Assisted Living in California

by | Apr 3, 2022 | Senior housing information | 0 comments

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The sunny state of California offers miles of sandy beaches, rolling mountains and beautiful weather year-round, making it a top retirement destination. Overall, it ranks 24th in the nation on Caring’s Senior Living Report based on factors such as access to health care, crime statistics and regional air quality. In the Quality of Life category, California is ranked second in the country for its high number of public libraries, parks and public transit options. The state is home to world-class medical facilities, including UCLA Medical Center in Los Angeles and UCSF Medical Center in San Francisco. It also has a range of long-term care options for those who need help with daily activities, including over 7,400 assisted living facilities. For older adults who need long-term residential services, assisted living rates come in several hundred dollars higher than the national average at $5,250.

This guide provides more information on assisted living rates in California and how costs compare throughout the state, to nearby states and to other types of care within California. It also lists some statewide nonprofit and government resources to help older adults obtain care, a summary of Medi-Cal benefits and an overview of the regulations that govern assisted living facilities in the state.

The Cost of Assisted Living in California

According to the Genworth 2021 Cost of Care Survey, assisted living residents in California pay an average of $5,250 per month for care. This is several hundred dollars higher than the U.S. monthly rate of $4,500, indicating that this state is one of the most expensive places in the nation for long-term residential care services. Even so, obtaining services in California may be more cost-effective than seeking care in Hawaii, where residents pay $5,375 for assisted living. In Oregon, rates are lower but still high compared to the national average at $5,045. Those seeking budget-friendly alternatives may consider Arizona or Nevada, where respective monthly rates come in at $4,000 and $3,750.$5250

California$4500

The United States$5375

Hawaii$5045

Oregon$3750

Nevada$4000

Arizona

Across California, assisted living rates vary from as low as $3,450 per month to over $7,000. Visalia has the lowest surveyed rates in the state, but Merced and the Hanford area are similarly affordable at $4,000 and $4,350 per month, respectively. In Vallejo, care costs exceed the national median at $4,950. Seniors in the Santa Cruz area pay $5,550 monthly, and in the San Jose area, rates average $6,000. The Santa Rosa area is the costliest surveyed city in California for obtaining services, with assisted living facilities charging $7,048 per month for care.$3450

Visalia$4000

Merced$4350

Hanford Area$4950

Vallejo$5550

Santa Cruz Area$6000

San Jose Area$7048

Santa Rosa Area

California seniors have several long-term care options depending on their lifestyle goals, care needs and budgets. Assisted living is moderately priced at $5,250 per month. Those who obtain care in their own homes pay $6,101 for basic home care and specialized home health care, and those who attend adult day health care facilities pay affordable rates of $1,842 per month. Nursing home care is the costliest, with facilities charging $9,794 for semiprivate accommodations.$5250

Assisted Living$6101

Home Care$6101

Home Health Care$1842

Adult Day Health Care$9794

Nursing Home Care (semiprivate)

Does Medicaid Cover Assisted Living in California?

Qualifying seniors in California may be able to pay for assisted living through Medi-Cal, the state’s Medicaid health care program. While Medi-Cal doesn’t cover residential long-term care services directly, it reimburses services for those enrolled in its Assisted Living Waiver. This waiver pays for assisted living services as an alternative to nursing home placement for those who require this level of care.

Unlike Medi-Cal, which is an entitlement that provides guaranteed coverage for everyone who meets eligibility guidelines, ALW has a limited number of participant slots. Up-to-date information on the waitlist is available through the Department of Health Care Services enrollment dashboard.

What Assisted Living Services Are Covered by Medicaid in California?

The Assisted Living Waiver covers a broad range of services depending on the individual’s needs as assessed by a Medi-Cal social worker. These services include:

  • Assistance with daily living activities such as bathing, eating and mobility
  • Assistance with instrumental activities of daily living, including medication reminders and transportation
  • Skilled nursing services
  • Social and recreational activities
  • Daily meals
  • Housekeeping and laundry services

Assisted Living Waiver Programs in California

Assisted Living Waiver

The ALW provides a community-based alternative to nursing home care for those who have extensive care needs but want to live in an assisted living facility. This program is open to all California residents. However, to have services covered, participants must live in an assisted living facility that accepts reimbursement from Medi-Cal. Currently, long-term placement is available in the following counties: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara and Sonoma. Additionally, the ALW doesn’t cover room and board, but costs are controlled for those who qualify for Supplemental Security Income.

