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By the year 2035 it’s projected that there will be more than 78 million person ages 65 and older living in the United States, up almost 60% from the 46 million in 2016, according to population data. Every state is expected to see massive growth as baby boomers age into retirement, but none will see an increase quite like California:  by 2036 the state will see more 10,000,000, and comprise 23% of our population.

Planning for an aging population is no longer conjecture. It is an absolute necessity. Doing so requires that we have the infrastructure in place to care for those who will need it, which means more licensed care facilities, more available beds, and more trained and certified RCFE administrators.

Getting there will not be easy, and setting out to open your own RCFE is not for the faint of heart. It’s a significant business decision, but one that carries with it one of the most rewarding acts of service one can provide:  caring for those who came before us. Here’s how you go about opening and RCFE in the state of California.

1. Find a qualified, certified Administrator.  

The first and most important step. Without having a qualified, certified administrator on your team, none of the rest can follow. In all likelihood, you’re probably intent to become certified yourself, but how do you go about doing that?

To become certified you must first take the DSS-required 80 hour Certification Course, and then take and pass the DSS-administered 100 question test with a minimum passing score of 70%. This test must be taken within 60 days of you completing the 80-hour course, after which you must submit the required paperwork and fee within 30 days of passing the test.

Not everyone is qualified to be an administrator of your facility. The general requirements call for a high school diploma or equivalent and being at least 21 years of age. For a 16-49 bed facility, you must have passed at least 15 college units and have at least 1 year of experience working in an RCFE or equivalent. To be an administrator of a 50+ bed facility, you’ll need to have a minimum of 2 years of college under your belt, and have at least 3 years of experience working in an RCFE or equivalent.

Are you qualified, and ready to take the DSS-required RCFE initial certification course for administrators?

2.  Secure the physical plant.

It will sound obvious in hindsight, but you can’t be the administrator of a residential facility for the elderly if you don’t have the actual facility part locked down. In order to submit a license application for your facility, you must show “control of property” — that is, proof that you either own the property outright, that you are either in the process of buying the property or that you will be leasing/renting the property.

3. Contact your local fire marshal for a pre-inspection.

The sooner you do this, the better! It’s possible that the fire marshal will charge you a nominal fee, but this inspection will let you know early on if you will need to make costly modifications to your home/facility in order to be compliant with local fire codes and state regulations. Money well spent! If you don’t make these modifications, you won’t be able to get the maximum number of non-ambulatory rooms or apartments out of your facility. You’ve already come this far! Maximize your investment by making these modifications, or find another location!

4. Take the online Orientation course with DSS.

You must take the DSS RCFE course.  You only need to take this course once. This is done through the DSS website, and then submit a copy of your orientation certificate.

5. Submit a license application to DSS.

Now we’re getting to the fun stuff. The next step in this process is to prepare and submit an RCFE license application for DSS, including parts A and B, along with the applicable fee. We won’t sugarcoat it:  this is not like filling out an application for a driver’s license. The Applications Instructions alone are 22 pages in length, and all told you’re looking at hundreds of pages to gather information for, prepare, and fill out. Attempting this on your own is a recipe for disaster — just one error could delay your facility’s opening by months! Instead, it’s smart to consider having yours completed by a professional. Our team has licensed hundreds of small and large RCFE’s, and worked with DSS licensing personnel for over 15 years. We have never had an application rejected due to error!

Do you have the required 3 months’ of operating costs in the bank? You must open a bank account in your facility name and deposit at least 3 months’ operating costs into it. The DSS will verify this in the process of reviewing your application.

Be patient. This process may take 4-5 months.

6. Market your Facility.

Congratulations, you’ve submitted your application! Now it is time to start meeting with the potential residents who fill your facility once you are licensed. You are NOT allowed to move residents into your facility until you secure the license from DSS. But DO start looking for residents. Don’t wait until you secure the license, because that will just be time lost! In our post detailing 6 Steps for a Successful RCFE we talked about the importance of choosing your residents wisely. Remember, your first resident is your benchmark and will set the tone for your facility in ways you might not expect.

