The advice to the aging population in the Bay Area: Do not grow old, it’s just too expensive.
The dearth of affordable assisted-living facilities could plague the region as the population ages, burdening families with the care of seniors or forcing them into nursing homes that are more costly.
More people are living longer — the number of people older than 85 is expected to more than double in San Francisco and on the Peninsula in the next 20 years — but there are virtually no options for low-income assisted living.
Between San Francisco and San Mateo counties, there are fewer than 50 low-income spots at large assisted-living facilities.
The advice for those who may not have the money for assistance when they are older?
“Don’t get old,” said Gary Passmore, director of the Congress of California Seniors.
The advice, only half in jest, is doled out to low- and moderate-income people who can no longer live independently because there simply aren’t affordable options for assisted living — a yawning hole in the feds’ social services net that the state and federal governments have made no move to mend.
In years past, small board and care homes, which accept six or fewer people for assisted living, once helped plug the hole in the social services net by accepting low-income residents. But those numbers are diminishing, according to Benson Nadell, program director of the San Francisco Long Term Care Ombudsman Program.
“When I first started working here, there were over 90 of these small board and care homes,” Nadell said. “Now, there’s 25 in San Francisco. And they’re all filled up.”
As ombudsman, he fields calls daily from people looking for placement for their elderly relatives who can no longer come home.
“What do we do when they call? We give them a very bleak picture, quite frankly,” Nadell said.
The cost of assisted living — $3,500 a month at the lower end or, if the resident has dementia, upward of $6,000 or $7,000 a month — can affect all incomes.
“What are people going to do when mother cannot return home, and mother only has an income of $2,200 a month — let alone $900 a month — where does mother go?” Nadell said. “And the short answer to that is there’s no place for mother to go unless you, the family member, can supplement the cost at a moderately priced residential care home.”
Many private insurers will pay for a limited amount of long-term care, up to a certain expenditure, and after that the patients are left to pay on their own.
Housing someone in an assisted-care facility is less than half as expensive as housing them in a nursing home. However, Medicare, the government insurance available to people 65 and older, does not cover assisted living. It does cover nursing home care, but in most cases will only cover that for 20 days before imposing a co-pay requirement, according to the AARP.
Medi-Cal, the state’s program for the very poor, only provides long-term care if the patient is essentially impoverished, Passmore said.
“Being in need of assisted-living care is considered a housing problem, as opposed to a health condition, so the big public health insurance programs do very little in the way of trying to support assisted-living arrangements for low-income people,” he said.
Despite an aging population in the region, there’s only one low-income assisted-living facility in San Mateo County, and it accepts 24 residents.
And San Francisco doesn’t have any, although a few of the facilities that received city assistance for construction have set aside a handful of beds for low-income residents, Nadell said. Those total about 15 beds.
The low-income facility in San Mateo County is run by Half Moon Bay-based Lesley Senior Communities, and the facility charges some $3,000 a month, at the discounted rate, Executive Director Sarah Lambert said. That may seem like a lot for a low-income person, but it’s still less expensive than market-rate facilities in the Bay Area, she said. She said the organization subsidizes some of the residents who can’t afford the full amount.
The organization would like to expand its low-income assisted-living facilities, but until the federal and state government start helping to pay for assisted living, it’s just not fiscally feasible, Lambert said.
The federal health care overhaul legislation begins to make some adjustments to the national system, including an act that will help younger people put away money toward long-term care insurance, Passmore said.
But for people who are already approaching retirement age, the problem is large and looming, he said. And any people approaching retirement now realized they have far less money for their old age than they thought they did because of the recession.
“The world changed overnight literally for hundreds of thousands of people who are just waking up to the fact that they are not prepared to live a long time,” Passmore said. “People in their 50s, between September of 2007 and September of 2009, lost on average something like 49 percent of their net worth, between savings and retirement plans and the equity in their homes.
“So there are a lot of people who are in the process of discovering they’re in a real bind.”
Not having enough assisted-living facilities that are affordable is likely to become a major problem for both San Francisco and San Mateo counties in the next two decades, experts say.
In San Francisco — already an older-than-average city, and one in which half the people 85 years and older have dementia — the 85-plus population will double by 2030, according to Anne Hinton, director of The City’s Department of Aging and Adult Services.
The situation is even more drastic on the Peninsula, where the population of people 85 years and older is expected to increase by 150 percent in the next 20 years, and fully one-quarter of the population is expected to be 65 years and older, according to ST Mayer, director of health policy and planning for San Mateo County.
