RCFE Lic #286804013

The Comforts of Home

Long Term Care

Before you do anything.

  • Take a deep breath, remove yourself from your immediate situation and try to become as objective as possible. Now, having done that, acknowledge that no matter how hard you try, it is nearly impossible to become truly objective at this stage. It doesn’t always, but, hopefully, objectivity will come later. Denial is a powerful and effective barrier.
  • It is therefore wise to consult an unbiased source for quality information on your situation. Keep in mind that although a physician may seem to be the correct choice in asking about care options, they often are not. Also keep in mind that your diligence in seeking out the altruistic and unbiased source of information is imperative. To complicate an already overwhelming maze of confusion, there are individuals lurking behind the guise of ally. Beware of anyone who claims to offer their services for free!
  • You will need to have a comprehensive geriatric assessment done by an individual who is trained to perform one. A physical assessment can be done by a physician and a psycho-social assessment can be done by a psychologist. Or, you may choose to enlist a geriatric case manager. If all else fails, you may contact Juliet Hahklotubbe for a free assessment at (707)815-3368.

Prior to embarking on finding a place, it is wise to have the following in check:

Physical Assessment

  • Ambulation
  • Any diagnosis/prognosis
  • Medications
  • Dietary needs
  • Allergies
  • Recent hospitalization

Cognitive/Psycho-Social Assessment

  • Memory impairment
  • Social requirements/Preference for interaction
  • Anxiety
  • Depression
  • Isolation
  • Inclination to wander/purposeful elopement

Financial Assessment

  • Long-term care coverage/insurance
  • Liquid/solid assets
  • Conservatorship
  • A durable power of attorney
  • Creating/Sticking to a reasonable budget


  • Tendencies
  • Family tree
  • Important people and events
  • Items that bring comfort
  • Important rituals

Health Care Desires

  • Durable Power of Attorney – health care
  • Advance Directives
  • End of life wishes

Your Well Being

Is making this large decision within your emotional capacity?

Are you educated? Or are you setting yourself, and your loved, one up for disappointment?

The term “Continuum of Care” is somewhat of a misnomer, considering there is no logical or predictable path of progression as we age. Meaning, aging is a process unique to each individual – I will do my best to put each option in some sort of order – please don’t expect to necessarily follow this path.

In-Home Care: In-home care ranges from part-time non-medical “companions” who simply provide supervision and social companionship to around-the-clock nurses who assist with every aspect of the person’s well-being.

Independent Living: Aka, Retirement Living:

Independent Living is a broad term. From the structural standpoint, most Independent Living communities are set up like hotels. Each apartment’s main entrance is within the building for safety and security. The industry of Independent Living, like In-Home Care, is once again an unlicensed field. However, by law, Independent Living communities are prohibited from providing care. Although most Independent Living communities are set up with apartments boasting kitchenettes, for an extra cost, they will offer dining services – some offer all 3 meals, while others will offer only 2. Since this setting is like an apartment, and they are not able to offer care, you can obtain In-Home Care (above) as you would at home. Most Independent Living communities offer or coordinate several social activities and outings.

Assisted Living: Assisted Living is a very large segment of the long-term care field.

Assisted Living is a regulated entity guided by the Department of Social Services, Community Care Licensing Division www.ccld.ca.gov . The Assisted Living industry is mainly run by the smaller family-owned 6-bed “board and care”. Within the past 10 years, the hospitality field has recognized the opportunity and capitalized on the multi billion dollar Assisted Living industry. Operators are allowed to offer any range of services within the parameters set forth by DSS/CCLD. Some operators will only offer care for those with minimal needs, whereas others will offer a wider range of care, further some will offer specialized care such as dementia care or hospice care. Assisted Living allows elders to receive housing, 24 hour care, supervision, meals and activities. Assisted Living is NOT a medical model – meaning, the operator is prohibited from providing nursing care.

Memory Care: Assisted Living (Dementia/Alzheimer’s Disease):

Bridging the gap between Assisted Living and our next category, Skilled Nursing lies Memory Care. If no “Nursing” or “Medical” care is needed, the elder may qualify to live in an Assisted Living community that specializes in care for those with Memory Impairments such as Dementia and Alzheimer’s Disease. The state has strict minimum requirements for operators to provide this type of care. Activities, Additional Staff Training, Conducive Physical Plant Layouts, and Increased Staffing Ratios are a few examples of provisions that differentiate a non-memory impairment provider from a memory care community.