7. DSS will schedule a Component II (face to face) meeting at their office.

This is step two in a three-part component process that must be completed by all new licensees. Once your application has been reviewed, you will be contacted by the DSS for a one-on-one with the the reviewing analyst.

Component I was the orientation course you took in #4 on this list, and Component III involves  “category specific training and discussion in areas not often understood by new licensees intended to promote successful facility operation.” Both components II and III will be done once DSS accepts your license application, but prior to actual licensure. These are all essential aspects of the license application process.

8. DSS will schedule a pre-licensing visit to inspect your facility.

You’re so close! You’re almost there! A pre-licensing inspection is by the DSS as the last step in the RCFE license application review process. DSS will send you a checklist for you to complete prior to this visit. Make sure you complete this checklist fully, and have it available for their review when they come to visit.  Note: the DSS will NOT conduct a pre-licensing until your fire marshal grants their approval.

9. Hire staff and train them accordingly.

Putting together your team and training them accordingly is arguably the most important step in this entire process. We’ve discussed before the perils of fire-drilling the hiring process in our post about The 10 Biggest Mistakes RCFE’s Make. You aren’t just looking for warm bodies to fill these important caretaking positions. You want a passionate team of people who want to come in every single day intent one making the lives of your residents better. Remember, you don’t want to wait until you are licensed to build your team, because you will not be able to move in and care for residents without staff! Once you’ve found the right people, make sure that they are properly trained and meet all the state requirements. And don’t forget the importance of ongoing CEU training for RCFE administrators and staff as well!

10. DSS issues you a facility license.

You did it! Yes, you! Let that feeling of pride wash over you. You are now the proud administrator of a fully licensed RCFE. This is everything you’ve worked so hard toward, and it’s time to open your doors. Now you can move in your residents that are on your waiting list!

The process to opening an RCFE facility in California may be long, but it’s rewarding. It’s okay if it takes you a year or more to get your facility off the ground — it’s not a race, and in the end it will all be worth it. The senior care industry is among the fastest growing industries in the country, and California is no different. We must be prepared to meet the needs of seniors with the best care possible. More growth, means more new facilities.

The need is there. Are you ready to provide it?

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Assisted Living Education is the leading provider of RCFE certification classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative.

Starting your first Resident Care Facility or RCFE can be exciting, fulfilling and daunting all at the same time. Between securing a location and getting your certifications it can be easy to overlook some of the important basic ideas that will help ensure your first RCFE is a success.

Over the years we have worked with hundreds of newly minted RCFE administrators to make sure their facilities, policies, and business strategies are setting them and their residents up for the best possible experience. In that time, we’ve learned a thing or two (or six) on some of the foundational elements of what makes a successful RCFE. Here is what we would say 0ur 6 most important tips for building a successful RCFE facility are…

1. Spend Time Creating Your Team

More than just a team, you are creating a culture. And where that culture starts is you and your employees. Those first several hires are vital to any new venture, regardless of the industry, and especially in a care-oriented industry like this one. The people you choose and personalities they bring set the tone and precedent for all that is to come.

With everything in flux, you might be tempted to “fire drill” the hiring process in a rush to hit the ground running. This is never a good idea. We’ve all heard the phrase beggars can’t be choosers. In hiring, no matter the circumstances, that should never apply. Give yourself permission to spend time creating your team. Yes, your team. You have a vision, and it is okay to be selective on who will join you on your path to seeing it through.

2. Choose Your Residents Wisely

Just as you are creating a culture with your first employees, so are you building a RCFE community. Your first resident is your benchmark and will set the tone for your facility in ways you might not expect. For example, if your first resident has Alzheimer’s and has repetition tendencies, then it might be difficult to admit residents who are cognitively with it.

Remember, just as you have a choice, so do your residents — and there’s a lot of factors that go into their decision to go with your RCFE facility. As facilities grow in size, culture and community are becoming increasingly important. If a resident-to-be doesn’t see a community they can engage with (even if one exists), they might very well pass. Whether it’s bound in fact or not, perception is reality.

3. Know All of Your State’s Regulations, Codes, and Policies — And Comply with Them

These laws exist for a reason, both for the protection of your residents and for yours. The quickest way to have your facility shuttered is to be out of compliance with your state’s RCFE regulations. You went into caregiving to do just that:  give care. How can you adequately do that if you’re out of compliance, or don’t even know what codes and policies your facility is supposed to be complying with?

