What does Assisted Living look like?
Assisted Living is an essential component of California’s care continuum, helping to care for a significant portion of the state’s growing older population. According to the Department of Social Services (DSS)1, California currently has 7545 licensed Residential Care Facilities for the Elderly (RCFEs) that can provide a home and care for more than 179,000 residents. Based on projections by the California Department of Finance2, that accounts for about one-fourth of the state’s 85-plus population.
Sixteen percent of California’s RCFEs are licensed to care for 16 or more residents; these communities serve 79 percent of the state’s Assisted Living residents. Eighty-four percent of RCFEs are small, board-and-care communities licensed to serve up to 15 residents; this type of RCFE serves 21 percent of California’s Assisted Living residents.
More than 550 California RCFEs are members of the California Assisted Living Association (CALA), which helps support the delivery of quality service and care by providing tools and resources, continuing education, and advocacy. CALA members serve about one third of the state’s Assisted Living residents.
Who does Assisted Living serve?
Assisted Living provides 24-hour care and supervision in a residential setting for seniors who need assistance but do not require around-the-clock nursing care. In addition to helping residents with activities of daily living (ADLs), Assisted Living communities who complete additional regulatory requirements can be licensed to care for residents who have dementia or receive hospice services.
According to the most recent collaborative research project3 to solely examine Assisted Living communities and residents, the typical resident is an 87-year-old widow who needs help with two or more ADLs, takes 10 prescription medications, and has an annual income of about $27,250.
About one-third of Assisted Living residents have some form of cognitive impairment. Of that portion, more than half (58 percent) have been diagnosed with Alzheimer’s disease. A majority of residents (66 percent) have high blood pressure or hypertension, and a significant portion have arthritis (42 percent), heart disease (33 percent), and depression (30 percent). Residents choose to live in Assisted Living communities because they can receive services and supports to help them live as independently as possible, despite conditions like these.
Residents commonly receive assistance with bathing, dressing and toileting, preparing meals and eating, housework and laundry, transferring and transportation, using the telephone, and medication management. Of these ADLs, the most common are transportation, preparing meals, housework, laundry, and medication management.
Residents live in an Assisted Living community for an average of two years, three and a half months. A majority of residents move out of their Assisted Living community for health reasons; this can happen when a resident develops a prohibited health condition or comes to require around-the-clock nursing care. Over a third of Assisted Living residents stay through to the end of life.
Residents are overwhelmingly satisfied with their Assisted Living experience. According to a recent national poll commissioned by the Assisted Living Federation of America (ALFA)4, 93 percent of residents are satisfied with the level of personal independence, personal attention, and quality of care they receive. Ninety-nine percent report feeling safe, and 94 percent are satisfied with the overall quality of life in their community.
What does Assisted Living cost?
According to a 2016 Genworth report5, Assisted Living in California costs an average of $4000 per month. The cost for dementia care is about one and a half times higher than for general Assisted Living.
According to the collaborative research project on Assisted Living communities and residents3, the typical payer source is the resident or family. About six percent use long-term care insurance as the primary payer source, and only about two percent of residents are on SSI/SSP. In California, Assisted Living is paid for by Medicare only through the Assisted Living Waiver program which is available in ten counties.
Assisted Living fees can be structured in different ways. About half, or 45 percent, of communities use a tiered pricing model with bundled services for different levels of needed care. A quarter of communities charge one all-inclusive rate, 17 percent use an al la carte/fee-for-service system, and only seven percent charge by the hour.
How is Assisted Living growing?
Assisted Living has grown steadily over the past decade in response to the aging of the population. Since 2005, DSS6 reports that an additional 1700 RCFEs have been licensed in California, adding the capacity to care for an additional 23,000 seniors. While the number of small communities caring for up to 15 residents has decreased slightly, the number of communities caring for 16 or more residents has increased.
According to the California State Plan on Aging7, California is home to more than six million people age 60 or older. By 2050, that population is expected to reach 13.9 million, an increase of 179 percent from 2010. In addition, the population of Californians 85 and older is expected to grow from 600,000 in 2010 to over 2 million in 2050. As those numbers increase, so too will the demand for Assisted Living.
1 “Number of State Licensed Facilities by County.” California Department of Social Services, accessed June 30, 2015.
2State and County Population Projections by Major Age Groups. California Department of Finance, December 15, 2014.
3 2009 Overview of Assisted Living. American Association of Homes and Services for the Aging, American Seniors Housing Association, Assisted Living Federation of America, National Center for Assisted Living, and the National Investment Center for the Seniors Housing & Care Industry, 2009.
4 2013 Survey of Assisted Living Residents. Assisted Living Federation of America, 2013.
5 Genworth 2016 Cost of Care Survey. Genworth Financial, 2016.
6 Community Care Licensing Division (2005-2014): RCFE/CCRC Facility List, requested via mail. California Department of Social Services.
7California State Plan on Aging: 2013-2017. California Department of Aging, 2013.