Memory Care in California

Because of the specialized staff training and resources required to provide high-quality memory care, memory care typically costs more than other types of residential care. On average, memory care will cost 20-30% more than assisted living.

The average cost of assisted living in California is $4,500 per month. This is almost $450 higher than the national monthly average of $4,051, but on par with neighboring Oregon where the cost is $4,499 per month. The average costs in the adjacent states of Arizona and Nevada are considerably lower at $3,750 and $3,400 per month, respectively. Presuming that memory care costs 25% more than assisted living, on average, seniors in California can expect to pay approximately $5,625 per month for residential memory care.

The cost of assisted living varies greatly across California, depending on the specific facility and its location within the state. For example, the average monthly cost in Los Angeles and Sacramento is $4,500, and it’s somewhat higher in San Francisco and San Diego at $4,750 per month. In San Jose, the price jumps to $5,853, which is the highest monthly cost of assisted living in the state. It is important to remember that these are average costs for assisted living, and memory care may cost an additional $1,000-$2,000 per month.

California Medicaid Programs for Memory Care

Assisted Living Waiver

The Assisted Living Waiver (ALW) program provides financial assistance to individuals enrolled in Medi-Cal so they may receive care in a community setting, such as a residential care facility for the elderly (RCFE), as an alternative to residing in a nursing facility. Those enrolled in the program must pay facility room and board fees, but the program covers a range of provided services including:

• Costs of transitioning from a nursing home
• Care coordination
• Assistance with activities of daily living (ADLs)
• Assistance with medication self-administration
• Daily meals and snacks
• Laundry and housekeeping
• Recreational and social programs
• Nonmedical transportation
• Intermittent skilled nursing care

The ALW program is available in 15 of California’s 58 counties, and not all licensed RCFEs in these counties participate, so approved applicants may have to relocate or be placed on a waiting list to receive services.

• Who is Eligible: To enroll in the ALW program, California residents must be aged 21 or older and meet the income and asset limits to qualify for full-scope Medi-Cal coverage with no share of cost. Currently, yearly income is limited to $14,904 for an individual and $20,184 for a married couple. Countable assets are limited to $2,000 for individual applicants, or $3,000 for couples who are both applying. Additionally, seniors must require the level of care provided in a nursing facility based on an assessment completed by a Care Coordination Agency registered nurse.

• How to Apply: Those who wish to apply for assistance through the ALW should contact a Care Coordination Agency serving the county they currently reside in or are willing to relocate to if approved for the program. Agency staff will perform a prescreening assessment by phone and schedule an appointment with an agency RN to determine the applicant’s care needs and eligibility.

Non-Medicaid Financial Assistance Programs for Memory Care in California

State Supplemental Payment

California provides a State Supplemental Payment to individuals who are eligible for federal Supplemental Security Income benefits through the Social Security Administration. This monthly cash payment may be used to help cover dementia care costs for those residing in a participating RCFE.

• Who is Eligible: Seniors aged 65 and older who meet the income and asset limits of the SSI program can also qualify for SSP benefits. Individuals must have $2,000 or less in assets, and a monthly income no greater than the current federal benefit rate. Married couples may have $3,000 in combined assets.

• How to Apply: Interested individuals can apply for SSI and SSP benefits in person at their nearest Social Security Administration office, or by calling the SSA at 800-772-1213.

Medicare Advantage Plans

Medicare Advantage plans, also commonly referred to as Medicare Part C, offer “all in one” alternative coverage for those enrolled in Original Medicare Parts A and B. There are several types of MA plans available to suit different needs, and all are offered through private insurance providers. Most MA plans provide Medicare Part D prescription drug coverage, along with extra benefits such as vision, hearing and dental care, plus other health and wellness programs.

Recently, Medicare expanded the definition of an MA plan enrollee’s home to include RCFEs that provide memory care, which allows for coverage of some of the costs incurred by residents. These benefits may not be available with all MA plans in all areas, so those interested should compare plans offered by various providers in their specific locale.

• Who is Eligible: Medicare Advantage plans are available to U.S. citizens and legal residents with five years of residency who are aged 65 or older and enrolled in Medicare Parts A and B. Preexisting conditions such as Alzheimer’s disease and dementia do not affect an individual’s eligibility. There are no income or asset limits to qualify for Medicare Advantage coverage, but enrollees must continue paying their monthly Medicare Part B monthly premium, and any additional premium due for the MA plan they choose.

• How to Apply: Interested seniors can compare available MA plans in their geographic area using Medicare’s plan finder tool, and then contact their chosen plan’s provider or call Medicare directly at 800-633-4227 to learn about specific enrollment periods and how to apply.

More Ways to Pay for Memory Care

In addition to the programs mentioned above, those looking for resources to finance memory care may consider:

• Long-Term Care Insurance: Depending on the policy details, long-term care insurance may be used to pay for memory care services. It’s best to sign up for a policy early, as coverage will likely be denied if one already has long-term care needs. More information about the intricacies of long-term care insurance can be found at longtermcare.acl.gov.
• Reverse Mortgages: Reverse mortgages allow some homeowners to take out a loan as an advance from the eventual sale of their primary residence. This can be a good way to fund memory care in the short-term, but the loans will need to be paid back after the sale of the home. The most commonly used type of reverse mortgages for seniors is the Home Equity Conversion Mortgage, which is the only reverse mortgage insured by the federal government.
• Veterans Benefits: The Department of Veterans Affairs offers several programs that veterans and their spouses may use to cover health care needs such as memory care. More information about these programs can be found on the VA website.
• Life Insurance: Some life insurance policies allow policyholders to cash out their policy before a qualifying death. There may be some downsides to accessing a life insurance benefit early, so be sure to read more about the process.

