What Happens When the Money Runs Out???

The first group of options is about staying put, which usually causes the least disruption.

SSI, or Supplemental Security Income, is often the best route. A resident who is out of savings and has a low enough monthly income can qualify at the board and care rate. The facility receives a set payment, which it has to accept as payment in full for basic services, and the resident keeps a small amount for personal needs. CANHR publishes a fact sheet on SSI in residential care facilities.

Military veterans have another option. The Veterans' Aid and Attendance benefit gives qualifying veterans a modest monthly payment toward the cost of care. CANHR has a fact sheet on this one too.

If the facility takes part in the Assisted Living Waiver program, a resident who has run out of money and qualifies for Medi-Cal should apply. The waiver exists to keep people out of more expensive nursing homes, and it pays the facility roughly 50 to 200 dollars a day. The catch is that not many facilities take part, and the waitlist is long.

If none of those work, there is one more thing to try. Negotiate. Some facilities have empty rooms and would rather keep a resident at a lower rate than lose them altogether. It is worth asking.

If staying is not possible, the obvious step is a less expensive facility. That can work well for someone leaving a high end assisted living facility with a reasonable income.

Residents on lower incomes who do not qualify for SSI have fewer options. Someone who needs less hands-on care may be able to return to independent living, with help cobbled together from family and friends, In-Home Supportive Services, adult day care, or another Medi-Cal funded home and community based program.

For residents who need a great deal of care and cannot manage independent living, a nursing home paid for mainly by Medi-Cal may be the only route. The difficulty is that nursing homes are reluctant to admit anyone whose primary payment source is Medi-Cal. Admission becomes far more likely if Medicare coverage can be triggered by a qualifying three day hospital stay, which means an increasing number of residents end up trying to get into hospital. That is a poor outcome for the resident and poor public policy.

State and federal governments offer very little to residential care residents who run out of money. For generations, public spending has favored nursing home care over community alternatives.

In 1999 the United States Supreme Court found in Olmstead v. L.C. that this bias against community based care violated disability discrimination law, which should have opened a new era. Home and community based programs have grown since then, but not nearly fast enough to keep up with an aging population, and public spending in California still favors institutional care.

Until that changes, residents who run out of money will keep facing a short list of difficult options.