Can Assisted Living Care for Someone With Heart Failure or COPD in California?

MedlinePlus, from the National Library of Medicine, says heart failure means the heart cannot pump enough oxygen-rich blood to meet the body's needs. It does not mean the heart has stopped. Symptoms can include shortness of breath, fatigue, and swelling and weight gain from fluid in the ankles, lower legs or belly.

COPD, or chronic obstructive pulmonary disease, is described by MedlinePlus as a group of lung diseases that make it hard to breathe and get worse over time. Symptoms can include frequent coughing, wheezing, shortness of breath and fatigue.

The two share a page here because they raise the same questions about a care home: who watches for changes from day to day, who handles oxygen, and what happens when the condition gets worse. Treatment questions belong with the cardiologist or lung doctor.

Assisted living communities and board and care homes, licensed in California as residential care facilities for the elderly (RCFEs), provide care and supervision, not nursing care. Title 22 lists restricted health conditions in section 87612 and prohibited ones in section 87615. Neither list names heart failure or COPD. Our guide to health conditions assisted living can accept walks through both.

Two services that often go with these conditions are on the restricted list: oxygen, and the use of an intermittent positive pressure breathing machine. A home may care for a resident who needs them only under the conditions written for each. Behind everything sits one firm limit in section 87455: no one who requires 24-hour skilled nursing care may be admitted or kept.

A home also decides for itself. Section 87464 says a facility need not accept a particular resident, so one home may say yes to a parent with heart failure and the next may say no.

MedlinePlus notes that people with heart failure need to pay close attention to symptoms, because the condition can worsen suddenly. In a care home, part of that watching falls to staff, and the regulations say so in general terms. Section 87466 requires a home to observe residents regularly for changes. When staff see changes such as unusual weight gains or losses, or a decline in a physical health condition, the home must document them and bring them to the attention of the resident's physician and responsible person.

The regulations do not say how often to weigh a resident or check for swelling. That comes from the doctor's orders. If the doctor wants a daily weight, a fluid limit or a call when a number is crossed, ask the home whether its staff will do that, where they write it down, and who makes the call. Get the answer before move-in, and ask for it to be written into the care plan.

Title 22 divides the common tasks this way:

MedlinePlus says most treatment plans for heart failure include eating less sodium and drinking less liquid to control fluid buildup. Title 22, section 87464, lists low salt or other modified diets prescribed by a doctor as a medical necessity among the basic services every home must provide.

So the diet itself is not optional for the home. How a kitchen carries it out varies from home to home. Ask to see a week of menus, ask how the cook keeps one resident's plate low in salt, and read our guide to special diets in assisted living. If the doctor has set a fluid limit, ask how staff would keep track of it.

MedlinePlus lists oxygen therapy among the treatments for severe COPD with low blood oxygen, and says a person may need it all the time or only at certain times. In a California RCFE, section 87618 allows oxygen in two situations. In the first, the resident is mentally and physically able to operate the equipment, can tell when he or she needs oxygen, and can administer it alone. In the second, an appropriately skilled professional, such as a nurse or respiratory therapist, gives intermittent oxygen.

The home has duties too. It must report in writing to the local fire authority that oxygen is in use, post warning signs, prohibit smoking where oxygen is in use, and see that staff know how the equipment works. Liquid oxygen needs prior approval from the licensing agency. Our guide to oxygen in assisted living covers this in full.

The question to think about ahead of time is what happens if your parent can no longer manage the equipment alone, for example because of memory loss. At that point the rule calls for a skilled professional, and the home has to decide whether it can arrange that.

Title 22 requires a home to call 911 immediately when a resident faces an imminent threat to health. After a hospital stay or any significant change in condition, the home must update its appraisal, and it may decide it can no longer meet the person's needs. These are points to ask about before move-in:

• Who decides that a resident who came back from the hospital can return, and what do you need from the hospital first?
• If my mother can no longer operate her oxygen, who would give it?
• Do you have a nurse on staff, or do you rely on home health agencies?
• Which staff are on at night, and what are they told to do when a resident is short of breath?

If the answer is that your parent now needs nursing care around the clock, the law does not let an RCFE keep him or her, and our guide on when assisted living is not enough explains the options. Hospice is a separate route for a person who is terminally ill. For a parent who also has kidney failure, see assisted living and dialysis.

Hamssa Benrekia is a senior living placement specialist in Torrance with a background in hospice, palliative care and home health. She can talk through your parent's needs and point to licensed homes in the South Bay and Harbor area that say they care for residents with heart or lung conditions, from large communities to six-bed homes: see assisted living placement. She goes on the tours with you. What a home may accept is decided by the home, the doctor and the state, not by her. To talk it through, contact Hamssa, or start with the California Assisted Living Placement Guide.