By Tippy Irwin, Executive Director
In the good old days in California, which may be as little as a few short years ago, the system was set to automatic default for seniors in assisted living facilities that had used up all their assets and had just flat run out of money. In cases such as that, we would submit an application to MediCal and, working with their physician, we would move the individual into a nursing home which could be paid for by MediCal dollars. I am not suggesting that this was a good system – far from it. The net result was that nursing homes were now home to many elders who in fact did not qualify for nursing care. But as there was no government benefit to cover the cost of assisted living facilities, it was the only avenue open to these newly indigent seniors to continue to live in custodial care, albeit at a level way beyond what they needed and at a price far higher than what would cover the cost of assisted living. Then it seems that our state government got wise to what was happening and made some changes. In keeping with the “transitioning” project to get seniors out of nursing homes and back into their own homes, or to lower and less costly levels of care, California began to implement an assisted living waiver project, which would allow, in some instances, for people who do not belong in nursing homes, to be transitioned out to the lower level of care in assisted living, paid for by MediCal. A pilot project in San Mateo (along with several other counties in the state) has been working to implement these changes. To date, I believe, about 100+ people have been transitioned out of nursing homes in our county. However, not everybody fits the template to qualify for these benefits, and the project only applies to those moving out of the nursing home setting.
So what happens now to those folk who are living in assisted living facilities who have spent down their assets and are now threatened with eviction for non-payment. It is a problem that California has yet to wrestle with. We are currently dealing with three separate cases of three elderly women, all in their nineties who live in different facilities, all of whom have run out of money. ‘Mrs. Marshall’ tells us “I don’t know what to do. I did everything by the book. I sold my house and utilized the money realized from the sale to pay for my assisted living unit over the past 10 years. I never expected to live this long, and the money is just gone.” All three of our clients have no family members and are completely competent. If they were conservable there might be other avenues available to them. If they qualified for SSI there would be yet another avenue open to them. But none of them do. All three are relatively healthy but somewhat frail. All have full capacity to make their own decisions. And so we are stuck with no recommendations to give them. All three are threatening suicide. Another aspect of gaps in our safety net system to ensure that our seniors are well taken care of in their frail years. I would suggest it is time to re-examine the very flawed assisted living waiver as practiced in California and to reset the parameters under which an individual might qualify for the benefit.