(also called skilled nursing homes, convalescent homes or convalescent hospitals)

Continuing Care

(also called all-in-one or Life Care Communities)

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Retirement/Assisted Living Hotels

Both large (hotel-like) and small (home-like) custodial care settings are considered by the state to be Residential Care Facilities for the Elderly (RCFEs). Most people used the term Retirement Home or Assisted Living to describe large settings that accommodate from 30 to 100-plus residents. They offer services such as meals, activities and transportation to doctors. Most retirement homes are licensed as board and care homes and have staffs that can accommodate custodial care needs, such as assistance with medicine, dressing and bathing. They also offer aid in getting out of bed or going to the bathroom or dining room. Generally, retirement homes will not accept a wheelchair-dependent resident or those who are not self-managed incontinent.

Retirement homes also accept residents with varying degrees of dementia. Some have installed specialized wings in their buildingsdesigned for those residents with advanced Alzheimer's who may wander. These areas, not permitted to be locked, provide a safe environment by utilizing "wanderguard" systems. One example is a home that monitors the location of a wanderer by requiring him/her to wear a special bracelet that trips an alarm when a door in this section is opened.

Although some retirement homes offer suites and two-bedroom units, most offer only a furnished room with a private bathroom. Meals are provided in a large group dining room. The rooms usually do not have ovens and stoves, although, hot plates, microwaves and small refrigerators are usually permitted. A shared room typically costs between $750 and $900 per month; a private room costs between $1,200 and $3,000 per month, depending on the location of the home, size of the room and care provided.

Under the 2005 California Supplemental Security Income (SSI) plan, the government will make up the difference between a recipient's Social Security benefits and the SSI subsidy limit of approximately $979. For instance, if a recipient receives a Social Security benefit of $300, the government would provide the additional $679 SSI benefit. For a Social Security recipient eligible for SSI benefits, retirement homes occasionally accept the SSI subsidy rate for a shared room (usually for residents who do not requires assistance) and return to the resident approximately $100 for living expenses.

Community Care Licensing (CCL), a branch of the Department of Social Services, is responsible for licensing and visiting all the 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 a board and care home 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

Residential Board and Care Homes (the small type of RCFEs) are usually considered to be 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 they are not permitted to accept or provide care for residents who are completely immobile, bedridden or unable to turn in bed. 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 who have a high level of physical care needs. The 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 (working in conjuction with an outside home health agency which can clean the catheter as needed). 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 range from $1,200 to $3,000 per month for a shared room; for a private room, the cost is between $2,000 and $4,000 per month, depending on the location of the home and the care provided. Most Residential Board and Care homes cannot afford to accept low-income residents who need care. 40 states permit funding for these settings for low income residents by using a combination of medicaid and social security supplemental income (SSI): California is not among them. For more information about this topic, see: Publications.

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 $84 to $120 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.