assisted living is typically average when compared to neighboring states. California is also more expensive compared to the national average.
This cost is the base cost for a one-bedroom assisted living unit in California. Additional fees beyond the base rate may apply.
Monthly Costs Compared to Neighboring States
Residential Care Facilities for the Elderly or, RCFE is how California defines an assisted living facility. A new law specifies that residents needing assistance being transferred to and from bed (but not assistance with turning or repositioning) are allowed to remain or be accepted in facilities having secured a non-ambulatory fire clearance. Residents unable to turn or reposition themselves in bed are considered bedridden and can only be retained in facilities that have secured a bedridden fire clearance. An RCFE is a voluntarily chosen housing arrangement where 75% of residents are 60 years old or older and where different levels of care and supervision are given, as agreed to at the time of admission. Residents ages 18-59 must have needs comparable to other residents. Additional disclosures are required if the facility advertises or promotes any specialized care such as care of persons with dementia.
A Residential Care Facility for the Elderly provides both care and supervision to its residents. This includes help with activities of day-to-day living, observation, reassessment, and when appropriate, postural supports. Residents with the following conditions, or in need of the following medical services may be admitted or retained as long as the procedures and services requiring a nurse or physical therapist are provided by a skilled professional: administration of oxygen, catheter care, colostomy/ileostomy care, contractures, diabetes, enemas/suppositories, incontinence, injections, intermittent positive pressure breathing machines, stage I and II dermal ulcers, and wound care. Dementia and hospice care can be provided if statutory and regulatory requirements are being met. Staff is not allowed to provide care further than what is allowed within the parameters of the RCFE license. Outside agencies such as those providing home health or hospice services are able to provide licensed medical services within their scope of practice to residents at the facility. These services are restricted to treatment of those conditions allowed in a licensed RCFE setting.
Before accepting a resident the licensee or designated representative must complete an admission agreement with the resident and his/her responsible party. The agreement must include basic and optional services, service rates, payment provisions, and refund conditions. Written notice must be given to the resident 60 days prior to rate changes. For any rate increase due to a change in the resident's level of care, the licensee shall provide the resident and the resident's representative written notice of the rate increase within two business days after providing services at the newer level of care. The notice shall include an explanation of the additional services at the new level of care, along with an itemization of charges. The agreement must include eviction policies. The licensee must provide the basic services and assistance with daily living activities, and must have a criminal background clearance. Licensee can provide services including companionship or additional baths. They can assist with self administration of medication if the resident's physician documents that the resident can store and administer his/her own medications. Residents cannot be admitted or retained if they have active communicable tuberculosis; require 24-hour skilled nursing, intermediate care; have a mental disorder resulting in behavior upsetting the resident group; would require a greater amount of care and supervision than the other residents; or cannot benefit from program services provided by the facility. A facility may issue a 30-day notice to a resident for: nonpayment of the rate for services within 10 days of due date; failure to comply with state or local laws; failure to comply with facility policies; a need not previously identified if it is the facility is unable to meet the new need; or if there is a change in the use of the facility. The department may grant a three-day eviction notice if evidence supports the licensee's assertion that the resident poses a threat to themselves or to others.
Each resident is assessed prior to moving in, including an evaluation of functional capacity, mental condition, and social considerations. No standard form is required though assessment forms are available at www.ccld.ca.gov. It is required that the appraisal be updated annually, or at the time of any changes in condition. A comprehensive physician report is part of the resident assessment tool and must be updated with any changes in a resident's condition.
Unless facility staff is an appropriately skilled professional, he or she is not allowed to administer medications to residents, but can assist with self-administration of medications.
California state regulations allow private or semi-private resident rooms. Rooms must be furnished by the licensee or resident and be an appropriate size allowing for mobility of both the resident and any medical or mobility equipment. Two residents are allowed per bedroom. Private and shared toilets, bathing, and lavatory facilities are allowed. At least one toilet and washbasin is required for every six people, and one bathtub or shower for every 10 residents, including residents, family, and facility-dwelling staff.
Personnel employed by the facility must provide services necessary to meet resident needs at all times. In RCFEs caring for 16 residents or more must have staff available throughout the night. In facilities caring for those with dementia, an adequate number of direct care staff must be available to support each resident's physical, social, emotional, safety, and health care needs. In facilities with less than 16 residents, there must be at least one night staff person on duty if any resident with dementia is living in the facility. Administrators must complete a 40-hour Certification Training Program from one of the department's approved training vendors, and pass a written test. Administrators possessing a valid Nursing Home Administrator license are exempt from this training, but must complete 12 hours in the core areas of laws and regulations, use and misuse of medication, and resident admission, retention, and assessment procedures. Administrators in facilities with a capacity for 16 or more residents must also have certain levels of college education and experience providing care to the elderly. All staff must have verifiable work experience working with the elderly, or related experience in their job assignment. Staff assisting residents with personal daily living needs must receive at least 10 hours of training within the first four weeks of employment, and at least four hours every year thereafter. Training must be documented and kept in facility files/records. Food service and activity directors must have experience and education or training. Staff providing direct care to residents will receive training in first aid. Each RCFE will provide training in recognizing and reporting elder and dependent adult abuse. Training includes hands-on instruction in general procedures and resident-specific procedures. Staff will gain knowledge and the ability to recognize and respond to problems, and shall contact the physician, appropriately skilled professional, and/or vendor as necessary. Direct care staff assisting those with self administration of medication in must meet specified medication training requirements. In facilities licensed to provide care for 15 or fewer persons, direct care staff shall complete six hours of training, including two hours of hands-on shadowing. In facilities licensed to provide care for 16 or more residents, employees must complete 16 hours of training, including eight hours of hands-on shadowing. Direct care staff must pass an exam and complete additional training every 12-months. The training material and exam must be developed by, or in consultation with a licensed nurse, pharmacist, or physician. Facilities licensed for 16 or more residents are also required to keep documentation demonstrating that a consultant pharmacist or nurse has reviewed the facility's medication program and procedures twice a year. Administrators must complete 40 hours of continuing education every two years The 40 hours must include eight hours in Alzheimer's disease and dementia training. Licensed Nursing Home Administrators with are only required to complete 20 hours of continuing education. With prior course approval, 20 of the 40 hours of CE may be completed through on-line training.
