It’s never too early to start planning for eldercare, whether for a relative, a spouse, or yourself.
Generally, eldercare is separate and distinct from nursing home care. Nursing homes provide medical and personal care in a clinical setting. Eldercare offers personal care in a home-like or social setting. In California, there are three primary types of eldercare: Assisted living, home care, and adult day care. The best choice depends on physical needs, financial resources, and availability.
The process of finding affordable care begins with an assessment of the older adult’s needs. Generally, a certain degree of functional independence is required for eldercare. For example, assisted living facilities are appropriate for individuals with disabilities or certain deficits who are mostly independent, but cannot safely live alone. Limited services are available for a fee, including housekeeping and laundry, meal preparation, and daily check-ins. In addition, assisted living facilities may offer opportunities for group meals and activities.
Home care is designed to keep older individuals in their homes. A wide range of services are available for an hourly fee, including assistance with medications, housekeeping, meals, and personal needs, such as bathing and dressing.
Adult day care is offered at non-residential facilities and typically include health, nutritional, social, and daytime services for older adults. Participants return to their own residences overnight.
The expense of each type of care can be calculated by using the cost of care calculator at https://www.payingforseniorcare.com/california. Generally, the costs break down as follows:
- Assisted Living. In 2019, the average cost of an assisted living facility in California was $4,500 a month. However, the cost ranged from $3,150 to $5,595. The most expensive facilities are located in Marin County (including San Francisco), San Jose, San Luis Obispo, Santa Cruz, and Napa. The least expensive facilities are located in Bakersfield, Madera, Merced, Stockton, and Modesto. In all locations, Memory or Alzheimer’scare can add up to $1,350 to the monthly fee.
- Home Care. In 2019, the average rate for home care in California was $26.00 an hour. However, depending on location, the hourly fee can range from $22.50 to $31.00. In Chico, Visalia, Vallejo, and Riverside, the average cost is $22.50 to $24.00 an hour. The cost in Napa, San Jose, Santa Rosa, and El Centro is approximately $29.50 to $31.00 an hour.
Adult Day Care. In 2019, the average daily cost for adult day care in California was $78. In Chico, San Jose, and Santa Rosa, the cost ranged from $92 to $109 a day. In Hanford, Vallejo, and Visalia the average cost ran between $40 and $63 a day. In addition, the daily cost of adult day care in Los Angeles, Modesto, Merced, Salinas, Riverside, and Fresno is below the state average–$70 to $77 a day.
For many families, finding affordable eldercare is a concern. Fortunately, multiple resources are available, including:
- Medi-Cal. In California, the federal Medicaid program (Medi-Cal) finances some eldercare. For example, the In-Home Supportive Services (IHSS) Program finances non-medical care for eligible elderly adults. The program is designed to prevent or delay nursing home placement. It provides assistance with daily living activities, such as housecleaning, meal preparation, and grocery shopping. More information is available at https://www.payingforseniorcare.com/california/inhome-supportive. In addition, Home and Community Based Services (HCBS) waivers provide assistance with home care, adult day care, home modifications, and assisted living. These programs have limited availability and require eligibility for Medi-Cal. Most have waiting lists. The programs include:
- The Assisted Living Waiver Program (ALWP). Available only in certain regions of California, this program provides financial assistance for individuals who are eligible for nursing home care, but prefer to live in an assisted living community. Several supportive services are available, such as personal care, medication administration, and prepared meals. However, room and board are not covered. More information is available at https://www.dhcs.ca.gov/services/ltc/Pages/AssistedLivingWaiver.aspx.
- The Multipurpose Senior Services Program (MSSP). This program enables nursing home eligible individuals to stay in their homes. Services include adult day care, assistive technology, and home modifications. It does not pay for medical care. For more information, visit https://www.payingforseniorcare.com/california/medicaid-waivers/multipurpose-senior-services-program.
- The Home and Community-Based Alternatives Program (HCBA). This program enables nursing home eligible individuals to receive care, including medical care, in their homes. Individuals who currently reside in nursing facilities and wish to move back to their home are also eligible. More information is available at https://www.payingforseniorcare.com/california/medicaid-waivers/nursing-facility-acute-hospital-waiver.
- The Community Based Adult Services(CBAS) Program. This program provides daytime care, meals, social activities, therapies, and skilled nursing services in adult day care centers or other specialized settings. For more information, visit https://www.payingforseniorcare.com/medicaid-waivers/medi-cal-cbas.
- State assistance programs (non-Medicaid). Californians not eligible for Medi-Cal programs do have other options. Contact your Area Agency on Aging Officesfor information on special funding and programs available locally. In addition, the California Paid Family Leave Program provides up to six weeks paid time off for working professionals who need to care for a family member. In San Francisco, a local, pilot program called Support at Home provides financial assistance for elderly individuals who desire to remain in their homes.
Other options. California also offers many non-profit and federal options. A Resource Locator Tool, available at https://www.payingforseniorcare.com/resources/locator_tool, assists seniors with locating financing for eldercare. For example, specific programs are available to assist older veterans with financing assisted living, (https://www.payingforseniorcare.com/veterans/veterans-pension). Loans are available to pay for eldercare, (https://www.payingforseniorcare.com/financial-products/bridge-loans). In addition, a reverse mortgage or Unison HomeOwner Agreement may be available to pay eldercare costs, (https://www.payingforseniorcare.com/resources/rex_agreement).
While there are multiple affordable eldercare options available in California, location does impact price and availability. Typically, communities outside of densely populated areas offer lower prices and sometimes, more program options. Assistance with finding affordable care is available at https://www.payingforseniorcare.com/home-care-assisted-living/find-affordable-elder-care.