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Types of Care Homes

Retirement/Assisted Living Hotels (30-100 beds)
Residential Board and Care (4-6 beds)
Skilled Nursing Homes (aka convalescent hospitals)
Continuing Care Facilities

Retirement/Assisted Living Hotels

Both large (hotel-like) and small (home-like) custodial care settings are considered by the state of California to be Residential Care Facilities for the Elderly (RCFEs). The term "Retirement Home" or "Assisted Living" usually describes large settings that accommodate from 50 to 100-plus residents. Basic services include meals, activities and transportation to doctors. Assisted living services usually include help with medicine, dressing and bathing. Some assisted living settings also provide help for patients who are incontinent or wheelchair dependent.

Due to fire safety guidelines most retirement homes cannot accept patients with advanced dementia and/or Alzheimers. Those that can frequently have specialized wings in their buildings for residents who could "wander" or utilize "wanderguard bracelets" which trip an alarm when a resident leaves a desiginated area.

Most retirement homes offer a furnished room with a private bathroom (suites and two-bedroom accomodations may be possible as well). Although rooms usually do not have ovens and stoves; hot plates, microwaves and small refrigerators are usually permitted. Meals are provided in a large group dining room. A shared room typically costs between $1,700 and $3,000 per month; a private room costs between $2,200 and $4,000 per month, depending on the location of the home, size of the room and care provided.

Some retirement homes accept the Supplemental Social Security Income (SSI) rate for low-income participants as payment. The current maximum SSI/SSP retirement home benefit is $1,122 for an individual. Unfortunately, fewer and fewer retirement homes are willing to accept this low payment.

Community Care Licensing (CCL), a branch of the Department of Social Services, is responsible for licensing and visiting all assisted living and residential board and care homes at least once a year. CCL requires the homes to adhere to Title 22, mandatory guidelines which govern the type of care provided, staffing and overall physical environment of the home. A retirement home not licensed as an assisted living setting is not bound by Title 22 guidelines and, therefore, is not permitted to provide residents with custodial care assistance. Any such needs must be provided by an outside home health agency.

Residential Board and Care Homes (4-6 beds)

Residential Board and Care Homes are usually small family homes in residential neighborhoods licensed to provide care to four to six residents. All custodial care, meals, and activities are provided by live-in staff. The administrator/owner, who generally does not live at the home, normally picks up the medication, does the shopping and provides the transportation to the doctor. Most are licensed to accept non-ambulatory residents and have been constructed with these residents needs in mind (e.g., wheelchair accessible bathrooms and inside/ outside ramps).

Residential Board and Care homes are allowed to provide assistance to residents who need help transferring from bed to wheelchair but usually not permitted to accept or provide care for residents who are completely immobile or unable to turn in bed (special exemptions may be allowed for hospice patients). The high staff-to-resident ratio (usually two staff to six residents) make this an ideal setting for residents who are incontinent, have advanced dementia, Parkinsons disease, Alzheimers disease, or have a high level of physical care needs. Most homes can also accept "wanderers" as long as they are equipped with alarms on the doors and are gated. Normally, Residential Board and Care homes will also accept respite (short-term) clients if a room is available.

Although Residential Board and Care homes are not permitted to accept residents with skilled nursing needs, there are times, however, when Community Care Licensing will grant exemptions to this rule. For example, depending on the nature of the condition and care required, administrators can frequently obtain waivers for residents who have catheters or colostomies (e.g. when working in conjuction with an outside home health agency which can clean the catheter as needed). Also, patients who are considered "bedridden" but can assist in transfering may be allowed to reside in board and care settings. Community Care Licensing evaluates each exemption request on a case-by-case basis. The administrator must be granted a waiver before the resident actually moves into the home.

Residential Board and Care homes usually range from $1,500 to $3,000 per month for a shared room and from $2000-$5,000/month for a private room with the price varying depending on the location of the home and the care provided. California is one of the few states in the nation that does not allow medi-cal to pay for RCFEs (except on a very limited basis). Currently, 40 states permit funding for these type of settings by using a combination of medicaid and social security supplemental income (SSI).

Skilled Nursing Facilities (SNFs)

SNFs are hospital-like settings which offer skilled nursing care for 40 to 200-plus residents, are licensed by the Department of Health Services. They must adhere to Title 22 as well as Federal Omnibus Budget Reconciliation Act (OBRA) guidelines governing patients rights and quality of life issues.

The 24-hour skilled nursing care offered in these settings is provided by licensed, trained professionals such as registered nurses (RNs), licensed vocation nurses (LVNs), and certified nursing assistants (CNAs).

Services provided in SNFs may include care for a resident who is completely bedridden or who has an IV or g-tube. Skilled Nursing Facilities also offer occupational, speech, respiratory and physical rehabilitation services. These services are usually provided by contracted companies that specialize in rehabilitation. Rehabilitation services are usually covered by Medicare Part A.

SNFs offer private rooms (single bed), as well as shared rooms (two to four beds). Costs range from $150 to $200 per day, depending on the number of beds in the room and the skilled nursing services required. Ancillary charges (including medicines, diapers, personal laundry, etc.), may also apply. Many SNFs accept medi-cal as payment for a shared or triple bed room.

Each SNF must have posted (usually next to the main nursing station) its most recent evaluation report, which reflects any deficiencies and violations as well as the home's plan of correction.

Continuing Care/ Life Care Communities

These are usually large campuses where all three levels of care (minimal services, custodial care and skilled nursing) are provided. These communities are attractive to residents who do not want to move as increased care needs develop. Some of these settings require a large entry fee for admittance. Others charge for services on a month-to-month basis. Continuing Care Communities require big campuses and there are generally very few of them in the city.


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