1. Senior Housing Options Presenter: Anat Louis, Psy.D.

2. Independence Independence Dignity Dignity Quality of Years Quality of Years vs. Quantity of Years vs. Quantity of Years Long Term Care

3. Long Term Care at Home Long Term Care at Home Roughly 70% of all long term care is provided in the home primarily by a spouse/partner, a daughter or daughter-in-law Roughly 70% of all long term care is provided in the home primarily by a spouse/partner, a daughter or daughter-in-law More family caregivers are in the workplace or live far away and are finding it difficult to care for loved ones at home More family caregivers are in the workplace or live far away and are finding it difficult to care for loved ones at home Help is available in a number of ways Help is available in a number of ways

4. Residential Options 55+ Community 55+ Community Independent Living Independent Living Assistant Living Assistant Living Nursing Home Nursing Home Continuing Care Continuing Care Veterans Adminstration (VA) Veterans Adminstration (VA)

5. Retirement & Care Communities Many active seniors are selling their homes and using the equity to purchase a retirement living arrangement Many active seniors are selling their homes and using the equity to purchase a retirement living arrangement Some seniors find new living arrangements that offer various degrees of eldercare. Some seniors find new living arrangements that offer various degrees of eldercare. “Alternative Living for the Aging” “Alternative Living for the Aging” “Aging In Place” Communities “Aging In Place” Communities

6. 55+ Communities Age restricted communities Age restricted communities Offer resort style amenities and social activities Offer resort style amenities and social activities Maybe ownership, rental or land lease communities Maybe ownership, rental or land lease communities

7. Independent Living Communities Enable INDEPENDENT seniors to recreational, educational and social activities with other seniors (banks, salon, fitness program, communal meals) Enable INDEPENDENT seniors to recreational, educational and social activities with other seniors (banks, salon, fitness program, communal meals) Apartment/condo complex Apartment/condo complex Start to worry about their safety or need more support and companionship Start to worry about their safety or need more support and companionship

8. Assisted Living Also Know As: Retirement home, board &care home, Residential Care facility for Elderly (RCFE for 60 years and older) Also Know As: Retirement home, board &care home, Residential Care facility for Elderly (RCFE for 60 years and older) Alternative that provides a more homelike environment, a more stimulating atmosphere and is generally about 60% of the cost of a nursing home. Alternative that provides a more homelike environment, a more stimulating atmosphere and is generally about 60% of the cost of a nursing home. For person who is unable to live by themselves but DO NOT need 24hr nursing care For person who is unable to live by themselves but DO NOT need 24hr nursing care Non-Medical: Providing room meals, activities (transportation, housekeeping/laundry, social and recreational) and if necessary, assists w/ ADL’s (eating, dressing, bating, toileting, etc.) Non-Medical: Providing room meals, activities (transportation, housekeeping/laundry, social and recreational) and if necessary, assists w/ ADL’s (eating, dressing, bating, toileting, etc.) Resident “Self Administer” meds but AL can “Store” meds Resident “Self Administer” meds but AL can “Store” meds Not required to have nurse/doctor on staff Not required to have nurse/doctor on staff Nursing services is available through Home Health agencies (medication management, treatments, wound care, etc) Nursing services is available through Home Health agencies (medication management, treatments, wound care, etc) Share room or option for private room Share room or option for private room Licensed and inspected by the Community Care Licensing Division of Calif Dept of Social Services. Licensed and inspected by the Community Care Licensing Division of Calif Dept of Social Services.

9. Assisted Living Costs 2006 in Los Angeles $1300-4800per month (average $2426) depending on location, accommodation, services, etc. SSI (Supplemental Security Income)- limits facility monthly charge $916. Single person who is 65 years old or Person w/ Disability with limited income. Can charge extra $44.40 for private room. Fewer AL are accepting SSI eligible. Couple, one or both in AL SSI (Supplemental Security Income)- limits facility monthly charge $916. Single person who is 65 years old or Person w/ Disability with limited income. Can charge extra $44.40 for private room. Fewer AL are accepting SSI eligible. Couple, one or both in AL Medicare &Medi-Cal- In general DOES NOT PAY for stay in AL. They CAN pay for certain health care services (thru home health agency or hospice agency). Limited program pays for approx 1,000 residents for 3 counties. 2006 Medi-Cal 3 year project Assisted Living Waiver Pilot Project (ALWPP) test whether AL as Medi-Cal benefit as alternative to NH. Medi-Cal person can get CM, transportation, personal hygiene and other services under Multipurpose Senior Service Program (MSSP) waiver. Medicare &Medi-Cal- In general DOES NOT PAY for stay in AL. They CAN pay for certain health care services (thru home health agency or hospice agency). Limited program pays for approx 1,000 residents for 3 counties. 2006 Medi-Cal 3 year project Assisted Living Waiver Pilot Project (ALWPP) test whether AL as Medi-Cal benefit as alternative to NH. Medi-Cal person can get CM, transportation, personal hygiene and other services under Multipurpose Senior Service Program (MSSP) waiver.