Moreover, having a firm grasp of your state’s regulations could very well be crucial down the line. Don’t be afraid to wield them like a shield — the first line of defense towards any future liability claims.

Need to brush up on your policy? You can always turn to experts like Assisted Living Education to help make sure you are up to date.

4. Communicate Regularly

Not only is communication vital so that everyone on your team can always be on the same page, but it’s also a regulatory requirement. The law mandates that any change of condition in the resident — say, they have a urinary tract infection or they’re more confused than usual — must be communicated to their physician and responsible party (i.e. a family member), if any.

This makes sense, of course. A change in an individual’s condition can have life or death consequences, and a lapse in communication could prevent a resident from receiving critical treatment. Shift changes present a particular challenge in this regard. There’s a potential for information to get lost in the mix in the transition between your facility’s day and night teams. Certain symptoms, such as insomnia — a potential indicator and risk factor of depression — might only present themselves at late in the evening, so it’s imperative everyone is kept in the loop, and that changes are noted in writing.

And let’s not forget your duty as an RCFE Administrator to maintain communication with your State Regulators. Any time a resident experiences an unusual incident — such as a fall, an injury, or a medical emergency requiring a 911 out to the hospital — a report must be made to your Licensing Program Analyst at the Department of Social Services with within 1 business day via telephone, and within 7 days via a written report. This takes us into our next tip.

5. Document, Document, Document

Any time there is a resident incident, such as a fall, it must be documented — either internally, if it isn’t that serious, or on a State-provided form to be submitted to the DSS if it triggers a 911 call or something similar. Like the above, incidents need to be reported to the resident’s physician and responsible party, and it’s best to do this in writing so you have a paper trail.

Liability, though you might not want to think about it, should always be a concern. Thus, it’s wise to perform internal audits and random record reviews on a routine basis. You always want to be able to certify compliance if the need arises. This is where the term “defensive documentation” comes into play. When you document incidents, or anything really, specificity, precision, and descriptive detail are all musts.

Resident records (appointments included), personnel records, administrative records, dementia records — these are all things you are required to keep, keeping in mind that certain records must be secured in a HIPAA compliant fashion. As a guideline, take a look at the list of documents and records that must be kept at residential care facilities in California. Remember that every state is different, so unless your facility is located in California, what you are required to retain might be different.

6. Don’t Be Afraid to Say No

The words “this is my island” spring to mind. This facility is yours, and as an RCFE Administrator, you cannot be afraid to say no. We covered this in part in Tips #1 and #2, what to do in the beginning, but there’s a corollary on the other end of the spectrum:  what to do when an end is inevitable.

If an employee misbehaves, routinely underperforms, or puts your residents or facility in any modicum of risk (health, liability, or otherwise), then it is your duty to fire them promptly. With the safety and wellbeing of those in your care on the line, they must be your first primary concern.

But what if an individual’s medical needs exceed your facilities abilities?

It’s sad to say, but this is a quandary you will likely face dealing with residents suffering from advanced Alzheimer’s and dementia. Much as you might want to keep them in your care, your licenses might not permit it. The care they require might go beyond the scope of what you can supply. In these situations, or in cases of residents who exhibit violent behaviors or a flagrant disregard for community rules, letting go of a resident might be a necessary course of action as well.

The Essential Component of Success

Looking back on the six tips we just shared, you might notice that at their core they are all about the same thing:  Care. Caring enough to do things right. Providing the best care. Taking time to assure your level of care by maintaining compliance, and by communicating. Although there is a lot more to running a successful RCFE facility than just these 6 things, mastery of these will give you a great foundation to build your business on. And in the event that you need additional support or training, the experts here at Assisted Living Education is always here to lend a hand.

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Assisted Living Education is the premier provider of RCFE classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative. They offer RCFE consulting services and share real RCFE experience that will help you be successful in this fast growing career industry.