“Every county is expecting an increase, but we’re definitely ahead of the curve. We’re one of the oldest counties in California,” Mayer said.
— Katie Worth
In 1999, San Francisco voters were faced with a ballot measure seeking a bond to rebuild Laguna Honda Hospital and Rehabilitation Center, demolish parts of the older, seismically unstable hospital, and build in its place a 250-room assisted-living facility for low-income people.
Voters approved the bond measure, but, as many San Franciscans know by now, the money ran out long before that last step.
The assisted-living facility would have helped take a bite out of the large number of older adults who need to be in such an environment but who don’t have the several-thousand-dollars-a-month income to pay for it.
But, as Laguna Honda Executive Director Mivic Hirose said, the plan isn’t exactly dead.
In 2007, the hospital completed a comparison report of several design options for the building and chose one.
“We’re very much in favor of Laguna Honda delivering long-term [assisted-living] care to San Franciscans,” Hirose said. “We cross our fingers that maybe in the future there will be money for it.”
It’s not clear how much impact that finger-crossing will have. Hirose admitted that with working to complete and certify the new hospital and preparing to move into it, applying for grants or looking for funding for the assisted-living facility have not been a top priority.
“Once we get tucked in, then we’ll be bored and need to do all of that,” she said, joking.
In the meantime, the list of older San Franciscans who need assisted living grows, said Benson Nadell, director of the San Francisco Long Term Care Ombudsman Program.
“There’s no surplus bed stock in San Francisco for people who are low-income, either seniors or low-income disabled residents,” Nadell said. “For those individuals who don’t have families to supplement their incomes, their choices are going to be really limited.”
— Katie Worth
Lesley Senior Housing was able to gut a floor of its independent-living facility in Belmont and re-create it as an affordable assisted-living facility thanks to a $4.2 million federal grant.
In total, 24 apartments in a 160-unit building were made completely accessible to seniors with limited mobility, and a staff was hired to do everything required by the state for assisted-living facilities — provide residents with transportation, help them take medications, provide three meals and two snacks a day and do housekeeping, among other things — said Lesley Services Executive Director Sarah Lambert.
The nonprofit would love to do the same to more of their facilities, opening up space for low-income residents, but it’s just not financially feasible. Lambert said she charges the low-income residents $3,000 per month because that’s as low as the facility can go while still staying afloat without federal subsidies.
And even that’s not feasible for many residents.
Lambert said many of the long-term residents of the independent-living facility face big problems when they are no longer independent enough to live there.
“There’s quite a number of [market-rate assisted-living facilities], but the problem is unless you have the funds, you can’t afford to live in them, and there’s no federal subsidy,” she said.
Some wind up living in nursing homes, which are better covered by federal and state health insurance programs than assisted-living facilities.
“They’ve got people who could be happy in an assisted-living environment living in skilled-nursing facilities, at a much greater expense to society,” Lambert said. “Somehow, the federal funding has to move in the direction of residents remaining in place, in their homes or in assisted-living environments, because that way you can serve them a lot better and do it a lot more humanely.”
— Katie Worth
As the population ages, more Peninsula and San Francisco residents will need assisted-living care.
14 Percent of California population 65 years and older
17.6 Percent of San Francisco population 65 years and older
7,000 San Francisco residents 85 years and older
100 Percent increase in number of San Francisco residents 85 years and older by 2030
148 Percent increase in number of San Mateo County residents 85 years and older by 2030
25 Percent of San Mateo County residents who will be 65 years and older by 2030
Low-income seniors don’t have many options for assisted living.
1 Low-income assisted-living facilities in San Mateo County
24 Low-income spaces at assisted-living facilities in San Mateo County
20 Or fewer, low-income spaces at assisted-living facilities in San Francisco
25 Small board and care homes that accept low-income seniors in San Francisco
0 Vacancies in the 25 small board and care homes that accept low-income seniors in San Francisco
Assisted-living facilities are less than half the cost of nursing homes. Assisted living, however, is not covered by government insurance programs like Medi-Cal.
$35,000 Average cost per year nationwide to house a person in assisted-living facility in 2008 (costs proportionately more expensive in California)
$76,000 Average cost per year nationwide to house a person in nursing home in 2007 (costs proportionately more expensive in California)
Sources: AARP, Genworth Financial