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Today's elders have many options, but shop carefully
Residential care facilities help seniors keep quality of life
By Rita Baum
"If I can no longer hold the paintbrush, then strap it to my wrist!" insisted French impressionist Pierre-Auguste Renoir (1841-1919). In his later years, the painter was so crippled by severe arthritis in his hands that he had to take drastic measures to continue his work. But nothing can cripple the creative spirit and the human will.
Today an artist with a disability such as Renoir's could find help in a residential care facility for the elderly (RCFE). In that setting, an occupational therapist might provide the training and assistive devices needed to help an artist continue his or her work. Help would also be available for more mundane tasks, such as buttoning a shirt or shaving. These facilities let disabled older adults maintain independence by providing specialized help in the areas needed.
RCFEs are licensed, regulated and monitored by Department of Social Services (DSS) licensing and certification to provide certain basic required services in a residential environment that maximizes individual functioning and autonomy for older people. DSS also does annual inspections and investigates complaints.
To obtain a license to operate an RCFE (also called a board and care home), the applicant must pass rigid requirements--including criminal clearance, demonstrating the ability to provide care that conforms to applicable laws, attending a training and certification program and more.
RCFEs are required to provide a number of basic services, which must be rendered in a combination that meets the needs of individual residents. These include three meals per day (including special diets); housekeeping and laundry; complete personal care assistance; transportation; storage, distribution and assistance with medication; arrangements for medical and dental appointments; and observation and supervision as needed.
RCFE license holders may request waivers, or exceptions, to provide additional care beyond the basic required services. The exceptions may be granted if the licensee can demonstrate availability of skilled staff and the ability to follow specific required procedures and monitor services. DSS may grant waivers for the administration of oxygen; colostomy/ileostomy, catheter, dementia, diabetic, respite and hospice care and others. When one or more of these special services is offered, the institution is referred to as an assisted living facility (ALF).
Developers have learned that older consumers reject residential care homes that evoke thoughts of hospitals or hotels, preferring instead designs that have a home-like appearance with porches, gardens and outdoor sitting areas. Popular options include modified kitchens, which enable residents to enjoy a private meal away from the community, or breakfast in a bathrobe over a newspaper. Semi-private rooms, studios and one- and two-bedroom apartments are available. Many residents bring their own furniture. Balconies and patios are common.
There are 389 RCFEs in Santa Clara County, ranging in size from six to 100 residents. Saratoga Retirement Center, part of the Odd Fellows Home--one of the county's oldest care facilities--provides a parklike campus with residential care and a skilled nursing facility; an assisted-living section under construction. Willow Glen Villa in San Jose offers independent- and assisted-living services and is known for its short outings almost every weekend. SunBridge Assisted Living Residence in San Jose opened this year and is almost full, with 50 percent of residents at a high functioning level and 50 percent requiring more extensive care and supervision. Sunnyside Gardens RCFE in Sunnyvale also offers short-term respite to caregivers. Rent and care at RCFEs start at around $2,000 a month.
Life-care contract communities are licensed to provide all levels of care, from independent living to medical and acute hospital care, physicians, and nursing-home care for the duration of the resident's life. Usually the applicant cannot be older than 80, must be in good health, independent in self-care and financially stable upon admission. The non-refundable entrance fee can range from $50,000 to $300,000, plus monthly charges. The benefits include assurance of lifetime care and medical services, socialization, a wide array of services over and above the basic services, extra amenities and tax benefits.
The choices are plentiful for older Americans of upper and moderate income, but remain limited for the country's 15.7 percent low-income elders. "Most residential facilities do not accept applicants on Supplemental Security Income because they can get paid more for private clients," says Barbara Mordy, licensing program manager in the San Jose DSS office. "However, when facilities are new and they are anxious to fill empty rooms, they often accept SSI clients," she adds. Legislation is expected this year for funds to build new assisted-living facilities and convert some subsidized congregate housing facilities into assisted living.
A list of RCFEs is available from DSS at (408) 277-1289. An abbreviated list can be obtained from Senior Information and Referral at (408) 345-4532. A video, Moving Into Assisted Living, is available from the Assisted Living Federation of America at (800) 258-7030 or on the Internet at www.alfa.org.
Don't become discouraged if it becomes apparent that help is needed in one or more of the activities of daily living. With appropriate assistance, older people can continue to live a good life and look forward to a new day each morning. If Renoir had stopped painting because of his arthritis, the world would never have received some of his most beautiful and sensitive works.
Rita Baum lives in Los Gatos. She has a master's degree in gerontology.
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Campbell, California