To determine eligibility for the ALW, individuals undergo an assessment that evaluates their care needs. This assessment, which individuals schedule through their local Care Coordination Agency, is conducted by a registered nurse. To apply for this program, seniors call their local agency for a pre-assessment over the phone and schedule an appointment for the actual assessment.

How To Know If You’re Eligible for Medicaid in California

To be eligible for Medi-Cal, applicants must

  • be legal U.S. citizens or residents and permanent residents of California.
  • be at least 65 years old, blind or disabled
  • meet income guidelines

As of 2022, single applicants can have an annual income of up to $17,609. Coverage is also available for those who reside in skilled nursing or intermediate care homes. Enrollment in certain programs, including Supplemental Security Income and the State Supplementary Payment Programs, guarantees eligibility for Medi-Cal.

How To Apply for Medicaid in California

To apply for Medicaid, seniors must submit an online Medi-Cal application to CoveredCA.com. Alternatively, they may mail a paper copy to Covered California at P.O. Box 989725, West Sacramento, CA 95798 or to their local county office. To request the ALW, contact your local Care Coordination Agency. This process takes approximately three to six months.

What Information You Will Need

  • Proof of age
  • Proof of U.S. citizenship or legal residency
  • Proof of permanent residency in California
  • Social Security number
  • Proof of all annual income, including government benefits, pensions and retirement savings
  • Policy numbers for current health insurance, including TRICARE and Medicare

How To Get Help Applying for Medicaid

Seniors in California have access to several free programs that can help them determine the best Medi-Cal coverage for their needs, enroll in the program and understand their benefits. The following resources can also help seniors resolve issues related to denied services and mishandled claims.

RESOURCE

CONTACT

SERVICE

Health Consumer Alliance

(888) 804-3536

Health Consumer Alliance provides free over-the-phone and in-person assistance for those who need help obtaining health insurance or resolving issues related to their coverage. Through this resource, seniors get information on their health insurance rights, find a doctor that takes Medi-Cal, dispute denied health services and resolve billing errors.

Medi-Cal Managed Care Ombudsman

(888) 452-8609

The Medi-Cal Managed Care Ombudsman Program advocates for Medi-Cal beneficiaries to ensure they obtain the medically necessary services covered by their insurance. The ombudsman provides information and referrals, connects seniors with the correct person or department they need to resolve a problem and helps individuals navigate the managed care system.

Medi-Cal Managed Care Health Care Options

(800) 430-4263

Medi-Cal Managed Care Health Care helps seniors enroll in, change or leave a Medi-Cal health plan.

Medi-Cal State Fair Hearing

(800) 952-5253

Medi-Cal State Fair Hearing investigates complaints regarding how an individual’s benefits and health services were handled by Medi-Cal. Seniors can call the toll-free hotline to speak with their local County Welfare Department regarding their complaint, file a discrimination complaint or request a hearing.

Does Medicare Cover Assisted Living in California?

The short answer is that no, Medicare does not cover the cost of assisted living in California Assisted living facilities are considered to be a “residential setting” and not a “clinical setting,” (think nursing homes). While Medicare doesn’t cover the cost of care received in an assisted living community, it does still cover things like approved medications, doctor visits, medical equipment, etc., just like it would if you lived at home.

For more information about when Medicare can be used to pay for senior living in a nursing home, and for Medicare-related resources, see our guide to Nursing Homes in California

Other Financial Assistance Options for Assisted Living in California

Seniors who are not eligible (due to location, financial situation, or other factors) for other types of financial assistance, do still have some options. See the table below for an overview of some of the most common ways to make Assisted Living affordable.

HOW TO APPLY

HOW IT WORKS

Aid and Attendance

Learn more and apply online at va.gov.

Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for Assisted Living.

Reverse Mortgages

Learn more about your options and how to apply at ftc.gov

If you own a home, you may be able to use a reverse mortgage to help pay for Assisted Living. Reverse mortgages are loans you can take out against the value of your home, essentially converting some of the home’s equity into cash. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.

Long-Term Care (LTC) Insurance

Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov.

Seniors who already have long-term care insurance may be able to use it to pay for Assisted Living. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of Assisted Living typically won’t be eligible to sign up for a LTC insurance policy.

Free and Low-Cost Resources for Seniors in California

Seniors in California have access to numerous nonprofit agencies and programs that can help them make informed decisions regarding their long-term care options. Through the following resources, older adults can get more information on assisted living in the state, advocacy services and options for covering care costs.

