What You Must Know About Assisted Living Facilities
by Karl Kim, CFP, CLTC
One of the major issues facing care givers today is determining what level of facility care to place their loved one at when more help is needed. The choices are varied and there is little guidance available to help care givers.
The levels of long-term care are:
1. Home Care. These services are provided by home health care agencies many of which advertise on television today. Typical services include shopping, cleaning, cooking, help with medication, personal care and other activities of daily living.
2. Home Health Care. Services are provided by licensed health care professionals and may be prescribed by a doctor and may be covered by Medicare or health insurance.
3. Adult Day Care Services (ADC). The person goes to a center for 5-8 hours per day while the caregiver is at work. It is analogous to day care for kids. Depending on the licensing, there may be a Registered Nurse on staff or Certified Nursing Assistants.
4. Independent Living Facility aka Retirement Home. Everyone has their own apartment and must be independent. Meals are served three times per day in a central dining room. Residents are free to come and go as they please. Typically there are many activities and social events. The fancier places may have a gym, library, club house or lounge or even a swimming pool.
5. Assisted Living Facility or Residential Care Facility for the Elderly (RCF) in California. This is the level of care that will be described in this article.
6. Intermediate Care Facility (ICF). There are only two free standing ICF’s in California. This is more of a transitional care level between a RCF and skilled care nursing facility or nursing home (SNF). Medi-Cal does pay for this level of care. Residents must be ambulatory but can use a walker.
7. Skilled Care Facility aka nursing home (SNF). Can provide both short term rehab care and long-term care. Licensed by the California Department of Health Services. Care is provided by licensed health care workers such as Certified Nursing Assistants (CNA), Licensed Vocational Nurses (LVN) and Registered Nurses (RN). Medi-Cal, Medicare and Medigap insurance may cover this level of care.
8. Sub Acute Care Facility. Just below hospital care. This level of care is for patients with tracheotomies and quadriplegics on 24 hour life support or require services that a SNF cannot provide. Medi-Cal also covers this level of care. This is the most expensive level of long-term care with monthly costs from $25,000-$35,000.
The decision arises when the senior no longer is able to function independently and needs assistance. 24 hour licensed home care is very costly and so some level of facility care is contemplated.
To determine the appropriate level of facility care, input from the senior’s doctor is recommended. There are also Geriatric Care Managers that can be retained for a reasonable fee to provide an assessment of the care level needed.
Another option is to have an assessment done by the head nurse of a facility. These assessments are done to ensure that the resident is suitable for the facility and services provided.
If they are not, the nurse will recommend the appropriate level of care.
The bottom line is that an assessment done by a health care professional should be done. This is an unemotional and objective assessment based on what is the best for the senior.
What our office often sees is placement at a level of care below what the senior needs. There are many reasons for this. Even when nursing home care is recommended, the guilt of having to admit a loved one to a nursing home is often too much to bear.
Often times the senior has extracted a promise from the care giver that they will never place them in a nursing home.
Some level of care is still needed because the care giver has a full time job, their own family to take care of, or is just exhausted from the responsibilities of care giving. In a lot of cases, their own health has deteriorated.
So the next best option is an assisted living facility otherwise called a Residential Care Facility for the Elderly (RCF) in California.
Part of the difficulty that we have seen over the past few years is that more and more RCF’s are acting like nursing homes. This is because as private pay facilities they need to keep their beds filled.
RCF’s can provide care greater than help with the activities of daily living but this care must be performed by an “appropriately skilled professional”. The problem is often times the care is not to keep costs down.
The other part of the conflict is that a larger RCF many times is decorated nicely and is pleasant for the care giver to look at.
This nice looking environment is done to make the care giver feel less guilty. So even though 24 hour skilled care by licensed health care professionals may be needed, adult children are hesitant about moving their parent from a nice environment to a nursing home environment.
In addition, the business office person will reassure the care giver that they are more than able to take care of the senior. What the care giver doesn’t know is that the RCF is a for profit business that needs customers. The bottom line is all they care about.
This is the main reason that we recommend an assessment from an objective and unbiased health care professional such as a geriatric care manager.
RCF is a broad term covering small 6 bed board and care homes to 100+ beds RCF’s. In California, there are over 8100 RCF’s providing assistance with the activities of daily living such as bathing, dressing, toileting, urinary and bowel care.
The RCF will also provide room, 3 meals a day and snacks, activities as well as protective supervision. Generally, the resident must be independent and able to perform most of the activities of daily living.
However, a facility can obtain a non-ambulatory waiver which will allow them to take care of a resident in a wheelchair or bed bound.
A RCF is not required to have a doctor or nurses on staff. But can help residents with medication management. If the residents have more serious health care needs, a home health care agency nurse or other professional is used.
RCF’s are licensed by the California Department of Social Services where as nursing homes are licensed by the California Department of Health Services. This is an important difference.
Eventually, what it usually comes down to all of the senior’s liquid cash is almost spent down and panic about how to continue paying, sets in. Because Medi-Cal does not pay for RCF’s, the resident’s only option is a Medi-Cal certified skilled care facility.
If the facility is of high quality like Keiro Nursing Home or Intermediate Care, many wish that they had moved their parent or family member sooner. The key is that these types of facilities provide health care that is hands on, 24 hours a day, 7 days a week. RCF’s do not.
So my mantra to families is, don’t shop with your eyes, shop for the proper level of care that your parent or family member needs.
Karl Kim, CFP, CLTC is the President of Retirement Planning Advisors, Inc. and is a Medi-Cal specialist. His office is located in La Mirada, CA and can be reached at 714-994-0599 or at www.KarlKimCo.com. He has submitted over 1000 applications with a 99.9% success rate over the past twenty years with a 99.9% success rate. This is meant to be an educational article. Do not make any decisions solely on the information contained herein. Consult your tax advisor, financial planner and attorney before taking any action. We are not responsible for any inaccuracies or misinformation.