No clue how to help my aunt find a retirement home.

July 12, 2023 1:14 PM

My aunt's partner died last year, and since then she's had a couple of major operations which have left her weak. The writing is on the wall: she's got to move out of her home and into some kind of senior living situation. I'm helping her. What should I be looking for?

Her Situation
She is in her early 70s but old for her age due to smoking, social isolation, sedentariness, and the wreckage of the last twelve months.

She requires various prescriptions and is likely a permanent fall risk. Right now she's walking 25 feet at a time, I'd be surprised if she's ever back to 150 or so. For now, I don't believe she needs on-site medical care, but she needs to be able to call for and/or get transport to it.

She can cook for herself minimally, but most likely it would be good for her to have meals provided and laundry service available. Another option would be to pay for home care a few times a week.

For now, her cognition is good! I imagine that in the next five years or so, memory care may need to be on the table.

As I've said, she's been isolated in recent years and is a bit of a recluse at times, but she also lives entirely for gossip and being in other people's business and having people in her business. I imagine she would benefit from having solitary space for herself but in a decent-sized community.

My Questions
What are the right search terms for the kind of place that might work for her? In other words, "retirement community," "independent living," "assisted living," and "senior living" all seem to overlap quite a bit in their meaning whenever I call places. I don't really know the name of what I'm looking for. She would be very independent but for her physical condition.

What questions should I be asking when I call around?

She has insurance through the Veterans Administration. Should I be looking for a place near to a VA hospital? Does the VA cover any portion of this?

In Southern CA, what is a reasonable or at least consensus market rate for these places? It seems to range from $4,000 to $9,000 for a studio apartment which is a wide range that makes me uncomfortable trying to parse. She has some money but I think the more expensive places are way out of her range.

What are signifiers of quality that I should look out for?

What should I ask them when I call and/or visit?

Oh, and of course: if you know a specific place that is great

posted by kensington314 to Health & Fitness (20 answers total)

Edit: My last sentence got cut off. Should read:

"Oh, and of course, if you know a specific place that is great for a person in her situation, I'd love to hear about it. Anywhere in the San Bernardino, Riverside, Orange, Ventura, or Los Angeles County areas is possible.
posted by kensington314 at 1:18 PM on July 12, 2023

Is she a veteran? If so, my dad was in the California Veteran's Home in Yountville and he really liked it there. It's one of those places where you can move from "I have a room and someone makes me meals" to skilled nursing.
posted by elmay at 1:27 PM on July 12, 2023

Thanks, elmay, looking into this now. Did he have his own room or was it shared beds type of situation?
posted by kensington314 at 1:48 PM on July 12, 2023

When my mother-in-law was getting into this situation we paid for the services of an "eldercare advisor" in her town, which turned out to be absolutely the right thing to do. This person knew *everything* we didn't know, and knew *every* available facility, and *every* government loophole to get as much funding as possible. I don't have a person to recommend you, but I think that should be your first search.
posted by BlahLaLa at 1:50 PM on July 12, 2023

Regarding the search terms/ names of types of care, some of those are regulated by the state and refer to the type of license that a facility has. This page will give you more precise information about the types of housing and care you may come across. That site has a lot of other info for you as well.

I also recommend an elder care advisor. Their services are invaluable and usually free (they often are paid commission by placement). Do look for a small local company, not a national company. You want a real human being who knows the area, not a service that will just blast your info to area facilities.
posted by hydra77 at 2:14 PM on July 12, 2023

Agreed with BlahLaLa. An advisor is incredibly helpful in this situation. Try really, really hard to find someone that you or your aunt is paying to do the legwork, not someone who gets a commission for placements, if you possibly can. I didn’t realize there was a difference until we were being strong-armed with some sales tactics. (Not every facility that pays them is amazing or a decent fit.) Some social workers do this for a flat rate. If you consult with an eldercare attorney they will know someone who can help.

There are facilities that are combination assisted living (person can live safely on their own, may need help with dressing and bathing, goes to a dining room to eat their meals) and skilled nursing (needs medications administered, needs assistance toileting, is non-ambulatory) and those can be a godsend in terms of staying in the same facility when someone needs a higher level of care. The caveat with those is that many places will only take ambulatory residents because they save the skilled nursing slots for existing residents as they need them. Get in while you can.

Many facilities charge a certain baseline rate for studio apartments with add-on charges for things like help with dressing or bathing. Find out how the facility handles staffing if your aunt needs more assistance. (Their staff? Someone you hire?)

