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Photograph by George Sakkestad
Helen Meinke, 95, enjoys a card game with Lincoln Glen staff members Hillary Kroeker (center) and Marigay Madriaga.
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Intermediate care facilities can help seniors stay independent
By Rita Baum
Heeding the advice of her physician, two years ago Angela moved to Casa Olga Intermediate Care Facility (ICF) in Palo Alto.
The independent 77-year old, who has a part-time job and a busy social life, found it difficult to maintain the special diet recommended for her diabetes, check her insulin level and administer her injections without help. She was too active to live in a nursing home, and a residential care facility would not provide the necessary nursing services.
At Casa Olga, her diabetes is managed by a nursing staff. An ICF enables independence and well-being by providing full professional assistance and monitoring without the restrictive environment of a hospital or nursing home.
Based on her low income from Social Security and her part-time job, Angela qualifies for Medi-Cal/Medicaid, the government program that pays for low-income individuals to receive care at home, in skilled and intermediate-care nursing facilities, hospitals, and doctors' and dentists' offices. Medi-Cal pays for care for most of the residents; nearly half of them pay a share of the cost.
Casa Olga, the only facility in Santa Clara County that devotes 100 percent of its health services to residents who need an intermediate level of care, serves individuals who come from all areas of the county, plus neighboring counties.
Lincoln Glen in San Jose, the only other ICF in the county, serves 32 intermediate-care residents as part of its continuum of care style of service, which starts with independent living and allows residents to transition to higher levels of care if needed.
An ICF is a long-term care facility licensed by the state health department; it has services such as a round-the-clock nursing staff and an emergency call-bell system for its residents. Like skilled nursing facilities (SNFs), ICFs are regulated by Title XXII of the California Code of Regulations, and undergo extensive annual inspections by the Department of Health Services.
ICFs differ from SNFs in that residents must be ambulatory and mentally competent to leave the facility and return on their own, but they must have medical needs that require nursing staff on duty 24 hours a day. At Casa Olga, residents are ambulatory or use walkers or canes; wheelchairs are allowed temporarily in special circumstances. Like SNFs, ICFs have a director of nursing and other nursing staff, a dietician and a full-time activity director.
An ICF cares for residents with a variety of health conditions--including cardiac heart failure, Huntington's Disease, diabetes, seizures and thyroid problems--as well as rehabilitated stroke patients, residents who require kidney dialysis, and others. Lab work is done on-site as often as necessary. Blood pressure is checked as needed, and medications and injections are administered. Outreach Transportation Service transports residents with kidney disease to the kidney dialysis center.
Generally, residents choose to receive medical care from the facility physician, who sees patients on-site several days a month. An optometrist and a podiatrist also provide services at the facility regularly, and a psychiatrist and psychologist make regular visits to monitor medications and provide counseling for those with mental health needs. Having in-house medical services circumvents the need for residents to find local physicians who accept Medi-Cal.
Residents at Casa Olga must be mentally competent to function alone in public. Some drive their own cars; others use public transportation or Outreach Transportation Service. In addition to medical services, housekeeping, meals in the dining room and laundry service are provided. An escort to meals and assistance with bathing are available. Some residents eventually move from an ICF to a skilled-nursing facility if more intensive medical services and equipment are needed. Others return home or to a residential care facility if their conditions have improved. Vacancies are filled quickly.
Lincoln Glen in San Jose is the only other facility in Santa Clara County licensed to provide intermediate care. The original facility, built by the Lincoln Glen Church in 1969, was an independent senior living unit with apartments and cottages located on the same property as the church. As residents aged and required more care, the church developed an intermediate-care facility in 1977.
In 1988, a few of the ICF beds were converted to skilled nursing to accommodate residents who needed a higher level of care, and later an assisted-living building was developed--all on the same campus.
"The idea behind the church-sponsored facility is to enable people to age in one place, with an easy transition to the next level of care if needed," says Executive Director Loren Kroeker. Approximately 40 percent of the 32 intermediate-care residents receive service under Medi-Cal. Lincoln Glen is a nonprofit, nondenominational continuing care facility that charges no admission fee.
While there are 54 skilled-nursing facilities serving more than 5,000 individuals in Santa Clara County, there is only one ICF that is fully dedicated to intermediate care, and it serves the entire county. Both Casa Olga and Lincoln Glen were built many years ago, when property in the Bay Area was cheaper. The cost to build an ICF in Santa Clara County today would be high, and government help is available only to pay for medical services, not to finance the building of new facilities. Also, Medi-Cal pays a lower rate for intermediate care than it does for skilled nursing.
In the future, more of the services now available in an ICF may be provided in assisted-living facilities that have been granted special medical waivers, as older people prefer this less restrictive form of care over nursing home or intermediate-level care.
However, assisted living, like other types of residential care for the elderly (RCFE), is not covered by Medi-Cal, which pays the lion's share of intermediate and skilled-nursing care costs. Therefore, a significant number of people would be excluded from care, as RCFEs provide care that is considered custodial rather than medical. Older people who are mentally or physically too frail to live at home and cannot afford an assisted-care facility or residential care have no option but premature and often unnecessary placement in a nursing home; quality of life and functional ability often subsequently decline.
By the year 2030, the older population in the United States will more than double--to about 70 million. Nearly one in five Americans will be age 65 or older. The 85-plus population is projected to increase from 4.2 million in 2000 to 8.9 million in 2030.
The need for assisted-living services will grow with the graying of America.
Resource List ICF and ICFDD
Medi-Cal General Information
408.271.5600
Casa Olga Intermediate Care Facility (ICF)
650. 325.7821
Lincoln Glen Intermediate Care Facility
408.265.3222
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Los Gatos, California Since 1881
