Moving From Independent Living to Assisted Living: Options and Steps

Independent living is built for people who can manage daily life on their own. The change is often gradual, and staff or neighbors may notice before family does.

These can be signs that more help is needed, not proof of anything: missed meals in the dining room, a medication routine that has slipped, falls or near falls, difficulty bathing or dressing, unpaid bills, or a call from the community's staff. Start with your parent's doctor, who can look at what has changed and why. Our guide to independent living compared with assisted living sets out what each setting does and does not include.

Many families first try adding help where their parent already lives. California Advocates for Nursing Home Reform (CANHR) notes that senior housing complexes, retirement villages and retirement hotels offering only lodging, cleaning and meals are not licensed as residential care facilities for the elderly (RCFEs). Under Health and Safety Code section 1569.2, a residential care facility for the elderly is a place where care and supervision, personal care or health-related services are provided. So in a building without a care license, personal care comes from a home care agency, a privately hired aide, or family.

The California Department of Social Services says that since January 2016, home care organizations must be licensed, and the state keeps a public online registry of home care aides who have been background checked. Before hiring, ask the community whether outside caregivers are allowed, whether they must check in, and whether any charge applies.

Home care is paid by the hour, so the total grows as needs grow. Our guide to assisted living compared with home care shows where the two tend to cross.

Some independent living communities have a licensed assisted living or memory care building on the same campus. A move across the courtyard keeps friends, staff faces and routines close. It still means a new admission, with the same health paperwork as any other licensed home.

In a continuing care retirement community, the contract governs the move. The California Department of Social Services suggests asking what adjustment, if any, is made to the monthly fee if a resident transfers to assisted living or nursing care, whether that care is on the campus or somewhere else, and what the payment procedures are for higher levels of care. Our guide to continuing care communities and their costs covers contract types.

When the community has no assisted living, has no room, or costs more than a separate licensed home, families look elsewhere. In California, both large assisted living communities and small board and care homes are licensed as RCFEs. CANHR describes them as non-medical facilities that provide a room, meals, housekeeping, supervision, storage and distribution of medication, and help with hygiene, dressing, eating, bathing and transferring. It notes that an administrator or approved substitute must be on the premises 24 hours a day.

A large community may feel closer to the independent living your parent knows. A six-bed board and care home is quieter and more like a house. Visiting both kinds before deciding is common.

Most moves from independent living follow this order:

1. 1

   Talk with the doctor

   Ask what has changed, what kind of help your parent needs, and whether anything can be treated first.

2. 2

   Read the lease or contract

   Find the notice period, any early termination terms, and any refund or deposit rules before choosing a move date.

3. 3

   Set a budget

   Add up income and savings, and how long they can cover the new monthly rate plus any care charges.

4. 4

   Shortlist and tour

   Visit homes that fit the care needs, location and budget. Bring your parent if they are able to come.

5. 5

   Complete the admission paperwork

   Title 22 requires a medical assessment signed by a licensed medical professional within the past year, including a tuberculosis check, and a pre-admission appraisal. See what is needed before move-in.

6. 6

   Give notice and plan the move

   Send written notice to the independent living community, then plan the move day and what furniture fits the new room.

For a month-to-month tenancy, California Civil Code section 1946 lets the tenant end it by giving at least 30 days' written notice at any time, with rent due up to the termination date. A fixed-term lease is different: the terms are in the lease itself, so look for an early termination clause and ask the manager in writing what applies. If the terms are unclear, a tenant legal aid office or an elder law attorney can explain them.

In a continuing care community, look at the contract's sections on transfers, fees after a transfer and refunds of the entrance fee. The Department of Social Services notes that some contracts refund part of the entrance fee when the contract ends and others amortize it to nothing after a set period. Timing matters too: many families try to overlap the two places for a short time so the move is not rushed, which can mean paying both for a few weeks.

Hamssa Benrekia is a senior living placement specialist in Torrance who helps families in the South Bay and Harbor area of Los Angeles County. She works with families moving a parent from independent living to assisted living communities and board and care homes: she listens to what has changed, shortlists licensed homes that fit, and goes on tours with you. More topics are in the California Assisted Living Placement Guide. To talk it through, contact Hamssa.