Random things I did not know about when we began this process: assisted living facilities cannot lift residents, so they need to call an ambulance if someone falls, even if they don’t seem hurt; some facilities are run by Catholic mendicant orders who rely on community donations to take care of their residents, and by that I mean “we have nothing to make sandwiches with for the residents’ lunches, can someone please donate something,” more than “fundraiser drive for new ramps”; assisted living places really want to fill those units so ask a lot of questions, including what the procedure is if someone suddenly requires more care than anticipated; not every facility is set up for wheelchair users, so ask about what that looks like if a resident has a mobility issue (our issue was the shower setup).
posted by corey flood at 2:20 PM on July 12, 2023

There's also a CalVet home in Lancaster. That will be closer for you. I don't know the details but my friends lived there for years and I presume did well. My impression was that it was set up precisely like elmay indicated.
posted by notned at 2:22 PM on July 12, 2023

Veterans services can be really hard to parse, calling the VA and getting an understanding of her benefits would be really helpful. If she's eligible for home aid and assistance that would be awesome support. But you won't know until you call. It helps if she's accessing care through the VA but you don't have to get your healthcare there. It just means that your health provider may not be as familiar with the VA paperwork and processes when you are trying to get a specific service. They may require documentation such as a DD214, having that available prior to making the call can save you some time/ back and forth.
posted by AlexiaSky at 2:25 PM on July 12, 2023

VA care is way less expensive than the quoted prices that you've been looking at above. My grandfather is currently recieving memory care in a locked unit through the VA and it is 2400 a month or so.
posted by AlexiaSky at 2:27 PM on July 12, 2023

In the interim until you get something set up, my aunt, a veteran, was able to get in-home help at no cost to do light tasks around the house. It was actually a helpful service and took some pressure off me, who was otherwise doing these tasks and trying to get her to go into assisted living. In my case she refused to move from her house, which was extremely poorly set up for an aging person though sudden health deterioration made the assisted living issue moot, and she had to go to an actual nursing home.

The VA gave her a few hours per week with an aide, 4 or 5 hours, I think. Sometimes the aide grocery shopped, sometimes she changed bed sheets and did laundry. I'm not absolutely sure of the tasks she was able to do - though nothing medical - but the cost was entirely paid for by the VA system. The aide had to be ordered by her VA primary care doc to be covered, and the VA contracted with a local home health agency.
posted by citygirl at 3:11 PM on July 12, 2023

Absolutely, positively finding a senior housing/eldercare consultant is the way to go. The one we found (in Seattle, sorry) cut through all the confusion and found us a great situation for my mom.

A lot of places are soup-to-nuts: independent living, assisted living, and memory care all in the same facility, which is why you found so much overlap. My mom had actually planned for this kind of situation, but when the time came to move her out of independent living, there were no openings in assisted living and the facility had elected not to build memory care.
posted by lhauser at 6:37 PM on July 12, 2023

Where I live, there is a mandatory safety and care audit of rest homes/hospitals on a regular cycle, and the results are in a publicly available database.

I think it's important that if possible, one facility offers all the levels of service, so that you don't have to leave familiar surroundings and if you have relationships in the community you can preserve them. So yes to "soup to nuts", and look for the audit reporting on the care facilities/medical facilities associated with any independent living setup, if that's a thing that exists where you are.
posted by i_am_joe's_spleen at 9:12 PM on July 12, 2023

I know she's not your mom, but A Place for Mom was very helpful to us with both a mom and an aunt, and they were free.
posted by TimHare at 9:15 PM on July 12, 2023

Since 2020 I've had to place both my brother and mother in assisted living situations (my shorthand for a range of care that includes assisted living plus other types which I'll outline below). It was a nightmare because I started from zero knowledge and was acting on suddenly urgent bases both times. A few lessons learned, some of which echo comments above:

Get expert help deciphering and choosing. I didn't like the sales tactics of A Place for Mom. You might not mind. I used Care Patrol, which has a similar setup--many local specialists all over the country, the facilities pay them a commission. But Care Patrol researches and recommends even the local places that do not pay them a commission, which is why I used them. They will not only recommend; they will also set up visit appointments and follow up afterward to learn how you liked it and adjust future recommendations.

Know the levels of care:
Independent living - like her own apartment on a campus where other levels of care also exist. Assisted living - feels like a cross between an apartment & a dorm, usually with nursing & other staff on-site. Typically there are tiers of care that pricing is based on. The lowest tier typically includes housekeeping and basic welfare checks, maybe incontinence supplies, organized on-site social activities, plus a meal plan in a communal eating area, and sometimes organized group trips out for shopping or local sightseeing. The highest level of care in these typically also includes things like medication dispensing, nutrition logging, help with toileting & bathing, and nursing staff doing observation/assessment. These folks are typically still ambulatory or otherwise do not need to be in a bed 24/7 but can't manage to live on their own without help being able to just walk into the living space anytime. Skilled nursing - what we also call a "nursing home," typically for people who are not ambulatory and need 24/7 nursing care. Sometimes a nursing home also offers post-acute rehab for people just discharged from a hospital stay after surgery or an accident who need x weeks or months of intensive PT before they can return to where they ordinarily live, or before they find a new long-term situation if needed. Memory care - for people who qualify using the facility's own independent rubric that demonstrates they need to live in a locked facility with 24/7 staff. Memory care places differ in the levels of care they offer. Doesn't sound like your aunt is in need, so I'll skip describing them.