Memory Care Regulation

Facilities in California that provide memory care are categorized as residential care facilities for the elderly, and include board-and-care homes with up to 15 residents and assisted living facilities with 16 or more residents. RCFEs are licensed and inspected through the Department of Social Services, Community Care Licensing Division (CCLD). Inspections of each facility in the state are conducted every five years, which the CCLD accomplishes by randomly selecting 30% to inspect annually. The CCLD also makes yearly targeted visits to facilities with a history of compliance issues.

RCFEs are licensed as non-medical facilities, and are not required to have doctors, registered nurses or certified nursing assistants on staff. Facilities that accept residents with memory impairment must comply with specific licensing requirements to ensure the state’s standard of care and safety of individuals with dementia is met. RCFEs that offer memory care must have a plan of operation that details the:

• Program philosophy
• Assessment process, both preadmission and ongoing
• Areas where memory care is provided
• Building design features
• Available services
• Activity programs
• Policies for changes in a resident’s condition
• Staff qualifications and training
• Program review procedures

Facility Scope of Care

The level of care provided in residential care facilities for the elderly is suitable for individuals who can no longer live on their own but do not require 24-hour nursing care. The scope of care includes housing and various support services to assist residents with the normal tasks of daily living. At minimum, RCFEs must provide or coordinate these services:

• Maintenance of healthy, safe living accommodations
• Sufficient staff to supervise and meet both scheduled and unscheduled resident needs
• A social and recreational activities program appropriate for the abilities and interests of residents
• Housekeeping and laundry
• Oversight and observation of the mental and physical condition of each resident
• Planning and transportation to meet residents’ medical and dental care needs
• Three well-balanced, nutritious meals along with snacks daily
• Monitoring food intake and special dietary requirements
• Arranging necessary outside health-related services, such as medication administration, wound care or special treatments

Facilities that offer care for those diagnosed with dementia must meet additional requirements that include:

• Arranging an annual medical assessment for each resident
• Ensuring an appropriate level of 24-hour supervision
• Providing an activity program relevant to memory care

Admissions Requirements

Residential care facilities for the elderly in California must have a minimum 75% ratio of residents aged 60 or older, and may only accept younger individuals who have care needs that are compatible with other residents. This chart details other requirements:

Care Plan Requirements

RCFEs must complete a preadmission assessment of an individual’s functional abilities, mental and physical condition, and interests, likes, and dislikes. They must also obtain medical assessment results, signed by a physician, to verify the person can receive an adequate level of care in the facility. For those with dementia, a written physician care plan that minimizes the use of psychoactive medications is also required.

Within two weeks of admission, facility staff must meet with a new resident and their family or legal representative to formulate a personalized care plan that details strategies to maintain or enhance the individual’s mental, social and physical well-being. An individual must be reassessed and their care plan updated if their condition changes significantly, or on an annual basis at a minimum.

Medication Management Requirements

RCFEs may store and distribute medications, however, residents must be able to self-administer their own medications with assistance from a facility staff member. Medications may only be administered by a licensed medical professional, and the facility has met any special regulations and licensing requirements set forth by the CCLD to arrange or provide such services.

Facility Requirements

RCFEs are not required to provide private apartments, but occupancy is limited to two residents per bedroom. There is no square footage requirement for rooms, but they must be sufficient to allow for furnishings, equipment and resident mobility. Facilities may offer either private or shared bathrooms, and must provide a minimum of one washbasin and toilet for every six residents, and one shower or bathtub for every 10 persons.

Staffing Requirements

RCFEs must employ a certified administrator who manages day-to-day operations and have an administrator, manager or qualified alternate on-site 24 hours per day. There are no specific staffing ratios required, but a facility must have sufficient care staff on duty to meet the needs of residents at all times. RCFEs with more than 16 residents must have an adequate number of awake overnight staff based on the number of residents. At least one staff member with CPR training must be on the premises at all times.

Administrators must complete an 80-hour long initial certification program, and pass a written exam. They must complete 40 hours of continuing education every two years, which includes eight hours of training in Alzheimer’s disease and dementia care.

Staff must have related experience in their assigned job or receive on-the-job training. Those providing direct care to residents must have 40 hours of initial training: they must complete 20 hours before working with residents independently and the remaining 20 in the first four weeks of employment.

Direct care staff working with memory care residents must receive 12 hours of initial training in dementia care, and complete half before working with residents independently and the remainder during the first four weeks of employment. Staff must also complete eight hours of in-service dementia care training each year.

Additional initial and ongoing training is required for staff who assist residents with medication self-administration, or provide hospice or restricted health care, and all facility staff must receive training in first aid.

Medicaid Policy

The California Medicaid program, Medi-Cal, does not pay room and board costs in RCFEs. However, the state offers the Assisted Living Waiver program to help eligible individuals cover the cost of certain memory-care related services received in RCFEs that have been approved as participating providers.

Reporting Abuse

The Long-Term Care Ombudsman Program provides assistance with complaints or concerns related to poor quality of care, safety and health issues or verbal, mental, physical or financial abuse in RCFEs. Residents and others may contact the local ombudsman in their county or call the Long-Term Care Ombudsman CRISISline at 800-231-4024 for immediate assistance.