This week, lawmakers in Sacramento get busy on 15 bills that together constitute the most comprehensive overhaul of assisted living facility regulation in three decades. But for many Californians, it's not even clear what an assisted living facility is. People often ask if assisted living is the same thing as a nursing home. It's not.
In nursing homes, people get round-the-clock medical care from licensed nurses. Assisted living comes in because not everyone who needs help also needs that level of care. Sometimes that assistance doesn't even involve a facility. Sometimes people can receive assistance and remain living in their own homes.
Say you've noticed your mother is walking with a new shuffle and dropping things, or that dad is mixing up his medications -- and getting argumentative when you bring it up. Something is going on that must be addressed, even though your parent is still physically healthy and wants to be independent.
Heather Angel-Collin is deeply familiar with this scenario. A 25-year veteran social worker, she runs a couple senior-focused programs for Jewish Family Service for Los Angeles, a non-profit social service agency that serves 100,000 people a year, regardless of religion or ability to pay.
"It’s a slow progression of, you know, becoming more frail, or becoming more forgetful." she says. "And those things can be very subtle, especially if you’re not seeing that person on a day-to-day basis."
Angel-Collin says it helps to think of tiers of care. Few people want to move out of their homes. They may not have to -- ever -- if domestic or medical support can be arranged.
"Maybe they need to have medications given every day," she says. "Maybe they need some assistance with taking a shower or bath or getting dressed." In California, In-Home Supportive Services provides in-home support for several hours a week, and there are people older than 100 drawing on the services to continue living at home, mostly independently and significantly less expensively than a nursing home would be.
Still, there may come a time when your parent's care needs are no longer feasible with continuing to live at home. California has more than 7,500 licensed facilities you can choose from, but where do you start?
Finding the Right Assisted Living Facility
There's no one right answer as to the kind of assisted facility you choose. What's available in your area? What can you afford? Does size matter? Many people prefer something small and homey, but larger facilities may offer more services and activities. Your parent may feel more comfortable in a facility that makes a special effort to make people of a certain cultural or career background feel at home. For example, Angel-Collins notes there's a waiting list of Armenian-Americans keen to live at Ararat Home of Los Angeles.
Remember that assisted living facilities -- unlike nursing homes -- do not provide skilled medical care. What they can offer includes services like meals and housekeeping, as well as supervised pill distribution, extra attention for patients with dementia, and transportation to the doctor’s office. In California, most families pay for assisted living out-of-pocket.
While most assisted living facilities are small, serving six people or less, most Californians who choose assisted living, especially in urban areas, live in large facilities, like Westchester Villa, a 174-bed residential care facility for the elderly in Inglewood, south of Los Angeles.
Westchester Villa is centrally located -- just down the street from Inglewood High School, within easy driving distance to restaurants, shopping malls and LAX. It's a modest neighborhood, and the facility reflects that. From the lobby, Westchester Villa looks a lot like a Best Western.
Matthew Chinichian is the chief administrator, a soft-spoken, amiable man who is one of three administrators at this facility. That in itself marks Westchester as a cut above many facilities in Los Angeles serving lower income populations, but there are other ways this place stands out. The first thing he notes about Westchester Villa is that it was purpose-built. More commonly, assisted living facilities are in retrofitted apartment buildings or smaller facilities are re-purposed single-family homes.
The cafeteria is huge. There are several lounges, not just one, featuring comfortable couches, big screen TVs, book collections, pianos and pool tables. For anybody who's lived in communal situation, the appeal is obvious. If you want a quiet space to think outside your bedroom, you'll find one. If you don't like what's on one TV, you can find another with nobody hogging the remote control.
Westchester caters to African-Americans. You don’t have to be black, but three out of four residents are, reflecting the neighborhood and positive word-of-mouth from local churches. In a community room for Bible study, local pastors from various denominations lead sessions "at least four times a week," Chinichian says. "Actually, our residents enjoy that more than any other type of activity. We have Bible study going all the time."
If you have the money, there are some fabulous places in California -- with breathtaking views, heated indoor swimming pools, and more. Those can cost $4,000-10,000 a month. A private room at Westchester is more modest: $2,340 a month. A double is $1,750. While most residents cover their own costs, there are some beds available for residents who rely on government support.
So let’s imagine you are trying to decide on a place for your mom or dad. How can you be confident in the quality of care? Who regulates assisted living facilities? Critics like Angel-Collin's colleague, Nancy Volpert, say oversight from the state is nowhere near as robust as it needs to be. Volpert is director of public policy at Jewish Family Service of LA, which is co-sponsoring eight of the bills pending in Sacramento. Volpert supports all 15 bills pending.
"We need to have regular inspections," Volpert says. "We need to have a robust complaint process. We need to have staffing sufficient to meet the need. We need to have training. These are facilities that serve all of us and all of our families. Neglect doesn’t know an income bracket."
Neglect can mean all sorts of things: from simple disorganization to willful failure to protect against injury, or follow up after injury. A series of reports last year from multiple media outlets – KQED/Center for Investigative Reporting, San Diego Union Tribune/Center for Health Reporting and the San Francisco Chronicle – all found abuse and neglect, sometimes leading to death, at assisted living facilities around the state.
Advocacy groups like California Advocates for Nursing Home Reform and Consumer Advocates for RCFE Reform seized the momentum these reports created in Sacramento to push for reform. The question now is whether there's enough momentum to carry most of the reforms all the way through and change the laws.
Already, Governor Jerry Brown has signed one bill into law, AB 1572 which requires every assisted living facility, at the request of just two or more residents, to assist in establishing and maintaining a resident council that could bring in family members, advocates, long-term care ombudsmen and others. The new law requires facilities to respond in writing within 14 calendar days regarding any action or inaction taken in response to written concerns or recommendations.
While many of the bills sailed through initial hearings and votes uncontested, arguments are heating up over the details as those who back them fight to get the bills through the legislature and on to Gov. Brown's desk for signature.
Polly Stryker contributed to this report.