Skilled Nursing: Aka, SNF, Nursing Home, Convalescent Home:

Skilled Nursing facilities offer nursing and rehabilitation care for those needing more than what can be provided in the home or in an Assisted Living setting. Licensed by the Department of Health Services, strict regulations guide these hospital-like environments. All care personnel are at least Certified Nursing Assistants (CNAs). The three main reasons why elders find themselves in this level are: Rehabilitation from a recent hospitalization, Debility and Decline, and, because most skilled nursing facilities accept Medi-cal, running out of funds. Over 50% of all nursing home patients have a level of memory impairment severe enough to be classified as dementia.

Hospice Care: Aka, Palliative Care, Comfort Care:

Skilled professionals who assist in making the process of dying a pleasant experience. The general rule (there are exceptions region to region) is that once a physician gives the elder* a prognosis of six months or less to live, Hospice becomes an option. There are multiple approaches to Hospice; PPOs, HMOs and Non-Profit Hospice organizations. Hospice is typically a service, which comes to the elder**, however, a growing trend is for Hospice organizations to build facilities to accommodate the terminally ill. In most cases, particularly with the non-profits, the services of Hospice are free of charge.

* Hospice is not exclusively available to the elderly, anyone of any age who is terminally ill, can qualify.

** Hospice will come to the elder’s home. However, it is imperative that you verify (preferably before making a decision in long-term care) the operator supports Hospice coming into their community – you will find how few Assisted Living communities allow hospice in their buildings.


OKAY, now it’s time to make that person-environment fit!

Where to start:

  • Choose the type of option you think your elder needs & call them.
  • Ask specific questions: if the provider won’t take the time to answer questions over the phone, can’t answer or dodges questions, put them on the bottom of the pile – don’t be lured into any community to take a tour before you determine whether it’s a possible fit – your time is valuable – don’t take a tour just to find that the community doesn’t meet your needs.

Remember, this field has become highly competitive which translates into high-pressure sales and creative marketing gimmicks.

  • Don’t be afraid to ask how much the care costs. In order to get a truthful quote, be truthful about the needs of your loved one. Remember OBJECTIVITY! With luck, the provider will be truthful about the costs! Caveat Emptor! (Buyer Beware)
  • Understand that most long-term care providers will quote the “base rate”, if they quote at all. Be sure to ask what that “base rate” includes. You will be shocked, more than once, to find out how “basic” the services are in the “base rate”.

Where are the highest-rated facilities? Call the people who know:

  • Long Term Care Ombudsman (volunteer service – watchdog for the state) – To locate an office in your region: www.ltcombudsman.org/static_pages/ombudsmen.cfm
  • Local hospital discharge planners
  • Skilled Nursing rehab units and discharge planners
  • Word of mouth experience – Although most won’t openly discuss the experience of placing a loved one, it’s more than likely that you know someone who has – try the office, church, school etc. You’ll be amazed at the common threads.

What to look for while on tour:

  • Do the clients look well kept?
  • Is there an odor?
  • Does the food look palatable?
  • What is the attitude of the staff?
  • What is the energy?
  • Do the clients resemble your elder?
  • How is the general cleanliness?
  • Speak to a resident and ask them their opinion
  • If able, speak to a caregiver and ask them their opinion.

Key questions to ask your potential provider:

  • Are there any openings? – male/female?
  • What range of services do you offer?
  • Do you offer services for memory impairment?
  • Do you offer hospice?
  • What is your facility’s philosophical approach to elder care?
  • What is included in monthly fees?
  • What services are extra? Each nickel and dime count!
  • What are the qualifications of the administrator?
  • What are the qualifications of the staff?
  • Who conducts your geriatric assessments?
  • How involved is the assessment (how long is it)?
  • What is your staff:client ratio?
  • Is the facility fully staffed?
  • How many of the staff are less than 6 months employed? (Turnover )
  • Is there a “move-in fee” “Community fee”? How much?
  • What is the community fee/deposit/move-in fee for? Is it refundable?
  • What does your facility do to prevent care giver burnout?
  • How often do you and your staff take vacations?
  • California state requires the most recent audit to be posted – ask to see it and read it

Be Prepared: What you will need prior to moving into any care home:

  • A physician’s report – care home will provide this
  • T.B. screen – on the physician’s report
  • Updated medication list – get from physician(s)
  • Time to read and understand the admission agreement – don’t sign anything without looking it over closely!
  • Time to assist with the comprehensive geriatric assessment

What if things go wrong; Contacts for assistance:

  • Local Long Term Care Ombudsman
  • Department of Social Services/Community Care Licensing Division
  • Local Adult Protective Services

This material is intended for the private use of those seeking assistance in bettering the quality of life of elders. Any other use of this material, without written consent, is strictly prohibited.