Memory Care in California

Table of Contents

Memory Care in California

Table of Contents

• The Cost of Memory Care in California
• California Medicaid Programs for Memory Care
• Can You Use Medicare To Pay for Memory Care in California?
• More Ways To Pay for Memory Care in California
• Memory Care Laws and Regulations in California
• Free Memory Care Resources in California
• California COVID-19 Rules for Memory Care Facilities

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.

To calculate the cost of memory care, we added 25% to the assisted living costs in the 2021 Genworth Cost of Care Survey. This shows that the average monthly cost of memory care in California is $6,563, which is almost $1,000 higher than the United States average of $5,625. California’s costs are also high when compared to its neighbors. Oregon’s prices are similar at $6,306, while in Arizona, seniors pay $5,000. Nevada is the most affordable of nearby states, with a cost of $4,688 per month. 

The Cost of Memory Care in California

Costs can vary widely depending on where you reside. Average rates in California range from $8,810 in Santa Rosa to $4,313 in Visalia. The state’s biggest cities fall on the higher end of the range. In Los Angeles, the cost is $6,563, and San Diego’s prices are slightly higher at $6,844. Farther north in San Francisco, seniors pay an average of $7,899 per month.

In California, Medicaid is known as Medi-Cal. It provides free and low-cost health coverage to eligible Californians. In addition to covering medical care, Medi-Cal offers nursing home care and some personal care in the home. Memory care that’s received in a residential setting isn’t covered directly by the program. Instead, Medi-Cal has four waiver programs that provide home and community-based services. This includes the Assisted Living Waiver, which can cover memory care services. 

• Who Is Eligible: California adopted Medicaid expansion, making it available to anyone who meets the financial eligibility requirements. Those requirements differ depending on an individual’s circumstances. Adults aged 65 and older must meet income and asset limits, residency and other requirements.
• How to Apply: People can apply for Medi-Cal online at Covered California or BenefitsCal. In-person applications are accepted at county offices of the California Department of Health Care Services. California also accepts applications by phone, fax, mail or email. These should also be directed to local county offices. 

Assisted Living Waiver Program

The Assisted Living Waiver Program helps people who need a nursing home level of care remain living in the community. It’s open to residents statewide but only available through certain providers. These providers are only located in 15 counties, so participants may need to relocate to access the program. In addition, there’s a limited number of slots available, so applicants may be put on a waitlist. 

People in the program get access to the range of services offered in assisted living facilities. This includes:

• Assistance with activities of daily living and instrumental activities of daily living
• Health-related services, including skilled nursing if required
• Social and recreational programming
• Meals
• Housekeeping and laundry
• Nursing home transition care

The ALWP asks participants to contribute to the cost of room and board. In 2021, the monthly rate for room and board was $1,079.37 or $1,099.37, depending on the individual’s income. 

• Who Is Eligible: Applicants must be at least 21 years of age and require a nursing home level of care. They must also meet the income and asset limits to qualify for Medi-Cal. The state won’t approve an application if it would be more affordable to provide care in a nursing home.
• How to Apply: Interested seniors must first apply for Medi-Cal through their local county office. Once enrolled in Medi-Cal, individuals can contact a local Care Coordination Agency to arrange an assessment to determine their level of care eligibility. 

Medicaid Eligibility for Seniors in California 

Seniors must meet both income and asset limits to be eligible for the program. In California, the financial criteria for waivers are the same as those for regular Medicaid for people aged 65 and over. Single applicants must earn less than $1,481 a month and have countable assets of less than $2,000. Married couples can have an income of up to $2,003 per month and assets of $3,000 when both spouses are applying.

When only one spouse is applying for the waiver, the limits are the same as for single applicants. However, the non-applicant spouse can have up to $137,400 in assets and may be eligible for a Minimum Monthly Maintenance Needs Allowance. This allows the non-applicant to keep some of the applicant's income to ensure they can meet their needs. 

2022 Medicaid Income Limits for Seniors in California

In addition to financial criteria, applicants for the waiver must also:

• Be a U.S. citizen, permanent resident or legal alien
• Be a resident of California
• Be aged 65 and over or aged 21 and over with a disability
• Require a nursing home level of care

How To Get Help Applying for Medicaid in California

California has assistance available to help people applying for Medicaid. This includes a helpline, guidebook and in-person counseling.

Unfortunately, Medicare does not generally cover the cost of Memory Care. Most Memory Care Facilities are considered to be "social settings," so Medicare does not cover the cost incurred in these facilities. The only exception to that is if you are receiving memory care services in a Nursing Home. While this situation is much less common, Medicare would sometimes cover the cost, depending on a number of circumstances.

That being said, Medicare does still cover qualified doctor visits, medications, etc., as it would if you were still at home, but it will not cover the cost of care received at the Memory Care Facility.

In addition to the state 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.

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:

Residents Who May Be Admitted

Older adults and people who:

• need oversight and assistance with ADLs
• need injections, such as diabetics
• need oxygen administration, if they can self-manage their care or get help from a non-staff medical professional such as visiting nurse
• need dementia care
• need hospice care
• are temporarily bedridden if the facility has met any CCLD regulatory requirements to provide such care.

Residents Who May NOT Be Admitted

Those who:

• are permanently bedridden
• have communicable diseases
• suffer from mental disorders resulting in behavior upsetting to other residents
• require access to around-the-clock intermediate or skilled nursing care
• require treatment of staph or other serious infections
• require assistance with all ADLs

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.

Seniors in California who require memory care can access many free and low-cost resources. Government and nonprofit organizations provide assistance with a range of needs, including diagnosis, care planning and connecting with other people who have dementia. 

Note: The following information was compiled and most recently updated on 2/2/2022. Since COVID-19 is a rapidly evolving crisis, be sure to contact your Memory Care Facility or local Area Agency on Aging for the most up-to-date information.