Lucinne McCauley visits her mother Lulu often at her new home, which is complete with a gated entry, lush landscaping and grazing miniature horses. Lulu’s daughter often finds her mom sitting in her favorite chair – at the end of the dining room, between a piano and large picture window.

But Lulu’s surroundings are in no ordinary house. Lulu has Alzheimer’s disease and two years ago, her daughter moved her to Silverado Senior Living, a residential long-term care facility in Encinitas.

Although the decision to put a loved one in a care facility can be difficult, McCauley’s mother has adapted well to her new environment.   She has a favorite nurse and a group of ladies who she sits with for meals and activities.  For McCauley and Lulu, Silverado is as close to a dream-come-true as they could hope for - under the circumstances.  That dream, however, is coming to an end.

The High Cost of Quality Care

Not all the residents are happy to be living at Silverado and, in fact, many have no real concept of where they are at all.  But in the spectrum of such facilities, the Encinitas facility is at the top.  And that level of care comes at a hefty price.  At around $6,000 per month, or $72,000 per year, a life savings can disappear very quickly.

“I do not make $72,000 a year at my job,” McCauley says.

Lulu has been living off the proceeds of the sale of her house and other savings for the past two years. But that money is finally running out.  McCauley has been managing her mother’s assets and trying to stretch the money as far as possible, but with less than $99,000 left she is looking at what else is out there for Lulu.

She is seeking out more affordable facilities, especially places that will accept Medi-Cal patients.  McCauley is concerned, though, about the quality of care that she might find.

“That part troubles me, and I hope to be around as much as possible because she’ll know (that she has moved),” she says.

Lulu is still much more lucid after two years at Silverado than her family had expected.  But that means she would be aware of the move to a new facility and any changes in comfort that could ensue.

McCauley says she is afraid of a significant difference between facilities like Silverado and even just the next level down in cost.  At a recent support group meeting, one of the facility’s doctors told her that there is a large gap in quality between top-of-the-line facilities and the ones that are approved for Medi-Cal assistance.

“My heart just sank,” she said after hearing the doctor’s point of view.

McCauley has looked around some and has an impression of what the lower cost options might be like.

“They’re not going to be laid out as nice, you know, these are real comfortable and homey.  Some of the other places, they’re so hospital-looking.”

In fact, McCauley worries that the change could accelerate her mother’s symptoms.

The Alternatives

McCauley’s fears may not be unfounded in terms of what is available to Alzheimer’s patients who can’t afford a place like Silverado.

To receive assistance from Medi-Cal in paying for resident care, the facility must be approved by Medi-Cal.  These places range from what is called “board and care” to the more expensive skilled nursing facilities.

Such facilities are more focused on the security of the patient and availability of medical care in case of injuries, infections or other complications.  Places like Silverado Senior Living cost much more and place a high importance on amenities, more individualized care, and quality of life.

While many families choose to bring a relative with Alzheimer’s into the their own home, this is not always a viable option, especially as the disease progresses and the patient needs more specialized medical and nursing care.

Margaret Galante is the manager and Director of Nursing at the George G. Glenner Alzheimer’s Family Centers, Inc.  She sees many people with early stages of the disease who are trying to learn as much as they can about Alzheimer’s and what their options are.

The Glenner centers are mainly day care facilities for patients with memory disorders, but Galente often helps families find a residential facility for those whose symptoms have progressed.

Galante likens the process of placement to that of finding the right college for a child.

“It’s a very individualized process,” says Galante.  “You can have an excellent facility but if it’s not a fit for the family and not a fit for the patient, then it’s not going to work.”

She explains that the level of care needed can vary widely.

“You could have, say, an 80-year-old lady who is comfortable in her environment and not seeking to leave, and a facility could take her even though she has dementia.”  But Galante adds that if the patient is a six-foot ex-Marine who does not want to stay, the type of facility needed would be much different.

Although McCauley questions whether Medi-Cal will provide much assistance to her, Galante describes the system as “decidedly helpful.”

Galante explains that a facility receiving funding from Medi-Cal or Medicare would have some of their beds paid for by the programs.  She says, though, that such programs can be very specific in their criteria and assessment of what level of care is needed.

“You just can’t decide you want your mom to go to a (particular) facility or you want Medi-Cal to pay for a facility,” she says.  “(Medi-Cal) may ask you to meet criteria and each person is evaluated (for level of need).”

The Glenner facility costs about $70 per day for eight hours of day care.  Residential facilities around San Diego run the gamut in price but most are well under the cost of a place like Silverado.

McCauley says that the assistance she can receive from Medi-Cal will only amount to what her mother has saved in social security.  She says that will only be about $800 per month and she is expecting to pay a couple thousand on top of that for wherever she ends up moving Lulu.

Making The Move

Even with assistance, what McCauley is most concerned about is the psychological impact of moving Lulu to a new home.

“It’s a really scary thought,” McCauley says.  “It’s kind of ironic because you place them somewhere where they get a lot of stimulation and they improve a lot.”

She says that Lulu is actually doing better at Silverado than she was at home with much less activity.  Now McCauley is afraid that moving to a nursing home will shatter what is left of her mother’s cognitive abilities.

McCauley figures that Lulu has less than a year left at Silverado and is bracing herself and her family for what she fears will be a traumatic change of address for her mom.

McCauley says she is learning a lot from her mother’s situation and has taken the precaution of investing in long-term health insurance for herself - something she recommends for everyone.

“I don’t want my kids to have to deal with struggling to find a place, struggling for a way to pay for it, having to use all of my assets.  I want to protect them from that.”