Aging and Independence Services (AIS) provides services to older adults, people with disabilities and their family members, to help keep clients safely in their homes, promote healthy and vital living, and publicize positive contributions made by older adults and persons with disabilities. AIS is the only single public or private organization in the county that combines so many services for older adults and disabled persons under one umbrella -- and mostly at no charge to county residents who use the services.
Services provided by Aging & Independence Services or through contracts with community-based organizations include five areas of focus:
Community Enrichment: Enhancing quality of life.
Aging & Independence Services has more than 30 programs, and each program has different eligibility criteria based on age, level of need, and income.
AIS provides a wide range of services, including information and access, advocacy, coordination, assessment, and authorization of direct services. Direct services are provided through contracts with vendors and agencies, and include in-home support, respite care, meals (senior dining centers and home-delivered), health promotions, legal assistance, adult day care, transportation, educational opportunities, employment, money management, and counseling programs. In general, if a San Diego resident is older or disabled, at risk of institutionalization, is low income, and/or needs help in arranging for appropriate services, AIS can probably help. The array of services available allows the agency to coordinate services effectively.
The gateway to AIS services is through the agency's Call Center that provides initial assessment and channeling to appropriate services and information. Calls are screened to determine eligibility for AIS programs and/or referred to other appropriate community programs. The Call Center has merged the efforts of information and referral, case management program intake and the elder abuse reporting function, providing AIS the opportunity to implement a "no wrong door" model.
TYPES OF FACILITIES
Sometimes circumstances-whether it's poor health, limited mobility, memory loss, loneliness or too much space to keep up with - compel older people and their families to look for alternatives to remaining home alone.
Fortunately, there's a vast array of housing choices in this county. And many older folks are surprised at how quickly a new address begins to feel like home. Some people simply opt for a smaller house, condominium, apartment or mobile home. Some hire part-time or live-in help, and others move in with family. Other alternatives run the gamut from senior apartments to retirement communities, board-and-care homes, continuum-of-care facilities, intermediate-care, assisted-living and skilled-nursing facilities. Consider using the services of placement agencies, especially those that make regular site visits, to help you sift through the hundreds of housing choices in San Diego County. Agency services are generally available at no charge to consumers.
SHARED HOUSING
Under this option, an elderly person shares his or her home with someone else in exchange for rent or services. Services might include cleaning; cooking; transportation; yard work or whatever is needed. Benefits include companionship, security and prolonged independence. Each person has his or her own bedroom and shares the common areas of the home. Roommates negotiate such items as guests, household duties, kitchen use, privacy and telephone use.
Shared-housing programs, administered by local housing authorities and social service agencies, usually match up people for free. To do so, the staff usually interviews the elderly homeowner, collects and checks references and processes the application. Then, the organization gives referrals to possible housemates, who also have gone through a screening process.
ADJACENT AND ACCESSORY APARTMENTS
Under the granny-flat concept, caregivers in some neighborhoods can erect a small, self-contained, portable housing unit on the family property for an elderly person. Before building such a unit, the property owner needs to check zoning laws with the planning department in that community and obtain the necessary permits if possible.
Remodeling the caregiver's home to provide separate living quarters for the older person also is an option. Another option is to remodel the elderly person's home to provide separate living quarters for a caregiver or renter.
RETIREMENT APARTMENTS
Apartment complexes for the elderly and disabled typically feature activity programs, group transportation, optional group meals, and maid and linen service. Private-pay apartment costs vary widely. Older people with annual incomes under a specified limit may be eligible for subsidized rent, which usually is about one-third of the renter's income. However, waiting lists for HUD-subsidized senior housing usually are long.
RETIREMENT COMMUNITIES
Housing in this type of complex might be comprised of single-family homes, town houses, mobile homes or apartments. Typical services include recreational activities, maid service, linen service and transportation. Fee arrangements vary.
Residents might buy, lease or rent, depending on the individual project. The number of units ranges from 30 to 300 units. Generally, this type of community provides more extensive professional services than the smaller board-and-care homes.
Facilities differ widely in basic concepts, atmosphere, amenities and services. For instance, there's a choice of hotel-like buildings or rambling campus-type communities.
CONTINUUM OF CARE COMMUNITIES
These communities might offer successive levels of care, from independent living to assisted care to skilled nursing.
