karl kimBy KARL KIM, CFP, CLTC

When an aging parent needs help, what are the options available? Selecting the proper level of care depends on whether the care needed is hands-on or hands-off, how much care, type of care and assistance a person needs. Financial considerations also play a major role in the decision.

Over the years, our experience has been that adult children underestimate the level of care that their parent needs. This is understandable as adult children do not want to think of their parent getting older and needing help. After all, their parent is the one who raised them and took care of them as children. It is difficult now that the roles are reversed.

To help determine the appropriate services and level of care, one should consult with a geriatric care professional. Nursing homes, assisted-iving facilities, home care agencies, and long-term care insurance companies have health care and geriatric professionals to help with these assessments.

Here are the seven basic levels of care.

1. Home care: This is care that you receive in your home. Home health care is provided by licensed medical professionals such as registered nurses and therapists. They provide medically necessary care typically after discharge from a hospital. The cost is usually covered by Medicare or Medicare Advantage HMO.

Home care or personal care is provided by non-licensed staff. Aides help with the activities of daily living such as bathing, eating, and dressing. They may also cook, clean the home and perform other light housekeeping duties. Home care usually ranges between $20 to $22 per hour. Service time can be anywhere from a few hours a day to a full 24 hours (live-in).

2. Independent living: Examples of this type of care are retirement homes or senior apartments. This is sort of like living in a college dormitory because you take care of yourself on a day-to-day basis but these places usually provide amenities like transportation, meals, and activities.

These environments are usually exclusive to the 55+ population and are built to make everyday living easier as you age. Commonly found in these units are safety measures like bathroom grab-bars, walk-in showers (as opposed to tubs), and a Life Alert type system. This type of care usually ranges from about $3,000 to $4,000 per month.

3. Assisted living: This is a step above independent living. You usually live in a community of other seniors but might need more help with your daily activities than someone in independent living. There are aides to provide intermittent help. A registered nurse is always on site.

Monthly cost ranges from about $4,000-$8,000 depending on the type of assisted living environment. Some places specialize in conditions like dementia/Alzheimer’s care, and other places simply provide a little more assistance than independent living. Some assisted living facilities allow people in wheelchairs while others may only allow people who can walk independently.

4. Board and care: This is kind of like assisted living but in a smaller setting. Sometimes referred to as “group homes,” board and care homes are usually run privately and have six residents. These homes do not have medical staff on-site, only caretakers. They are often located in residential neighborhoods. Board and care starts at about $3,000 per month.

5. Intermediate care: This care is provided in a facility. Think of this as a transition between assisted living and a nursing home. Medi-Cal will help to pay for intermediate care. The resident must be able to get to the dining room for meals. A cane or a walker is fine but no wheelchairs. Intermediate care costs about $4,500 to $5,000 per month.

6. Nursing homes: These provide services to those people that require 24-hour hands-on care. Facilities have both non-medical certified nurse’s aides and medical staff, including registered nurses, to constantly monitor the residents. Many nursing home residents use wheelchairs and need help with eating, toileting, dressing — all of the above. Nursing homes start at around $7,000 per month. Facilities could provide both rehab or short-term care, which is covered by Medicare and insurance, or long-term care, which could be covered by Medi-Cal or cash.

7. Sub-acute care: This is the highest level of care and can range from $30,000-$90,000 per month (yes, per month!). Patients have special conditions that cannot be provided in a regular nursing home, like tracheotomies or quadriplegics. These residents may not be able to breathe on their own or might require complex wound management. Intensive round-the-clock care with constant monitoring is needed.

As you can see, there are several levels of long-term care. Each level is designed to care for its residents in the safest way possible. Making sure you have chosen the right level of care will be vital to your parent’s ongoing health and safety. Please consult your health care or geriatric care professional with questions on what level of care might be appropriate for you.


Karl Kim, CFP, CLTC is the president of Retirement Planning Advisors, Inc. and a long-term care Medi-Cal specialist. His office is located in La Mirada. He can be reached at (714) 994-0599 or at www.RetirementCrisisPlanning.com. He has submitted over 1,000 Medi-Cal applications over the past 20 years with a 99.9% success rate. This is meant to be an educational article. Kim’s book “Don’t Go Broke Paying the Nursing Home: How Californians Can Protect Their Home, Cash and Retirement Accounts” is available at Amazon.com. Do not make any decisions solely on the information in this article. Consult your tax advisor, financial advisor or attorney before taking any action. We are not responsible for any inaccuracies or misinformation.


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