The Department of Health Care Services administers a federal home and community-based services waiver to provide a Medi-Cal benefit to those individuals taking part in the Assisted Living Waiver. Participants must be both Medi-Cal eligible and nursing home eligible, and they may reside in either a licensed Residential Care Facility for the Elderly or publicly subsidized housing.
The State of California offers the Home and Community Based Services waivers and they are administered by the California Department of Developmental Services. The Assisted Living Waiver only targets seniors living in or are qualified for a nursing home.
The state of California believes that people qualified for nursing home care can receive the same quality of care in assisted living but at a lower cost to the state.
Medi-Cal (California Medicaid) pays for assisted living via the Assisted Living Waiver but the waiver is only available in 7 major counties:
- Los Angeles
- San Bernardino
- San Joaquin
The services provided under the Assisted Living Waiver:
- Assistance with activities of daily living such as bathing, grooming
- Assistance with the instrumental activities of daily living such as transportation and medication administration
- Health related services including skilled nursing if necessary
- Social and recreational activities
- Prepared meals
- Housekeeping and laundry
To determine an individual's Medicaid eligibility use the free service provided by the American Council on Aging http://www.medicaidplanningassistance.org/find-a-medicaid-planner.
Here is the full description of the additional seven California Waivers
HCBS Waiver for Californians is designed for individuals with autism and developmental disability. This waiver provides behavioral intervention, community living arrangements, day service, home health aide, homemaker, prevocational services, respite care, supported employment (enhanced habilitation), chore, communication aides, community-based training, dental, environmental accessibility adaptations, non-medical transportation, nutritional consultation, optometric/optician services, PERS, prescription lenses and frames, psychology services, skilled nursing, specialized medical equipment and supplies, specialized therapeutic services, speech/hearing and language services, transition/set up expenses, vehicle mods and adaptations.
Nursing Facility and Acute Hospital Waiver is designed for the medically fragile and technology dependent individuals of all ages. The waiver offers case management and coordination, habilitation, home respite, personal care services, community transition, continuous nursing and supportive services, environmental accessibility adaptations, facility respite, family/caregiver training, medical equipment operating expense, PERS-installation and testing, PERS, private duty nursing including home health and shared services, and transitional case management.
HIV/AIDS Waiver is designed for individuals with HIV/AIDS and offers enhanced case management, homemaker, attendant care, home delivered meals/nutritional supplements, Medi-Cal supplement for infants and children in foster care, minor physical adaptations to the home/specialized medical equipment and supplies, non-emergency medical transportation, nutritional counseling, psychotherapy, skilled nursing/licensed vocational nurse, skilled nursing/registered nurse.
Pediatric Palliative Care waiver is for the medically fragile and technology dependent individuals ages 0-20. It also offer care coordination, home respite care, expressive therapies, family counseling, family training, out of home respite care, pain and symptom management.
Assisted Living designed for people 65+; and for the physically disabled individuals ages 21-64. The assisted living waiver offer assisted care services like homemaker, home health aide, personal care, care coordination, environmental accessibility adaptations, and nursing facility transition.
Multipurpose Senior Services Program is designed for people 65 and older and offers care management, respite care, supplemental personal care, adult day care, adult day support center, communication, housing assistance, nutritional services, protective services, purchased care management, supplemental chore, supplemental health care, supplemental professional care assistance, supplemental protective supervision, transportation.
In Home Operations is designed for the medically fragile and technology dependent individuals of all ages. This waiver provides case management, coordination, habilitation services, home respite, waiver personal care, community transition, environmental accessibility adaptations, facility respite, family training, medical equipment operating expense, PERS-installation and testing, PERS, private duty nursing-including shared services, transitional case management.
Department of Social Services, Community Care Licensing Division Phone (916) 651-3456
Contact: Fernando Sandoval Phone (916) 654-2105
Web Site: http://www.ccld.ca.gov
What is the best number to call to get started? Call (916) 654-1888.
Is there a website? http://www.dds.ca.gov
Much of the information above was adapted from the National Center of Assisted Living 2010 Regulatory Review.
License information source: California Department of Social Services
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