What is the room and board fee?
The room and board feesare established by DHCS in order to participate in the Assisted Living Waiver Program (ALWP). This fee is based on individual income and changes each year in January. For the year 2022, the fee is $1211-1233 per month.
Where does the individual make the room and board payment to?
Each month they will make this payment to the assisted living facility. If the individual fails to pay, they could potentially face eviction and loss of their ALW program funding.
Why must the induvial pay the room and board fee?
The Department of Health Care services only pays for the care for the individual. The room and board fees are the same as paying rent on a private home. The fee covers the cost of the room for the individual to stay in.
What if I don’t make the required amount to pay the room and board fee?
If the individual is on Supplemental Social Security from retirement and is in a skilled nursing setting or home setting their home/skilled nursing rate is much lower than the assisted living rate. As long as the Social Security income is not from disability, the individual may qualify for the assisted living rate once they have moved into an assisted living facility. The individual can call Social Security prior to the move to see what type of benefit they receive to see if they are eligible for the benefit increase.
If the individual is conserved or unable to speak on their own behalf, a legal representative can call for them. However, you will need to submit a Power of Attorney showing legal rights to manage financial affairs.
If the individual is not qualified for the benefit of increase, they may have the remaining amount supplemented from other resources such as family assistance. Some facilities might be willing to work with an individual and their families if they’re lacking sufficient funding.
How does the Social Security Administration know the individual has moved into an assisted living facility?
The assisted living facility will fax over the admissions agreement showing the individual has moved into the facility.
Who determines the need for assistance with activities of daily living (ADLs)?
Determination of care needs is done by registered nurses (RN) employed by a Care Coordination Agency (CCA). A pre-screening “assessment” will be done over the phone before an appointment is set up for the actual assessment. The CCA will go over the individual’s entire health and mental history, including current medications, and available resources they have to assist the individual with their activities of daily living. The CCA will also ask to speak to all involved in the individual’s care, go over financial resources to ensure the individual has sufficient funds for their room and board fee.
Are there any disqualifications?
Yes, not all individuals who reside in a skilled nursing facility are eligible to live in an assisted living facility. The Department of Social Services has rules and regulations called Title 22 that all assisted living facilities must follow to have a license to operate in California. This includes restricted health conditions regardless of payment for care. The restricted conditions are as follows:
No IV therapies
No sliding scale insulins
No NG or Feeding tubes
No active traumatic brain injury (TBI)
Injectable medications must be in a pen from, no vials
No stage three or four wounds (unless on hospice care)
The individual must be able self-inject if on any injectable medications
No oxygen, CPAP or BiPAPS that the individual cannot operate on their own
If the individual has a colostomy or ostomy bag, they must be able to change this on their own. Note they must also not have a diagnosis of Alzheimer’s or Dementia with either one of the devices