RESOURCE

CONTACT

SERVICE

Area Agencies on Aging

(800) 510-2020

California has a network of 33 Area Agencies on Aging, each serving a designated geographic area within the state. Through their local AAA, those aged 60 and over can connect with local senior centers and congregate meal sites, durable medical equipment loan programs, financial and legal counseling and community-based services. The agencies are staffed with options counselors who help individuals evaluate their care needs and options and determine whether they may qualify for public benefits that can help cover long-term care costs.

Long-Term Care Ombudsman

(800) 231-4024

The statewide Long-Term Care Ombudsman Program supports older adults in assisted living by helping them understand their rights, obtain the services in their care plans and resolve issues related to substandard care. The ombudsman can mediate family disagreements regarding their loved ones’ care and represent seniors’ interests regarding problems with insufficient or excessive services, billing mistakes and unfair intake or discharge procedures. The ombudsman can also investigate concerns about abuse, neglect or exploitation.

Medicare Counseling

(800) 434-0222

The Health Insurance Counseling and Advocacy Program is a volunteer-driven program that provides free, unbiased health insurance options counseling for Medicare-eligible individuals. HICAP counselors host workshops and participate in community events across the state and provide one-on-one in-person and over-the-phone assistance to help older adults understand their Medicare coverage and compare prescription drug, Medicare Advantage and Medigap plans. HICAP counselors can also help older adults determine whether they qualify for Medi-Cal and the Assisted Living Waiver Program.

California Department of Veterans Affairs

(800) 952-5626

The California Department of Veterans Affairs serves the state’s 1.6 million veterans by helping them access state health care benefits and the VA Aid and Attendance and veterans’ and survivors’ pension programs. It provides advocacy and assistance via County Veteran Service Offices throughout the state. It can also help veterans determine whether they qualify for placement in one of California’s eight veterans’ homes, which may be an affordable alternative to private long-term care services.

State Bar of California

(415) 538-2000

The State Bar of California funds nonprofit legal agencies across the state and maintains a comprehensive database of local offices that provide free civil legal services to those aged 60 and over. Through these offices, older adults can get one-on-one assistance with determining whether they’re eligible for public benefits including Supplemental Security Income, Social Security Disability Insurance and Medi-Cal. The State Bar also publishes legal guides with topics such as legal resources for veterans, how seniors can avoid legal fraud and what to know before hiring an attorney.

Social Security Administration

(800) 772-1213

California is home to over 100 local Social Security offices. At these locations, older adults can apply for retirement, disability and Medicare benefits, which can help them control care and medical expenses. Through their local office, seniors can also request replacement Social Security and Medicare cards, appeal decisions or print proof of benefits.

COVID-19 Rules for Assisted Living in California

The following information is based on research done on several government websites, including cdph.ca.gov and publichealth.lacounty.gov. These rules apply to nursing homes, and other types of senior living facilities. We’ve most recently updated this data on 2/22/2022, but since COVID-19 is a rapidly evolving pandemic, contact your local senior living facility or Area Agency on Aging for more specific and up-to-date information.

Visitation Policies

RULES FOR CALIFORNIA COMMUNITIES

Are loved ones allowed to visit to provide emotional support?Yes (Conditions Apply)

Are relatives allowed to visit for end-of-life care?Yes

Are residents required to quarantine after visiting with a loved one?No (Conditions Apply)

Are visitors required to wear PPE (including masks) in order to visit residents?Yes

Are non-medical contractors (such as hairdressers and entertainers) allowed in senior living facilities?Yes (Conditions Apply)

Does the state recommend or require that senior living facilities assist families with setting up virtual visit alternatives?Yes

Are visitors checked for elevated temperatures?Yes

Are visitors required to answer questions about health, travel, and potential virus contact?Yes

Outings & Social Activities

RULES FOR CALIFORNIA COMMUNITIES

Are residents allowed to leave (errands, visiting family, etc.) for non-medical reasons?Yes

Are residents who leave required to quarantine when they return?No (Conditions Apply)

Are senior living communities required to cancel all group outings?

Not Available*

Are residents allowed to eat meals together in a common area?Yes (Conditions Apply)

Are residents allowed to gather in common areas for group activites?Yes (Conditions Apply)

*Note: This information was not available for this state, contact your local area agency on aging or senior living facility for more information.

