How Does a Senior Qualify for Assisted Living?

Many key factors go into choosing an assisted living facility that will meet the medical, emotional, and cognitive needs of your loved one. Families must carefully weigh the most important aspects of care, compare facilities and services, and determine which assisted living community will provide the care needed, offer social activities and recreation for an active lifestyle, and help your family member feel at home.

Many assisted living facilities have specific qualifications and criteria that guide this critical decision and ensure that staff, residents, and families are all aligned on the care, services, and costs.

So how does a senior qualify for assisted living? By knowing this you’ll have a head start on finding the best facility to provide care for your family member in assisted living.

Age and Overall Physical Health

Assisted living facilities are typically designed for older adults, retirees, or seniors who are aged 55-65 or older. However, the specific age requirements may vary depending on the facility you choose and the specialized care, services, or activities that are offered.

Assisted living communities are designed to provide the daily support that seniors need to go through the day safely and independently. Seniors considering assisted living will usually be able to perform daily activities such as eating meals, using the bathroom, bathing, and moving around the facility with help from the staff as needed.

It’s important to understand, though, that different facilities will offer varying levels of assistance, care, and programs for seniors, so you must choose a community that provides the type of care and assistance your loved one needs each day.

Cognitive Health

Many assisted living communities will accept new residents in the very early stages of Alzheimer’s or other types of dementia. However, seniors in the advancing phases of dementia typically require higher levels of support and will require specialized cognitive care programs focused on cognitive function and preservation to thrive.

If your loved one is living with Alzheimer’s or dementia, then looking into assisted living facilities with a memory care community will help ensure your loved one will qualify for care and get the support needed for their cognitive health.

Medical Conditions

Assisted living facilities are typically set up to provide care and support for seniors who are in a stable medical condition and need assistance with daily life activities. Some assisted living communities will accept residents with medical conditions if they can be safely managed with help from external medical providers.

If your loved one needs ongoing medical care for health conditions, then looking into a skilled nursing facility may provide you with more options for the type of care your loved one requires.

Safety and Security

Resident safety is a top priority in assisted living, and seniors will need to be able to navigate the facility safely. An assisted living facility might want to assess the mobility of your family member to ensure that they get around safely with assistance and identify any potential risk factors that will need to be considered for care.

Financial Obligations

Health insurance plans, Medicaid, and Medicare do not typically cover assisted living, so residents or family members must cover care costs out of pocket. Assisted living costs vary from facility to facility, so it’s important to make sure you understand the financial obligations of care and any services that will add on extra costs.

Some seniors might qualify for government assistance programs if they meet the proper criteria, and some facilities offer payment plans to help manage costs.

No specific age dictates when a senior can transition into assisted living. Other factors such as age, physical and cognitive health, and ability to live independently tend to weigh more heavily into the decision for seniors and family members. Seniors will usually begin considering assisted living when they can no longer safely care for their daily needs at home or with the help of family or in-home care. Some retirees choose to move into a more vibrant assisted living community to fulfill socialization needs and stay active as they age.

However, on average, most seniors move into an assisted living facility in their late 70s or early 80s. With advancing age, many seniors lose the ability to safely maintain their homes, care for their personal needs and hygiene, or deal with ongoing medical conditions requiring regular care and assistance for overall well-being. Assisted living communities provide a range of services designed to fulfill various needs of residents, from daily assistance in personal care, managing medications, preparing healthy meals, and participating in social activities that are very attractive to seniors who need some help with daily activities but do not need skilled nursing care, memory care services, or 24/7 medical monitoring.

Ultimately, the decision to move to assisted living depends on the individual’s needs, preferences, and available support systems, and not age alone. Some older adults will transition into care in their 60s, while others will only make the move to assisted living well into their 80s. It’s important to keep open lines of communication flowing with your loved one, family members, and medical professionals to assess the need and readiness for assisted living.

There are many various and unique reasons that a senior and family members decide that a transition to assisted living is the best choice for the family. This is a highly personal and often emotional decision for families that require careful consideration and planning for a smooth transition.

Understanding some common reasons seniors decide on assisted living can help guide your family’s discussions about assisted living:

Health Declines

Seniors who choose to transition into assisted living often do so because they are struggling with limitations at home due to illness, mobility issues, or other disabilities that make it difficult for them to live independently. Assisted living facilities provide seniors with the daily assistance they need to safely complete self-care and hygiene tasks such as taking medications on schedule, eating, bathing, and dressing.

Cognitive Declines

Seniors living with Alzheimer’s or other forms of dementia will exhibit cognitive declines that affect memory, decision-making, and judgment. As these conditions progress, seniors will need 24/7 monitoring and care along with specialized care plans to preserve current cognition and improve well-being. Assisted living facilities with memory care communities are a great option for seniors with memory-impairing conditions like dementia.

Safety Issues or Concerns

Seniors experiencing falls frequently, having trouble managing their home or personal care, or having safety issues living at home alone will often choose to transition to assisted living. Facilities are designed with safety features for seniors as well as trained staff to ensure safety as they move around the facility each day.

