Faq | A True Blessing Senior Services

Frequently Asked Question's

What is the difference between a six-bed facility vs. a large residential care facility for the elderly (RCFE)?

The main difference between them is the size, they all offer the same services that are required to provide care. Provision and oversight of personal and support services such as bathing and dressing, assistance with self-medication with medication oversight, providing meals and snacks, housekeeping with laundry, transportation or arrangement of transportation, activities, and coordination of care with other services providers such as physicians, home health, hospice, hospitals, and nursing home care.

With smaller facilities such as six-bed facilities, you will find a more home-like environment feeling to the facility. Located in residential housing areas, these types of facilities are in regular homes that have been approved to provide care for the elderly around the clock. Many of these homes are in housing communities and many are unaware of their operations. These types of care facilities are recommended for individuals who are not big on a lot of large group interactions. They, like their larger counterparts, still provide group and individual activities to provide stimulation for the seniors they care for. For these smaller care facilities, a majority of the time will need to outsource some of their services such as transportation, due to the fact they might not have a vehicle that is wheelchair adaptive. Smaller care facilities that offer memory care are not recommended for seniors who are at risk of wandering away from home due to a lack of additional staff and delayed egress doors that help deter an individual from walking away from the care facility.

Is assisted living the right level of care?

The assisted living facility is recommended when a senior is unsafe to live alone anymore, such as if a history of repeated falls, forgets to take medications, forgets to eat regularly on time meals, is unable to do activities of daily living independently, or in many cases lives alone and is at risk of isolation.

Many families seek out care after moving a loved one in with them and finding out that care is more than one individual or family can handle. Even though the senior is now living with others, their safety is at risk such as family members working and unable to provide care during work hours, the senior has had a change of mental condition causing them to place their or someone else’s safety in jeopardy, and caregiver burnout.

What is the difference between RCFE vs. a Memory Care Facility?

RCFEs can offer memory care or memory care can be a stand-alone facility. Memory Care facilities offer specialized care that must be approved by the Department of Social Services. Staff are required to take additional training on how to care for memory-impaired individuals impacted by Alzheimer's and Dementia.

It is important to ensure that your loved one is placed in the right setting based on their symptoms. Such as being at risk of wandering away from the facility or severe aggression. Smaller facilities such as six beds may not have wounder guard systems such as delayed egress doors, or alarm systems that alert staff when an at-risk individual is too close to an exit.

It is recommended that you tour each facility and ask what safety measures they have in place to ensure the safety of individuals who are at risk of wandering away from the care facility. Along with what is their protocol on elopement. Contact your local Alzheimer’s Association as well for recommendations that best fit your loved one’s memory care needs.

Can Hospice Services be provided in an RCFE setting?

Yes, hospice services may be provided in RCFE settings. However, a physician’s order must be provided, and special documentation of care must be provided by the care facility. Facilities are required to update their care plan to include hospice services and must meet with the hospice provider regularly to ensure care is being provided safely. Not all facilities are approved for hospice services, and many have a limited number of beds that they have been approved for by the Department of Social Services.

If you anticipate hospice care is needed in the very near future, it is important to relay this information to all care facilities that you’re considering for placement. This is to ensure that they accept hospice residents and that there will be potential for bed availability for new hospice admission. If they don’t offer hospice services or have enough bed availability, you may have to defer hospice care or search for a new care facility, which can be very hard on an individual receiving care to move facilities multiple times.

Once I place a loved one in care, am I able to bring them home for visits?

Yes, many families bring their loved ones home for visits. You will have to ask the care facility about their home visit policy and plan out the visit accordingly. Such as ensuring you will have all the necessary medications needed for the visit, any special equipment to provide care, and are completely updated on all concerns such as changes of mental status and recent falls.

How do we pay for care?

Most seniors and their families pay for care privately out of personal finances such as savings or retirement funds. Some Long-Term Care Insurances such as Cal-Pers have special benefits to help pay for a portion of care or all depending upon the policy.

Individuals who have run out of funds or other resources such as VA assistance, may apply for assistance through the Medi-Cal HSBC Waiver program. There are many different Medi-Cal programs that offer to help pay for care, however, the Assisted Living Waiver Program (ALWP) is the only approved program currently offering financial assistance to pay for care.

What are the Guidelines for visiting a loved one in a care facility?

Many facilities may have limited hours of visitation or rules on overnight guests. It is best to ask about the rules for visitations during tours with potential facilities. For many families, the main concern with rules around visiting is about COVID-19. All care facilities must follow the rules on visitation set forth by the Department of Social Services.

Set rules for visiting a loved one in any care facility are as follows:

Wear a facial mask during the visit.
Wash and or sanitize hands after entering the facility and prior to any visitation.
If there are active COVID-19 cases in the facility, wear an N95 mask, gown, gloves, and other protective equipment.
Be fully vaccinated or have a recent negative test. (This rule is usually in effect when COVID-19 is in peak season)
Wash and or Sanitize hands when leaving the facility and throw out any protective equipment used when visiting someone with COVID-19.

Note: these are just general guidelines and are subject to change.

The Department of Social Services follows the recommendation of the CDC and California of Public Health. For additional information from the CDSS website click here: COVID-19 Information and Resources (ca.gov)

What are the benefits of placing a loved one into a facility that accepts the Assisted Living Waiver Program?

Whether you are not currently in the ALW program or may need to have financial help through the ALW program in the future. Moving a loved one into a facility that is ALWP approved has two benefits, financial assistance through Medi-Cal once approved for the program. Also, with the peace of mind knowing these types of care facilities undergo two different types of state approvals, subjecting them to two separate audits by a state-appointed entity. These facilities must pass the initial California Department of Social Services license process and then undergo the licensing process through the Department of Health Care Services.