COVID-19 Safety Measures for Staff and Residents

RULES FOR CALIFORNIA COMMUNITIES

Are staff members regularly required to do a temperature check?Yes

Are staff members regularly tested for COVID-19?Yes

Are staff members members regularly required to do a health and safety screening, including questions about travel, contact with positive cases, etc?Yes

Are residents regularly screened for COVID-19 symptoms?Yes

Are residents regularly checked for elevated temperatures?Yes

Are residents regularly tested for COVID-19?Yes (Conditions Apply)

Assisted Living Laws and Regulations in California

In California, assisted living facilities are licensed by the Department of Social Services, Senior Care Licensing Program, and comply with extensive regulations to ensure high-quality care for residents. The department supports prospective and current assisted living residents via 13 regional offices throughout the state.CALIFORNIA LAWS AND REGULATIONS

Assisted Living Service Plan Requirements

Prior to admission, the facility must conduct a comprehensive appraisal that assesses the prospective resident’s level of functioning, mental condition and social factors such as their interests and hobbies. The facility must also obtain documentation of a medical assessment conducted within the last year and signed by the prospective resident’s primary care doctor. This documentation should include the individual’s height, weight and blood pressure. Based on these factors, facilities create personalized care plans to meet residents’ functional needs and goals. This care plan should be updated whenever the resident has a significant change in their health or status.

Assisted Living Admission Requirements

Assisted living facilities can only admit a resident if the individual or their guardian consents. To be admitted, residents must be able to administer their own medication. If they need services beyond the facility’s scope of care, they must be able to obtain services off-site. The facility isn’t permitted to admit anyone who requires around-the-clock skilled nursing services, care for Stage III and IV dermal ulcers, treatment for serious infections or catheter care. It can’t retain residents who become bedridden, require help with all daily living activities or develop mental conditions with behaviors that may be disruptive to other residents.

Assisted Living Scope of Care

Assisted living facilities provide ongoing assistance with daily living activities including personal care, money management and assistance with self-administered medication. Additionally, they provide three meals plus snacks daily, regular observation of residents’ health and condition and planned activities programming.

Assisted Living Medicaid Policy

Medi-Cal, California’s Medicaid program, covers long-term residential care under the Assisted Living Waiver Program. This program covers the services the individual obtains through assisted living, but it doesn’t cover room and board. While it’s open to residents statewide, there’s a limited number of assisted living facilities that accept payment from this program.

Assisted Living Facility Requirements

Assisted living facilities must be clean, sanitary and in good repair at all times. Residents must have furnished bedrooms and storage space, and there must be at least one toilet per six people and one shower or bathtub per 10 people. Facilities must also have common rooms including living rooms and dens, recreation and activity rooms and dining rooms.

Medication Management Regulations

Assisted living facilities can provide medication reminders and assist with self-administration of medications in limited circumstances, such as if a resident needs assistance due to arthritis or hand tremors. Assisted living facilities can only admit and retain residents with diabetes if they can perform their own glucose testing and medication administration. For other residents who require intramuscular, subcutaneous or intradermal injections, either the resident or an appropriately skilled professional can administer the medication.

Staffing Requirements

Assisted living facilities must have certified administrators and may hire skilled professionals, including pharmacists or licensed nurses, to provide medication administration or limited medical services. Facilities are expected to have enough direct care staff members on-site to see to residents’ scheduled and unscheduled needs.

Staff Training Requirements

All staff members who work directly with residents must complete at least 10 hours of training within the first four weeks of their hire date, plus four hours annually. This training may be given on the job and/or in a classroom setting. Topics training covers include the special needs of older adults, techniques for personal care services, residents’ rights, seniors’ psychosocial needs and how to recognize dementia.

Background Checks for Assisted Living

All administrative staff, direct care staff and employees who have frequent contact with residents are subject to criminal background checks. All facility staff and private-pay personal assistants must be fingerprint cleared before their physical presence at the facility. Anyone with a prior conviction for anything more than a minor traffic violation is ineligible for hire unless the director grants an exemption. Under limited circumstances, volunteers may be exempt from this rule.

Requirements for Reporting Abuse

All assisted living employees are mandated reporters and must report instances of physical, sexual, emotional or financial abuse, neglect or exploitation. Anyone can file complaints regarding suspected abuse to local law enforcement, as well as the Department of Social Services, Community Care Licensing Division by calling 1 (844) LET US NO/1 (844) 538-8766.

Assisted Living Facilities in California (346)

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