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Who Pays for Care in a California Assisted Living Facility?

It's a common question:  Medicare?  Medi-Cal?  Assisted living is considered a 'non-medical' care model, therefore no health insurance benefit covers assisted living services.  Assisted living services are largely private pay.  Funds for 'private pay' come from the individual's pensions, investments, savings, and sometimes - long term care insurance.  Individuals considering placing themselves or their loved ones in assisted living should be budgeting between $88,000 and $100,000 to cover the cost of care if the individual ages, and dies, in place. Those estimates should be increased between 3 and 5% annually. 

CARR's $88,000 estimate is based on an average monthly cost of $4,000 for the estimated average of 22 months that an individual lives in assisted living. In California, 80% of the assisted living facility inventory is in facilities licensed for 1 to 6 beds.  These are the facilities where you can find monthly care in the $4,000 to $5,000 range.  If you or your loved one is considering placement in a 'senior retirement community' (an industry marketing term for larger facilities) the monthly prices will be higher (~$7,000 to ~$12,000). 

Medicare is a federal health insurance program; it pays only for covered medical care and costs, not for room and board as assisted living facilities are licensed as non-medical facilities.  The exception to this is hospice.  If an individual living in an assisted living setting meets the eligibility requirements for hospice care, and enrolls with a certified hospice agency, hospice services will then be a covered benefit through Medicare.

Medi-Cal is California's Medicaid health care program; it is administered by the California Department of Health Care Services.   Medi-Cal pays for medical services for seniors (and others) having limited resources and income.  An individual must apply for Medi-Cal, and meet the eligibility requirements.  If the individual is Medi-Cal approved, and applies and is accepted for the Assisted Living Waiver Program (ALWP) program,  Medi-Cal will pay a portion of the assisted living facility care and supervision bill.  

Before you start looking for an assisted living setting, assess your financial condition recognizing that unless you or yours qualify for Medi-Cal,  you will be paying for assisted living services from your savings, pension or investment income.  Social Security payments alone (~$1,400) are generally insufficient to meet the average monthly cost of assisted living care.  Once you understand how much money you have, and what the care needs are, you will be better equipped to understand the care and services you will be able to afford and ultimately receive.  CARR encourages families to question providers carefully to understand the admission requirements including the signing fee, the monthly rates, any extra costs (i.e. levels of care, point systems, etc.) that might show up on the monthly invoice.

If you have additional questions, please feel free to contact our office for further guidance or resources at (619) 540-1648.

Consumer support / Assisted Living Information
The Front Page

Facility Finder

How To Use Our Statewide Facility Search

Enter values in the appropriate fields. You don't have to fill in all the fields' You can use any or all of the name, etc. For example, To find Mount Helix Manor Elder Care you could enter "Manor" in the Name field and "La Mesa" in the City field then click the "Find a Facility" button

Some names might use abbreviated words such as "Casa St. James" while others might spell out the word such as " Saint Mary Homecare" so you may try several spellings before you find your facility.

Please note: A maximum of 60 facilities can be viewed. If you have more than 60 found facilities, you may want to be more specific in your search.

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News / CARR in the news
Data & Research

Following successful completion of a six month pilot program to develop a uniform rating system using public documents data for California assisted living facilities, CARR received a one-year follow-on contract to launch the program.  The San Diego County sponsored program is called "Choose Well", and will offer consumers direct contact with providers volunteering to participate.  Facilities who join the program will have their facility rated, using the Choose Well Scoring tool; they will receive a Facility Profile Page where the facility can promote the amenities, care, services, price range, and philosophy of care that make them a distinguished provider in the county.  

News / CARR in the news
Data & Research

"CARR is honored to be the County of San Diego's vendor entrusted with developing a fair rating system deserving the confidence of the public and providers." --Chris Murphy, CARR's Executive Director

SAN DIEGO, Calif., May 5, 2015 -- The County of San Diego, Aging & Independence Services awarded Consumer Advocates for RCFE Reform (CARR) a fixed price contract for a pilot project to create a rating system for the County's assisted living facilities, and to develop a consumer-friendly website to display the ratings and facility information.  The pilot program is a six-month effort with a current contract value of $50,000.

News / RCFEs in the news

On 13 July, 2016, the San Diego Union Tribune' published three articles about care, staffing and death in Elmcroft La Mesa.  The articles were penned by Paul Sisson, staff writer on health care issues.  Elmcroft La Mesa is a licensed Residential Care Facility for the Elderly (RCFE) licensed by California's Department of Social Services, Community Care Licensing (CDSS/CCL).  The state has initiated administrative law procedures for revoking Elmcroft's license as a result of the deaths that Mr. Sisson discusses in his articles.  You will find links to these articles below.

News / CARR in the news
Data & Research

CARR  is one of the four grant recipients under the 2017 San Diego Foundation's Age Friendly Communities Program - a partnership between The San Diego Foundation and The Del Mar Healthcare Fund at The San Diego Foundation.  The grant project's findings will move San Diego towards receiving an Age Friendly/Livable Community for All Ages designation from the World Health Organization/AARP.

Recent CARR Blogs - see more -

Watchdog & Advocacy
Data & Research
Blog

Our review of CCL licensing data found 40% of facilities receive their license more than 120 days following their first pre-licensing visit.  Facilities may contact their local state representatives explaining to them the financial hardship associated with a delay in licensure. Contact information for your local representative(s) is available in the following article.