Both look at employee records, training of all staff, residential files related to care, and tours of the facility to ensure the facility is safe to operate and no potential health or safety hazards are found.

Does Social Security Benefits or Medicare cover care in an RCFE?

No, currently Medicare does not offer care services in an RCFE facility. When it comes to Social Security, they do not offer care services programs. There are select facilities that may accommodate seniors on Social Security Payment only. When a qualified individual who is on Social Security moves into an RCFE facility, the individual may qualify for a benefit increase. This is called an Assisted Living Rate; this rate is higher than what an individual would qualify for at home. The benefit increase is given to help cover the room and board fees that are associated with living in an RCFE, with enough left over for personal expenses such as medical bills, clothing, etc.

What is the Assisted Living Waiver Program?

The Assisted Living Waiver Program is a Medi-Cal-funded program through the HSBC waiver program. This program is to assist low-income adults with disabilities and seniors to pay for care in RCFE or ARF facilities. The goal of the ALW is to:

1) facilitate a safe and timely transition of Medi-Cal-eligible seniors and persons with disabilities from a nursing facility to a community home-like setting in a Residential Care Facility (RCF), an Adult Residential Care Facility (ARF), or public subsidized housing, utilizing ALW services.

2) offer eligible seniors and persons with disabilities, who reside in the community, but are at risk of being institutionalized, the option of utilizing ALW services to develop a program that will safely meet his/her care needs while continuing to reside in an RCF, ARF, or public subsidized housing.

What are the qualifications for the ALWP?

To be eligible to receive services as an ALW Participant, an individual must meet all the following ALW eligibility criteria:

Age 21 or older.
Have full-scope Medi-Cal eligibility with zero share of cost.
Have care needs equal to those of Medi-Cal-funded residents living and receiving care in Nursing Facilities.
Willing to live in an assisted living setting as an alternative to a Nursing Facility.
Able to reside safely in an assisted living facility or public subsidized housing.
Willing to live in an assisted living setting located in one of the following counties providing ALW services: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, and Sonoma counties.

How do I apply for the Assisted Living Waiver Program?

To apply for the Assisted Living Waiver Program (ALWP), you must first meet the qualifications. If you or your loved one meet the qualifications, you can contact a local Care Coordination Agency (CCA) for assistance with the application process. Note, you must go through an approved CCA to have an application submitted.

The CCA will have a Registered Nurse contact you once all the initial required documentation is submitted to them. The RN will conduct an assessment to make sure the applicant meets the safety requirements to move into a care facility. A care plan will be developed and submitted to the Department of Health Care Services (DHCS) Assisted Living Waiver Program Directors for approval.

There are many important steps to the application process that each take time. Each step varies depending on DHCS’s current requirements for enrollment and application in process.

What is a Care Coordination Agency?

A Care Coordination Agency also known as a CCA is an entity that must meet the requirements of the Department of Health Care Services to act as a liaison between the Medi-Cal recipient and the Department of Health Care Services. The CCA is made up of a specialized group of individuals that specialize in the needs of low-income seniors and adults with disabilities. The care provided in an RCFE or ARF setting while in the ALW program is overseen by Registered Nurses and Master Social Workers. The care team acts as the eyes and ears of the state to ensure that the right level of care is being provided to the ALW recipient in a safe and timely manner. Monthly Case Management visits are conducted by either the RN or MSW. They meet with not only the care team at each care facility but also the ALW recipient themselves to ensure that they are happy, healthy, and thriving in the care environment.

If the facility can no longer provide the care that is required or the applicant and or family requests new placement into another facility. The CCA care team will meet and find appropriate care. The CCA care team may also make recommendations for referrals for such things as visits to physicians, home health, hospice, medical equipment, or other services that fit the needs of the ALW recipient. Note, that referrals or recommendations made by the CCA RN must be approved by the primary care provider and have an appropriate order from the primary care physician.

What if I don't meet the current qualifications, is there a waitlist?

If you or your loved one do not meet the current qualifications to apply at this time for the ALW program, you may request to be placed on the waiting list with the Department of Health Care Services. Both individuals at home and already in a care setting can request a waitlist form. The ALW wait request form must be submitted through a CCA. The wait times can usually be very lengthy, sometimes over two years. However, If your circumstances change during the time you’re waiting on the state’s waiting list, contact your CCA that has submitted your waitlist request to see if you meet the current requirements.

Can I, on behalf of my loved one, complete an ALWP application with a CCA?

Yes, only if you’re the legally appointed Power of Attorney or are named on the Advance Health Care Directive. The POA document must state that you have the right to make Health Care Decisions for Medical. If the POA document does not state that you have the right to make health care decisions, you will not be able to sign any legal ALW required paperwork, and the Medi-Cal recipient must sign the documents themselves.

Note: if the Medi-Cal recipient has been deemed not able to make any decisions for themselves, you must then ask for legal conservatorship over the individual and supporting documents must be provided to the CCA.

How long will it take to complete and get approval on an ALWP application?

Times vary based on ALW program slot availability. The time frame to complete the application for ALWP from submission to enrollment can take anywhere from 1 month-6 months.

Note: Approval for the ALW program does not mean enrollment, to be considered enrolled in the ALW program you must after approval be moved into an approved ALW facility, have zero share of cost on your Medi-Cal report, and not be enrolled in other Medi-Cal specialty programs.