Pricing:
There are essentially two types. Monthly, or "continuing care" for a place that includes all or almost all of the types of care from independent living all the way up to skilled nursing care. Continuing care often but not always requires forking over a huge sum of money (the ones I know about in Va and Md are 300-500k up front + monthly costs) to buy your way in while you are still ambulatory. Some, but not many, will refund a pro-rated portion of that fee to the estate/ the family upon the resident's death, up to a certain amount of years of residency. With continuing care, you typically pay the up front fee and also a monthly fee, but your monthly price will never go up no matter if the level of care you need increases to their most expensive tier. With monthly, it's more like rent. They can increase it when they want, plus you pay extra for higher levels of care such as needing their meds locked away & dispensed to them vs their keeping it in their own room because they're still able to manage it themselves. Some places offer both types of pricing. Some places are only one or the other. I'm sorry that I don't know what the VA will and won't pay for as far as assisted living and nursing care. Medicare does not pay for assisted living, contrary to what some people assume. Medicare does pay for skilled nursing care if the person meets certain clinical criteria, which is why they regulate the care where it's taken (see below).

Quality regulations & inspections:
Skilled nursing care is heavily regulated by states. Pro Publica publishes quality data by state, along with the fine amounts and the names of violations. Here's California's nursing home regulator site, which is searchable for at least some of the same info as the Pro Publica site. Past history is not a guarantee of future performance, but it's a good trailing indicator of what your loved one might expect. If a skilled nursing care facility takes Medicare, they are also regulated and scored on quality as measured by what statistically has the most impact on health outcomes. Medicare's Care Compare is a good place to check quality info on nursing homes. Although your aunt has VA insurance, and it sounds like she doesn't yet need nursing care, a place she's considering might also offer skilled nursing care and show up on this list.

I wish you the very best of luck! Doing this now, while it's not an emergency, is the best gift you can give each other. She can choose herself, and avoid pushing the choice onto you during an emergency.
posted by ImproviseOrDie at 5:11 AM on July 13, 2023

My dad shared a room for most of the time he was there. They have single rooms, but they have a waiting list to get them. That said, there were far fewer women vets that lived there, so perhaps they have a better chance of getting a single.
posted by elmay at 5:12 AM on July 13, 2023

A Place For Mom is paid by the facilities, and I have one friend (east coast, not Calif) who found them quite pushy. I agree with the recommendation to work with an elder care advisor that you or your aunt (not the facilities) are paying.

I have worked with a local person who was a member of the Aging Lifecare Association. You can search for someone associated with this organization here. (I did not get this person through this organization but rather through another local child-of-an-aging-parent; I found the organization from the web page of the person I worked with)

I’m a fan of CCRCs which are the sort of place where someone can move through different stages of care all within the same organization. Here is a page with a general explanation.

Having said that, I don’t know anything about what may be available to her as a vet.

You are a kind soul. Best wishes to both you and your aunt.
posted by 2 cats in the yard at 8:54 AM on July 13, 2023

Probably not relevant since your aunt is on VA benefits, but I wanted to point out for other people reading that Medi-Cal (CA's implementation of Medicaid) actually DOES pay for or toward assisted living if you get into an "Assisted Living Waiver Program." CA recently expanded that.
posted by bluesky78987 at 10:00 AM on July 13, 2023

Just a note - if you are planning to sign up with A Place for Mom, do it with an email account set up specifically for this purpose. They will share your email with every elder care living place in the universe (it's part of the process) and you will NEVER stop getting the emails from these places even if you kill your account.
posted by invincible summer at 10:33 AM on July 13, 2023

Medi-Cal (CA's implementation of Medicaid) actually DOES pay for or toward assisted living if you get into an "Assisted Living Waiver Program."

Thanks, bluesky78987. For future searching purposes, and in case you were responding to a comment I made, I was referring to Medicare and assisted living, not Medicaid. Medicare, which is a federal program for everyone over 65 (plus a couple of other groups not relevant here) administered federally, does not pay for assisted living. Medicaid, which is a federal program for low-income people of any age and those with qualifying lifelong disabilities, administered by the states, does pay for assisted living, skilled nursing, and memory care--if you qualify according to Medicaid income/net worth criteria. Many people in most states, even people who are not low-income, get these types of care paid for by Medicaid, but they typically have to spend down their net worth to qualify if they don't already qualify. It's super common. Hopefully the OP's aunt doesn't have to deal with any of this if her care is paid for by the VA.
posted by ImproviseOrDie at 5:49 AM on July 14, 2023

Effective Jan. 1, 2024, California no longer has an asset limit for Medi-Cal eligibility. This change impacts many areas of determining eligibility...

posted by Iris Gambol at 3:55 PM on January 31