For many, the holidays and winter months are the time of year for family get-togethers, traditions, friends, and fun. But this isn’t always the case, and for a large number of seniors Holiday Depression and Seasonal Affective Disorder are a painful reality. The causes for each can be numerous — both psychological and physiological — and often they present similarly. However, considering the more insidious nature of the latter, it’s important that caregivers know what to look out for, and the different factors that can play a role in their onset.

Spotting the Signs of Holiday Depression

The key to any effective individual care plan is in simply knowing your residents. Familiarity with their personalities and ‘baseline’ behaviors, disposition, and temperament are crucial in detecting any kind of change.

The following are typical depressive symptoms presenting in an elderly resident around the holidays:

• Subdued or irritable mood; sadness
• Fatigue, or difficulty sleeping
• Anxiety
• Loss of interest in daily activities
• Change in appetite
• Lack of attention to personal care, hygiene

Unlike other forms of depression, the Holiday Blues are situationally dependent. They begin in the lead up to the holidays, and fade in their wake. Rather than being physiological in origin — the individuals personal biology and brain chemistry — they are based in psychology and sadness. Sometimes, the thing triggers one’s holiday depression isn’t current. Instead, the holidays might dredge up trauma of some kind from a person’s past.

Even if your residents already present some of these symptoms, it’s important to note if they become more severe or if additional symptoms arise. If you notice the symptoms worsening, or if they continue beyond the holidays, this is very likely indicative of a more insidious form of depression.

Seasonal Affective Disorder

Seasonal Affective Disorder is a type of depression whose onset is triggered by changes in seasons. The most common form of SAD occurs in fall through winter, but there are some cases in which the condition affects an individual in the spring/summer months (sometimes referred to as Reverse SAD).

In both cases, there is marked change in mood and disposition, which start out mildly when the season is in its initial stages, but become more severe as the season progresses. Considering it can be easily confused with the Holiday Blues, we’re going to focus on the fall/winter end of the spectrum.

The fall/winter manifestation of SAD resembles the more classic symptoms of depression. Here’s what to look out for:

• Irritability, trouble getting along with others
• Fatigue, lethargy, low energy
• Emotionally hypersensitive
• Change in appetite, especially craving for high carbohydrate foods
• Oversleeping 

People who live in regions with distinctive weather changes or where sunlight can be very limited are more likely to develop symptoms SAD. However, even in places like California, where the weather may not change as dramatically, the cooler temperatures can prevent more frequent visits outside, especially for elderly residents, and thereby makes for less exposure to the ever important sunlight.

For individuals with Fall/Winter SAD, symptoms persist for more than two weeks. The reduced sun exposure can lead result in deficiencies or imbalances in the body. For example, serotonin production drops with a lack of sunlight, and this chemical imbalance causes an individual to feel depressed. The cravings for high carbohydrate foods are the body’s way of attempting to increase serotonin levels. Vitamin D also plays an important role in our health, including supporting bone health, preventatives with certain cancers & conditions, as well as help with incontinence. However, Vitamin D is also found naturally in certain foods and also via dietary supplements. Sleep patterns can also be thrown off as well, since the body’s circadian rhythms depend on regular sun exposure. The disrupted sleep prevents the resident from getting quality rest, which can result in depressive symptoms.

Making the Call

While nurses and caretakers play a critical role in determining whether a resident is suffering for Holiday Depression or Seasonal Affective Disorder — considering the frequency with which they might interact with an individual — the ultimate determination must come from the resident’s attending or personal psychiatrist/psychologist.

Psychiatric professionals should determine the best course of treatment, depending on the individual’s needs, cognitive capabilities, and severity of symptoms. Even if the resident is already receiving specific treatment from their psychiatrist/psychologist, it is vital that team members keep all doctors, therapists, dieticians, and other caretakers abreast of any adjustments to the resident’s routines, medical or otherwise. This will help maintain the consistency and effectiveness of the resident’s treatment and care.

In our next article (Part 2 of this series), we’ll take a look at how you as a caretaker can help the seniors in your charge throughout the fall and winter months. While you might not be able to hold the effects of the Holiday Blues or SAD at bay, you can at the very least take steps make their days warmer, merrier, and bright.

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Assisted Living Education is the leading provider of RCFE certification classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative.

