For the first time in California history, older adults will outnumber those under 18 in five years, a harbinger of what most likely will be mushrooming demand for elder care services, both at home and in nursing facilities.
But for many Baby Boomers and aging San Diegans, the choices may be limited, increasingly forcing family members into caretaker roles, say experts.
The statistics paint a stark picture. By 2030 the number of people needing skilled nursing care will increase by 32,000 people, according to the Public Policy Institute of California. Currently the number of people receiving such care stands at approximately 100,000.
The reality for those needing a skilled nursing facility is that many will face a number of life-or-death issues that may well depend on which facility they end up choosing.
And the figures cited by the Public Policy Institute don’t even include the number of older adults needing memory care, assisted living, or other types of residential facilities.
For many families, home care — frequently provied by relatives — becomes the only option for aging Americans because the cost of outside caregivers and nursing homes is simply unaffordable and Medicare does not cover long-term care.
Another dynamic — the makeup of our senior population is different than it was in the past, as researchers at San Diego State University’s Center for Excellence in Aging & Longevity (CEAL) have observed.
Steven Hornberger, co-director at CEAL, notes, “The over-sixty population is more diverse in terms of race, ethnicity, language spoken, sexual orientation, and socioeconomic status.”
These demographic changes, he says, pose new challenges, as many older adults may lack the resources available to the previous generation.
“The forgotten middle — those who aren’t wealthy enough for private care or poor enough to qualify for government programs — are often left to manage on their own,” says Hornberger.
CEAL launched San Diego Caregiver Connections, which is a useful resource. It provides a training and peer support caregivers program for both paid care workers and family members.
“We’ve trained over 6,200 people in the first year of the program thanks to two grants from the state of California,” Hornberger said. The program’s success has spurred some additional funding, but the center is still seeking long-term support for the program.
If you are a family caregiver, California has a program to pay you called the Paid Family Leave Program and there is also Home Supportive Services.
Medicaid does not cover long-term care, only short-term stays following hospitalization. While Medicaid (known as Medi-Cal in California) covers the vast majority of those in nursing homes, there are no guarantees you will find placement, according to experts interviewed for this article.
Private long-term care insurance is an option, but in recent years, premiums have increased dramatically, and monthly payouts don’t always cover the full cost of care.
If your choice is an assisted living situation, it’s almost all private pay and typically very expensive, on average $6,000 to $7,000 a month, says Tony Chicotel, lead attorney for the widely respected California Advocates for Nursing Home Reform (CANHR).
He says there are numerous issues facing families, with solutions available only if you know where to look and what to ask for. For older citizens, the options may well be limited, so the earlier decisions are made, the better the prospect of some success.
For anyone younger, one proposed strategy for future planning seems almost laughable but it’s not.
“What I tell people is have a lot of kids,” says Chicotel.
He suggests your children could provide a safety net. “I know that’s not really popular anymore,” he explains, “but I think people with kids are in better positions than those who don’t have kids.”
Of course, this is not always an option. But it was for Wilbur Woodside, whose daughter, Julie Henrickson, has been his safety net, his advocate and partner in planning his living arrangements.
Woodside, a retired fireman, suffered a basal ganglia stroke five years ago. The 86-year-old’s recovery began with daughter Julie’s support. She says this “included learning a new normal for his self-care and asking for help. His right side weakness and coordination issues are still present at some level.”
Despite his mobility issues, in time Wilbur was stable enough to try assisted living. The family saw it as a chance to enhance his daily activity and increase his social connections.
They chose The Montera in La Mesa and they agreed it felt the least institutional of all the places they researched. So papers were signed and Wilbur moved into The Montera in June 2024. His firefighter pension was enough to cover most of the costs. The facility is part of MBK Senior Living based in Irvine.
In short order, Hendrickson began finding “hiccups” in getting her father settled in. The facility promised to handle his medication needs but hadn’t ordered anything by the time he moved in. And here were other problems.
But Hendrickson is a 20-year Navy veteran, an experienced registered nurse who has worked in the emergency room, ICU, and elsewhere for the Navy. Because of her background, she recognized the importance of having a system that works, and when it came to her father’s care at the facility, she was concerned.
The agreement for her father’s move-in included a reference to a “family council.” She felt this might help in the transition and continuing care of her father. The council was created by state law for families, friends or representatives to provide a meeting place at the facility to discuss concerns and issues. It’s considered by CANHR to be a powerful tool that has a positive influence on quality of resident care.
Henrickson was interested but the facility denied having any information about a family council program. So she continued to push, this time reaching out to the corporate director of administration as “I have learned to follow up and escalate my complaints.”
Thanks to her and the collaborative efforts of other families, what’s in place now at Montera is an 11-member council of friends and family members who have begun to monitor and document the treatment of their loved ones. They receive updates from the administration and have ongoing dialogues with the staff. It’s been helpful in clearing up issues for all residents in the facility.
“The council is an important tool for supporting loved ones; it’s a force multiplier,” says the former Navy nurse.
The administrator of MBK Senior Living (it’s a wholly-owned subsidiary of Mitsui & Co., Ltd. a global Fortune 500 company) did not respond to our request to comment for this story. Nor did Mitsui headquarters in New York City.
The State of California provides a website created by the Department of Social Services to compare different assisted living facilities. However, Chicotel of CANHR says the website “suffers from neglect.”
“It’s impossible,” he says, “to see which complaints are ‘substantiated,’ ‘unsubstantiated,’ or involve serious abuse or neglect unless one tediously reads the reports one at a time.” There are no quality measures, just reports.
CANHR has seen cases where a facility with a poor track record makes a “tiny change” in its name (e.g., “Sarah’s Care Home” to “Sarah’s Care House”) to wipe “its record clean on the site.” But the website is “better than nothing,” he adds.
If assisted living isn’t an option, and you have someone with exceptional care needs requiring a nursing home level of care, “a lot of times they’re out of luck until there’s a hospitalization,” says Chicotel.
“I would say in a lot of communities, it’s almost impossible” because nursing homes have set themselves up as assembly lines. Their interest is in maximizing the number of residents coming in from hospitals with a Medicare payment benefit “that you can only get by having a hospitalization prior to your admission to the nursing home.” He says they take in the resident from the hospital, provide some rehabilitation and then cut them loose.
Chicotel says that’s how he believes nursing homes can generate big profits. Some experts say this is the prevailing business model in the industry.
That’s not the case, according to the California Association of Health Facilities (CAHF), which says it is “dedicated to promoting quality patient care in skilled nursing facilities (SNFs) across the state, and our members are deeply committed to ensuring the well-being of residents.”
The association also says that “our members are steadfast in providing a safe and compassionate environment for all who rely on skilled nursing care.”
No matter which claims you believe, Chicotel says you should always err on the side of caution.
“You don’t want your loved one to suffer an acute condition where they need to be hospitalized,” he says. “But if you’re in a position where you’re not sure and you think your family member may need to be hospitalized, call an ambulance, get them to a hospital.” He adds that in this way “it opens up this opportunity to get into a nursing home that you otherwise wouldn’t have.”
Choosing a skilled nursing facility that will provide a safe and secure environment for a loved one is not an easy task.
We asked online for experiences people have encountered, and Judie Kinonen responded to our query. She’s the communications director at the University of Texas and is well acquainted with doing online research into nursing homes.
Kinonen says she “did look at reviews online but they were not very helpful. Some of the facilities had no reviews at all, and others had only a few, but very mixed — just one-star or five-star reviews. And often there was no explanation, just the rating. It was so hard to tell fact from fiction.”
In the second part of this report next weekend, Times of San Diego will examine how to find a nursing home for a loved one.
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