Housing & Care Options for Older Adults
There are many housing and care offerings available for older adults with different amenities, levels of care, and cost, depending on insurance coverage. This article discusses several common housing options, including independent living, assisted living, and skilled nursing.
Independent living communities can be single-family homes with multiple residents, or larger communities with many apartments, in which residents are required to be able to live safely by themselves. Older adults residing in an independent living community should require little or no assistance. These communities do not provide supportive services, or help with activities of daily living1. A private room can range from $700 to $1,000 a month2, usually not including meals. Caregivers are available through private pay, or through the state’s In-Home Supportive Services (IHSS) program and subsidized by Medi-Cal, to provide scheduled non-medical care. A resident in an independent living home, whose health declines to the point where they need more advanced care, will have to find alternative housing.
An assisted living facility refers to a special combination of housing, personalized supportive services, and health-related care designed to respond to the individual needs of those who require help with activities of daily living1. Assisted living provides services such as three meals a day, medication management, and assistance with bathing, dressing, and laundry. In California, assisted living facilities that are licensed by the state are called Residential Care Facilities for the Elderly (RCFE). Single-family homes that have been converted into an RCFE are sometimes called “board and care” facilities, while larger communities with dozens to hundreds of apartment units can be marketed as a “retirement community” or “senior living community.” All RCFEs are regulated and licensed by California’s Department of Social Services and receive regular, random inspections by the state and are held to rigorous licensing standards. Updated on a quarterly basis, Choose Well lists only licensed RCFEs in San Diego County and monitors compliance with the requirements that licensed facilities must follow.
Depending on the location, community, size of apartment, and number of services needed, a private room in San Diego County can range from $3,200 to over $8,000 per month3. Assisted living services are almost always private pay because it is considered a non-medical service, and therefore not covered by health insurance nor Medi-Cal. Under very limited circumstances, a Supplemental Security Income (SSI) participant may qualify for placement into a facility under California’s Assisted Living Waiver (ALW) program.
Participating in the ALW program requires the facility to have a licensed nurse present, however most facilities in San Diego do not meet this requirement, resulting in few ALW approved facilities3. There are fewer than 50 approved facilities for the ALW program in San Diego County and most do not have immediate openings. For an updated list of facilities participating in the ALW program, refer to the following: List-of-RCFE ARF-facilities.pdf (ca.gov). Residents living with dementia require a facility that is approved to provide care for residents with dementia, which is often marketed as a “memory care” community. These facilities have additional features, such as perimeter alarms, and staff who have received more in-depth training on dementia care.
A skilled nursing facility (SNF), also referred to as “rehabilitation” or “acute care” centers, provide 24-hour skilled nursing care, as well as related or rehabilitative services4. Because it is medical care, skilled nursing care is covered by Medicare/Medi-Cal. It is not long-term care, however, as a stay is limited to a maximum of 100 days at a time. After that, the patient must remain out of a hospital or SNF for at least 60 days in order to be eligible for Medicare coverage again. This duration where a patient receives Medicare-covered services is called a “benefit period.” Patients who have used up their benefit and do not qualify for a benefit period renewal must pay out of pocket if they wish to stay at the facility. Skilled nursing can cost between $300 to over $500 per day5. Read more about Medicare coverage for SNFs here: https://www.medicare.gov/Pubs/pdf/10153-Medicare-Skilled-Nursing-Facility-Care.pdf.
It is not uncommon for an older adult to transition from independent living to assisted living, and finally to skilled nursing, as their health declines. Knowing the basic housing and care options in California may help make the process of finding appropriate care less stressful, allowing families to focus their efforts on asking prospective facilities the right questions and learning specific details that may impact a resident’s health later in life. Assisted living facility operators also benefit from understanding various housing options so that they can better assist their clients and families when the time comes for residents to transition to a different level of care.
3 Choose Well Database: https://choosewellsandiego.org/facility-search