The Assisted Living Care Assessment in California

Assisted living communities and board and care homes are licensed in California as residential care facilities for the elderly (RCFEs). Title 22, section 87456, lists what an RCFE must do before it accepts a resident, in order to judge whether the person is suited to the home.

No one may be admitted without their own consent and agreement, or that of their responsible person. During the interview the home must also give enough information about itself and its services for everyone involved to make an informed decision. The assessment runs both ways: it is your chance to judge the home.

1. 1

   An interview

   The licensee or the employee responsible for admissions interviews the prospective resident and the responsible person, if there is one. They discuss the person's wishes about moving in, background, service needs, medical history and functional limits.

2. 2

   A pre-admission appraisal

   A written appraisal of the person's individual service needs, compared with the state's rules on who a home may accept and keep.

3. 3

   A recent medical assessment

   The home must obtain and evaluate a medical assessment signed by a licensed medical professional.

4. 4

   The admission agreement

   The home and the resident, or the resident's representative, sign a written agreement. See what an admission agreement must contain.

The regulations name three areas the home must evaluate.

The prospective resident, or the responsible person, must be involved in developing the appraisal. If a placement agency or consultant has already completed a needs assessment, the regulation says the home is to obtain it and include it in its own.

The appraisal also has to note whether the person, or other residents, would be at risk if the person had access to certain items that the regulations require homes to control. Answer these questions fully. A home that learns about night wandering or frequent falls after move-in has planned its staffing around the wrong picture.

• Functional capabilities: bathing, dressing and grooming, toileting, transferring in and out of a bed or chair, continence, eating, vision, hearing, speech, walking, dietary limits, medical history and the need for prescribed medications.
• Mental condition: whether the person tends to wander, is confused or forgetful, can manage their own cash, takes part in social activities or is withdrawn, and has a documented history of behaviors that may result in harm to self or others.
• Social factors: likes, dislikes, interests and activities, to judge whether the living arrangements will suit the person and which activities they may want to join.

Title 22, section 87458, calls it the medical assessment. Before accepting a resident, the home must have one that is signed by a licensed medical professional acting within the scope of their practice and was made within the last year. Families and homes often call it the physician's report.

It must include, at a minimum:

• A physical examination with the diagnoses and the results of an examination for communicable tuberculosis and for other infectious or contagious diseases.
• Prior medical services and history, and current status including height, weight and blood pressure.
• A record of current prescribed medications, and whether they should be centrally stored by the home.
• Physical limitations, including any medically necessary diet.
• Whether the person is ambulatory, nonambulatory or bedridden, as state law defines those terms.
• Cognitive conditions, such as mild cognitive impairment or dementia, and a description of any known behavior that may result in harm to self or others.

The home compares these findings with the state's lists of restricted and prohibited conditions, explained in health conditions assisted living can accept. The appointment can take time to arrange, so book it early. Our guide to move-in requirements lists the rest of the paperwork.

The first result is a yes or no. Title 22 says a home need not accept a particular resident, but if it does, it is responsible for meeting the needs identified in the appraisal, directly or through outside resources. If the appraisal finds a need the home's general program does not meet, the home must get advice from a physician, social worker or other consultant on whether it can meet that need, and write a plan if it can.

The second result is the fee. The regulations say what must be assessed. They do not set price tiers. California Advocates for Nursing Home Reform notes that many larger facilities have different fee options depending on the type of care needed. Each home sets its own. The admission agreement must list the rate for basic services and a fee schedule for anything charged separately.

Ask to see how the appraisal was turned into a level, in writing. For what the totals tend to look like, see assisted living costs in California.

Prices can change when needs change. Under Health and Safety Code section 1569.657, when a rate goes up because of a change in the resident's level of care, the home must give written notice within two business days after it starts providing services at the new level. The notice must include a detailed explanation of the added services and an itemized list of charges.

Two rules keep the picture current. Health and Safety Code section 1569.80 gives a resident and the resident's representative the right to take part in decisions about care. Before admission, or within two weeks after it, the home must hold a meeting with them and prepare a written record of the care the resident will receive and the resident's preferences. That record is reviewed at least once every 12 months, or sooner upon a significant change in condition.

Title 22, section 87463, requires the appraisal itself to be updated in writing as often as necessary, and at least every 12 months. Examples of a significant change in the regulation include a heart attack or stroke, a change in thinking or memory, behavior that may cause harm, such as wandering or leaving the home unnoticed, and an illness or injury that changes the person's health care or dietary needs.

When a significant change happens, the home must bring it to the attention of the appropriate licensed medical professional and tell the resident and the resident's representative, immediately or as soon as reasonably possible. It must then share the reappraisal in a meeting or call. The home is also required to ask that each resident have a routine visit with a medical professional every twelve months.

Hamssa Benrekia is a senior living placement specialist in Torrance. Her work with a family starts with a conversation about the senior's care needs, health conditions, preferences and monthly budget, which helps you describe those needs clearly to each home. She then suggests licensed homes in the South Bay and Harbor area that may fit, and goes on tours with you. Each home still completes its own appraisal. To start with assisted living placement, contact Hamssa, or read the California Assisted Living Placement Guide.