Loneliness, Depression, and Social Isolation

Seniors often begin to experience loneliness and isolation due to the loss of friends, spouses, or personal mobility. Assisted living facilities offer an array of social activities and recreation for seniors who want an active, social lifestyle.

Caregiver Burnout

Family members will often assume a caregiver role for aging loved ones, and over time and depending on the complexity of care needed, caregivers can experience burnout that impacts their health and the family dynamic. Assisted living provides family members with respite from caregiving and provides a safe environment for seniors so families can have peace of mind due to their loved ones having access to professional care.

The requirements for an assisted living facility in California can vary depending on the state’s specific regulations and licensing standards. It’s important to note that rules can change over time, so it’s always a good idea to consult with the California Department of Social Services or a legal professional to ensure you have the most up-to-date information.

Here are some common requirements for an assisted living facility in California that you should know and understand as you decide on assisted living services for your family:

• State Licensing: Assisted living facilities located in California must be licensed by the California Department of Social Services under the Community Care Licensing Division.
• Staffing: Assisted living communities must have properly trained and qualified staff members. Facilities must also ensure that there are enough employees on staff to provide the level of care needed for all residents.
• Health and Safety of Physical Setting: An assisted living facility in California must comply with all state health and safety standards. This includes accessible exits, fire alarms, handrails, and wheelchair access. Food storage and handling, cleaning and maintenance, waste disposal, and infection control protocols must also all be up to the state’s standards of care and cleanliness.
• Care: Assisted living communities must also comply with a standard of care and services that meets the needs of all residents in care at the facility. Facilities must follow the proper procedures of care in delivering assistance in daily activities such as medication management, resident mobility, bathing, dressing, and eating meals.
• Resident Protection and Rights: In California, assisted living residents have rights and protections in place to ensure proper care and treatment. Residents have rights to respect, dignity, and privacy while in care that are protected by the state as resident safeguards.
• Records Compliance: Assisted living facilities in the state of California must comply with record-keeping and reporting requirements, including incident documentation, care information, accident recording, as well as any suspicions around abuse or neglect of residents.

In the state of California, Medicaid operates a program called Medi-Cal, which provides healthcare coverage for low-income individuals and families. While Medi-Cal does not directly cover assisted living costs, it does provide funds to provide long-term care through a waiver program called the Home and Community-Based Services (HCBS) program. HCBS exists to help seniors pay for care costs at home or in a community-based setting like a nursing home or assisted living facility.

Seniors must be eligible to take advantage of this waiver program, and there are limitations to the coverage that you’ll need to understand fully to know exactly how much coverage your loved one can receive each month.

An HCBS waiver may partially cover services such as case management, home modifications, and personal care assistance for eligible seniors. However, there are limitations to the program, and there is often a waiting list to receive these benefits.

The requirements and coverage policies of Medi-Cal tend to change each year, so consulting with a lawyer and getting details about your loved one’s exact needs is a good step to determine the potential for coverage. The Department of Health Care services or a local Medicaid office can provide you with the most updated eligibility and coverage details for your family member.

Choosing an assisted living facility where your loved one will thrive is an important decision that requires thoughtful planning, careful consideration, and family involvement. Here are some of the most important aspects of assisted living care that you should consider as you’re determining which facility will provide senior care for your family:

Location, Services, and Amenities

The location of the assisted living community you choose for your loved one is very important to fostering strong family bonds while your loved one is in care. You should consider facilities close to family members and have access to external medical services such as healthcare providers, pharmacies, and recreation spots your loved one enjoys.

Facilities should be clean, well-maintained, and equipped with safety features that meet California standards of care. You should also understand your family member’s care needs and compare those with the services, programs, and activities offered at various assisted living facilities to choose the best fit for your family.

Personalized Care Plans and Individualized Programs

Assisted living centers often provide personalized care plans to ensure that the needs and preferences of each resident are covered. Every resident is unique, so their care plans and activities should be tailored to individual needs, personalities, and preferences.

Consider speaking with current residents and their families, if allowed, to get an idea of how residents are treated and what amenities are available. You can also read online reviews from families of past or current residents to get an idea of what others with experience in the facility think about the services and care provided.

Staff-to-Resident Ratio

Inquire about the staff-to-resident ratio to determine if there are enough caregivers to provide individual attention and assistance to residents. A lower ratio generally indicates better care.

Licensing and Accreditation

Ensure that the facility is licensed, accredited, and compliant with the regulations set by the appropriate governing bodies. This ensures that the facility meets specific standards of care and safety.

Cost Structure

Understanding the monthly costs, payment options, Medi-Cal eligibility, and any other additional fees that may be necessary for your loved one’s assisted living care will help you fine-tune the price you’ll need to pay for assisted living services. Make sure to carefully review your care contract and ensure the terms are transparent and suitable for your family.

The Shores at Vivante Assisted Living and Memory Care is dedicated to preserving life stories, treating residents with dignity, and providing top-quality assisted living care and services to seniors in California.

Contact Us today to learn more about our assisted living facilities!