Growing old is never easy, but for lesbian, gay, bisexual, transgender, and queer-identified (LGBTQ+) baby boomers — the overwhelming majority of whom have endured lifetimes of discrimination and prejudice — the process of aging can be particularly fraught. According to a major, 2017 survey published in The Gerontologist, it’s estimated that living in the U.S. there more than 2.7 million LGBTQ+ people aged 50 and older, including an estimated 1.1 million seniors (ages 65+).

The report came on the heels of several recent landmark studies, each intent on understanding the unique aging and health needs of LGBTQ+ older adults — an intersecting community of people who, until only the past decade, had been largely ignored and understudied by the field of gerontology.

The growing interest in this intersection reflects a shifting landscape within assisted living facilities and their concomitants (e.g. healthcare providers), and recognizes that increasing diversity among the senior segment necessitates a greater level of awareness, compassion, and inclusivity by caregivers and nursing homes:  by 2060, “the total number of older adults who self-identify as LGBT, have engaged in same-sex sexual behavior or romantic relationships, and/or are attracted to members of the same sex is estimated to increase to more than 20 million,” (The Gerontologist).

For a group historically underserved by policy and healthcare services, the relative invisibility of LGBTQ+ elders to researchers has been dispiriting — if unsurprising, considering society’s slow uptake of acceptance. But what’s become immediately clear from the studies done since is that LGBTQ+ older adults face a number of special challenges as they age, and have medical, social, and emotional needs that differ greatly from their heterosexual and/or cisgender¹  peers.

It’s important that providers of elder care services be aware that these baby boomers and seniors — the aging faces of the Stonewall Generation, who in 1969 led the charge for equality following the powder-keg uprising at Stonewall Inn that propelled the fight for gay rights to the national stage — are now confronting an open ridicule as the first out members in their assisted living communities. And while they’ve proven their resilience, having also fought to reach an old age that too many of their peers never would — lost to the AIDS crisis at the height of young adulthood — few of these individuals will have made here untouched by trauma, and the punishing effects of stigma, discrimination, rejection, and struggle.

In the second half of this article, we will explore the kinds of challenges faced by LGBTQ+ older adults, and why it is so important that for us as caregivers to understand them.

To continue reading Part Two of this article, please click here.

In the second half of this article, we will explore the kinds of challenges faced by LGBTQ+ older adults, and why it is so important that for us as caregivers to understand them.

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Assisted Living Education is the leading provider of RCFE certification classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative.

In our previous post, Part One of our two-part series concerning seniors and medical marijuana, we explored the increasing use of cannabis among our aging populations.

As laws across the nation continue to change (allowing individuals safe and legal access to its myriad therapeutic benefits), and prior to considering it for themselves, it is important that both patients and their caregivers have a more complete picture of marijuana—one that extends beyond its oft depicted “bad boy” image as a dangerous, gateway drug.

With that said, prior to diving into Part Two of our primer, as always, we would like to impress on our readers that it is always best to consult a doctor first before making any changes to an individual’s treatment plan.

The Benefits

One of the conditions cannabis is most notable for helping treat is epilepsy, which we touched on in the last post. But the benefits don’t just end there. There are dozens of diseases and disorders (or their symptoms) that have been shown to improve with medical marijuana. Here are just a handful:

• Cancer
  It’s one of the reasons medical marijuana laws were first passed in California in the 90’s. The ability of cannabis to alleviate many of the deleterious effects of chemotherapy, especially pain and nausea, seems nothing short of miraculous. But there’s more. Research has shown the marijuana can not only kill cancer cells, but also prevent its spread. 

• Chronic pain
  There’s a fascinating bit of science behind the anti-inflammatory properties of cannabis, but sadly we don’t have the requisite space to dive into it. Many seniors suffer from debilitating pain from a variety of conditions, but it doesn’t have to be that way. Arthritis, nerve pain, and fibromyalgia are all conditions that seniors are experiencing relief from with the ingestion of cannabis. Its two most notable compounds, THC and CBD, both have been shown to inhibit proinflammatory molecules in our bodies, working together with our endogenous opioid systems to reduce pain.