Residents typically enter when they are relatively independent, with access to more intensive care if and when needed. A big benefit is that residents don't have to move to another community if their situation or their spouse's changes.
Costs vary. Some facilities require a nonrefundable initial investment or long-term obligation; some offer fee-for-service. Some charge extra for special care, supplies and medications. For additional information about continuing-care retirement communities, contact the Continuing Care Accreditation Commission and the American Association of Homes and Services for the Aging (ask for a copy of AAHSA's "Consumer's Directory of Continuing Care Retirement Communities").
BOARD AND CARE HOMES
Board and care homes also are known as assisted-living facilities, residential-care facilities, or residential-care homes. Smaller residences are sometimes called group homes, adult-care homes and adult family homes.
These congregate-care facilities might allow residents to have their own room, but share the living room, dining room, kitchen and (sometimes) bathroom. The facilities are licensed by the Community Care Licensing Division of the California Department of Social Services or the California Department of Health Services. Service includes meals, medication reminders or administration, and assistance with dressing and bathing. The staff is responsible for coordinating medical and dental care, making appointments and scheduling transportation to doctor and dentist appointments.
Skilled-nursing facilities (also known as nursing homes) offer both short- and long-term skilled care.
Examples of skilled care include tube feeding, administration of intravenous fluids or medications, monitoring of vital signs or the effects of new medications, and wound care and dressing changes. These state and federally licensed institutions also offer therapy on a less intensive level than do rehabilitation hospitals.
On the other hand, licensed intermediate-care facilities serve people who need help with mobility, meals, medication monitoring, bathing and care for incontinence. Other services might include social and recreational activities, as well as therapy (physical, occupational or speech).
Although most people fear moving to a skilled-nursing facility, many improve there enough to return to independent living. The best skilled-nursing facilities offer 24-hour nursing care, medically supervised diets, social activities, religious programs and therapy. Federal law requires that a skilled-nursing facility provide services and activities to attain or maintain the highest practical physical, mental and psychosocial wellbeing of each resident. The average cost of a skilled-nursing facility often exceeds $3,000 a month.
Medicare does not cover long-term care or custodial care for those who only require assistance with the activities of daily living, such as walking, toileting and eating. To qualify for help under Medicare, the person must have spent at least three days in a hospital and have a condition that requires daily skilled care that can only be provided by a skilled-nursing facility. A doctor must certify the short-term care.
Skilled-nursing facilities must meet standards set by federal regulation to become certified. Facilities choosing to participate in the Medicare or MediCal programs must be licensed, provide 24-hour nursing-care services under supervision of a licensed nurse, have one or more doctors on call at all times and meet established standards of care.
ADULT DAY CARE
Social and healthcare facilities provide adult day care.
Adult social day care offers non-medical services, including social activities, supervision and assistance with daily-living activities. These centers are ideal for otherwise socially isolated adults who enjoy peer support, but aren't as active as those who attend senior centers.
Another choice is adult day healthcare, which offers medical, rehabilitative and social services to adults with physical or mental impairments. These centers can be ideal for physically, mentally or functionally impaired adults who wish to maintain or improve their level of functioning to avoid placement in a skilled-nursing facility.
Both types of centers are for older persons who need assistance, but not round-the-clock care. Most facilities are set up to work with confused, incontinent and wheelchair-bound individuals. Transportation to and from the facility often is available, as is a hot meal. Other services might include care management, exercise, education, health monitoring, and information and referral.
Some centers offer half-day and full-day care. Most are open from 9 a.m. to 5 p.m., five or six days a week.
Currently, there is no national accreditation program to guarantee quality or consistency of care. However, facilities in this state are licensed by the California Department of Social Services, Community Care Licensing Division.
ADDITIONAL RESOURCE
The San Diego Eldercare Directory is published annually by The Union-Tribune Publishing Company. It includes information on services and community programs that make it possible for seniors to live more independently, remain in their homes longer, or find the best long-term care for their specific needs. In addition to the hundreds of resources and tips for cutting through the eldercare maze, they have included answers to some of the questions asked most frequently by caregivers.
Copies of the San Diego Eldercare Directory are available free of charge at your local library or by calling (619) 718-5245.