10. Nursing Homes (Nursing Care/Skilled Nursing Facilities) For many, long term care is an evolving process of losing more and more physical or mental capacity For many, long term care is an evolving process of losing more and more physical or mental capacity Nursing homes are usually the last stop Nursing homes are usually the last stop Nursing homes are equipped to handle medical problems, disability and in some cases behavior problems Nursing homes are equipped to handle medical problems, disability and in some cases behavior problems Now that there are so many options for care prior to a nursing home, the trend is that residents on average are much sicker and older than in the past Now that there are so many options for care prior to a nursing home, the trend is that residents on average are much sicker and older than in the past For person needing long term nursing care or for recuperation from an illness/injury. For person needing long term nursing care or for recuperation from an illness/injury. Licensed by Calif Dept of Health Services Licensed by Calif Dept of Health Services 24-hour nursing care

11. Nursing Homes CA NH charge between ($5,000-$10,000 per month) Provides Medical, Nursing and Rehabilitative Care Provides Medical, Nursing and Rehabilitative Care Residents often cannot walk w/o assistance Residents often cannot walk w/o assistance Generally need help w/ 1 or more ADL. Generally need help w/ 1 or more ADL. Medicare and Medi-Cal both pay for care under some circumstances. Medicare and Medi-Cal both pay for care under some circumstances. Medicare pays for only short term NH stay of 100 days or fewer (100% coverage for up to 20 days, 21-100 day person pays daily co-pay) but only if person all: has Medicare part A coverage and days left in benefit period, physician certifies the person needing NH care, admitted to NH w/I 30days of consecutive 3day hospital stay, person needs daily skilled nursing/rehab services and NH is Medicare-certified provider Medicare pays for only short term NH stay of 100 days or fewer (100% coverage for up to 20 days, 21-100 day person pays daily co-pay) but only if person all: has Medicare part A coverage and days left in benefit period, physician certifies the person needing NH care, admitted to NH w/I 30days of consecutive 3day hospital stay, person needs daily skilled nursing/rehab services and NH is Medicare-certified provider Medi-Cal pays for all NH costs for qualified persons, no limitation on days in facility. Pay for non-skilled care as long as services are “medically necessary.” Medi-Cal pays for all NH costs for qualified persons, no limitation on days in facility. Pay for non-skilled care as long as services are “medically necessary.”

12. Continuing Care Retirement Communities (CCRC) Offers range of eldercare options from independent living units to assisted to skilled all in one place. Offers range of eldercare options from independent living units to assisted to skilled all in one place. Costly – a large entrance fee Costly – a large entrance fee

13. Veteran’s Administration Veteran’s Eligibility for Housing depends on: eligibility criteria involving your service connected status, level of disability, and income Veteran’s Eligibility for Housing depends on: eligibility criteria involving your service connected status, level of disability, and income Home and Community Based Services Home and Community Based Services Community Living Centers (VA Nursing Homes) Community Living Centers (VA Nursing Homes) Community Nursing Homes- contracted Community Nursing Homes- contracted State Veterans Homes State Veterans Homes Adult Family Homes Adult Family Homes Assisted Living Facilities Assisted Living Facilities

14. Hospice Care Is a valuable service and generally underused Is a valuable service and generally underused Allows for compassion and dignity during the end of life transition Allows for compassion and dignity during the end of life transition Most families wait too long to have their doctor prescribe hospice from Medicare Most families wait too long to have their doctor prescribe hospice from Medicare It helps the patient and the entire family It helps the patient and the entire family

15. The Role of the Ombudsman The Wise & Healthy Aging Long-Term Care Ombudsman Program provide the following services: The Wise & Healthy Aging Long-Term Care Ombudsman Program provide the following services: Advocacy by voicing residents' concerns to a facility's administration. Advocacy by voicing residents' concerns to a facility's administration. Investigation of complaints made by or on behalf of residents Investigation of complaints made by or on behalf of residents Informal mediation to help parties involved reach agreements and settle conflicts, with the resident's satisfaction as the main focus Informal mediation to help parties involved reach agreements and settle conflicts, with the resident's satisfaction as the main focus Elder abuse investigation. Ombudsmen are trained to investigate and report suspected cases of elder and dependent adult abuse in long-term care facilities. Elder abuse investigation. Ombudsmen are trained to investigate and report suspected cases of elder and dependent adult abuse in long-term care facilities. Education to make residents and caregiver more aware of residents’ rights under State and federal regulations. Education to make residents and caregiver more aware of residents’ rights under State and federal regulations. Witnessing of residents’ signatures on documents such as Advance Health Care Directives in skilled nursing facilities. Witnessing of residents’ signatures on documents such as Advance Health Care Directives in skilled nursing facilities. Conducting regular unannounced visits to skilled nursing facilities and assisted living or board and care facilities. Conducting regular unannounced visits to skilled nursing facilities and assisted living or board and care facilities.

16. Caring for a Dependent Elder Build a Support Network Build a Support Network Involve Others Involve Others Understand Needs of the Person Understand Needs of the Person Learn about the Illness Learn about the Illness Communicate Communicate Seek Community Resources Seek Community Resources

17. Community Resources Bet Tzedek Legal Services Bet Tzedek Legal Services ALWPP information: www.californiaassistedliving.org ALWPP information: www.californiaassistedliving.org California Dept of Health Care Services: www.dhcs.ca.gov/services (800) 236-9747 California Dept of Health Care Services: www.dhcs.ca.gov/services (800) 236-9747dhcs.ca.gov/services California Advocates for Nursing Home Reform: www.canhr.org or nursinghomeguide.org (800)474-1116 California Advocates for Nursing Home Reform: www.canhr.org or nursinghomeguide.org (800)474-1116www.canhr.org Medicare.gov (800) MEDICARE (633-4227) Medicare.gov (800) MEDICARE (633-4227) Family Caregiver Alliance: www.caregiver.org Family Caregiver Alliance: www.caregiver.orgwww.caregiver.org Consumer Consortium of Assisted Living: www.ccal.org Consumer Consortium of Assisted Living: www.ccal.orgwww.ccal.org Long Term Care Ombudsman Program 310-394-9871 Long Term Care Ombudsman Program 310-394-9871 Veterans Administration: www.va.gov/GERIATRICS/Guide/LongTermCare/ Veterans Administration: www.va.gov/GERIATRICS/Guide/LongTermCare/

18. Thank You... Any Questions?

19. (800) 510-2020 www.aging.lacity.org or City Operator “311”