• Parkinson’s
  It’s one of the most astonishing videos on the internet. A man named Larry, who suffers from Parkinson’s disease, is seen with severe tremor dyskinesia. He struggles to speak, telling someone off camera that it’s been a rough week. He’s advised to take a single droplet of a cannabis-infused tincture, the first time this former police captain has ever tried such a thing. After rubbing it beneath his tongue, and on his inner cheeks, he lies back on a couch. Four minute later, he sits up, a smile breaking across his face. “So quickly,” he says. His tremors are gone, and for the first time in a long while, he can speak in a clear and controlled voice.

• Glaucoma
  It’s estimated that more than 3 million Americans suffer from glaucoma, a disease of the optic nerve that can lead to a progressive and irreversible loss of vision. Glaucoma is the leading cause of blindness worldwide. Though clinical trials have been few, many patients have reported a marked decrease in intraocular pressure following the inhalation of cannabis, while other have found relief from CBD-infused eye drops.

• Sleep
  You’d be hard-pressed to find someone who doesn’t enjoy dessert. With the medical marijuana industry in the midst of a massive boom, one of the most popular forms of ingestion is in the form of edibles. Pot brownies might seem like something of a joke, but in fact countless seniors are turning to their nightly “something sweet” as a way to relax and induce sleepiness. Individuals who’d previously suffered from insomnia have reported that cannabis not only gives them the ability to sleep through the night, but makes it so that they don’t feel groggy in the morning—unlike many users of sleeping pills.

• Eating disorders
  It’s common for individuals to lose their appetites as they age (especially in conjunction with #7 on this list). Startlingly, a 2014 study by the CDC revealed that 78% of anorexia-related deaths were of seniors. It doesn’t have to be that way, though. It’s usually a punchline in a film, but the “munchies” is a real phenomenon. Cannabis can give seniors their appetite back, and allow them to enjoy food once more. 

• Depression and Anxiety
  There’s a rising epidemic among our assisted living population, and it’s not always obvious. Depression and anxiety, among other mental health disorders, can be crippling. As we age, and our bodies break down, it’s not surprising that our mental health takes a turn for the worst. Grappling with these changes is difficult, and can really take a toll on our inner lives. Many who are diagnosed with anxiety or depression may choose to go on antidepressants, but that’s not always the right course of action for everyone, considering the side effects that come along with it. Cannabis has been shown to improve people’s mood, and alleviate symptoms of both anxiety and depression, offering up a viable alternative psychiatric medications.

Things You Should Know

It’s understandable that people might be hesitant to try marijuana as a part of their treatment plan, but much of this leeriness is likely to stem from common misconceptions. Contrary to popular belief, marijuana will neither lower your IQ or cause brain damage. In fact, in the case of Alzheimer’s disease, cannabis has been shown to actually prevent brain cell death.

A lot of individuals are also concerned that cannabis is physically addictive. Unlike the opiates or sleeping pills that many seniors take, this is untrue. And, since there are hundreds of different “strains” of marijuana currently being cultivated, it’s easy to find relief without the high, depending on one’s personal preference.

Overall, and despite not being covered by medical plans, cannabis is safer and more cost effective than prescription drugs, while also coming in a wider variety of forms. While cannabis does exist in capsule form, many opt for one of the other methods of ingestion. In addition to smoking it, marijuana can be added to food and consumed (in the form of edibles), vaporized, rubbed into the skin, or taken orally in the form of droplets. The many different methods of receiving relief means that individuals can customize their personal treatment plans to suit their own physical needs and tastes.

Moving Forward

If one of the individuals in your care has recently expressed an interest in trying medical marijuana for themselves, the process of doing so is fairly straightforward, with countless resource online to guide them along the way.

That said, given that cannabis is still illegal on the federal level, insurance companies are hesitant to cover its use (or consultations specifically for its use). These does mean that all expenses will be out-of-pocket, though in the long run medical marijuana is often much less expensive than treatments traditionally covered by health plans.

We understand that marijuana, despite it being legal here in California, can be a controversial subject, but in the interest of furthering knowledge, we wanted to take the time to talk about the ways others are finding relief. Because ultimately, that education is what we are all about.