Geriatric Care Management

Why have a Geriatric Care Manager on your team? During a medical crisis, it is difficult to piece together the puzzle of needs, services, and options while enduring a difficult and emotional for Custodial Care is provided for in many ways. 

  • Your Moonlite GCM coordinates critical communication between you and medical professionals to insure continuity of care.

  • Your Moonlite GCM advocates for you to insure prevention of unnecessary hospitalization, duplication of services, and inappropriate placements.

  • Your Moonlite GCM insures your entire process is handled with quality control as set forth by the National Association of Geriatric Care Managers (N.A.P.G.A.M.) Standards of Practice and Pledge of Ethics.

  • Your Moonlite GCM will work with you to develop a Personalized Care Plan and assist with putting that plan into action.

  • Your Moonlite GCM will follow your families’ case all the way through end of life insuring the quality of care and personal needs are met according to current level of needs.

  • Your Moonlite GCM will work to insure quality of life and maximum potential for the senior to maintain independence and safety.

Placement Options for Seniors 

 Moonlite’s care managers provide you with a safe and easy way of finding home care. 

  • We will do a comprehensive Safety Evaluation of your home to identify possible ‘safety hazards’, then provide valuable suggestions to modify your home when needed. 

  • We will provide you with no-cost/low cost contractors to make the needed changes to ensure your safety, should home care be what you want. 

  • We help with finding screened non-medical personnel to help with your home care needs. This can be as simple as meal preparation, house-keeping chores, medication reminders, bathing, dressing transferring from chair or bed, stand by assistance when needed, transportation to doctors and errands or simple companionship.

After our assessment of your needs:

  • ​We will help develop a care plan that fits you and only you.

Our Geriatric Care Management team can also provide:

  • Medication management which care givers cannot do.

Below are descriptions of advanced long-term care options. They are all non-medical care choices, pertaining to your activities of daily living (ADL’s).

Custodial Care primary types are…

  • Non-medical In Home Care (care in your home)

  • Non-medical Assisted R.C.F.E. (care provided in Assisted Living and Board & Care Homes)

  • Non-medical Skilled Nursing or Convalescent Home (care provided in a sub-acute hospital)

  • Veterans Benefits Aid and Attendance Pension Plan (click on VA tab for more information)

  • In-Home Care

R.C.F.E. Residential Care Facilities for the Elderly

Residential care takes on two forms…The larger Apartment style living facility, also known as an "ALF" and the Board and Care facility or B&C. 

They are both:

  • Licensed under Title 22, with the same guidelines and regulations and are managed under the watchful eye of, Department of Social Services. 

  • All employees must have a D.O.J. background screen before working in either type of R.C.F.E. and both facility types are licensed through the state. 

  • There is no long term commitment and no long term contract to sign. These facilities are on a month to month 30 day notice agreement. 

  • All new residents must have a recent TB test or Chest X-ray and a Physicians Report for Residential Care Facilities for The Elderly RCFE (document required by the state) form LIC 602, which will be provide to you by our care managers when placement has been determined as the care plan. 

  • Both types of RCFE can take seniors through, End of Life issues as well, with a hospice waiver from the state.

  • Both offer several options for the seniors with Dementia’s/ Alzheimer’s as well depending on the stage the senior is in. From a mild dementia setting to the most severe, our care managers can help assess the level of need and guide you in the right direction.

  • All RCFE’s are private pay, Medicare do not pay for any care pertaining to issues surrounding Activities of Daily Living! Medi-cal does not pay for this type of custodial care. There are also certain restrictions regarding non allowable conditions in a RCFE as well, your geriatric care manager can explain these to you.

Assisted Living Facilities (ALF)

An Assisted Living Facility (ALF) offers:

  • Apartment style living for the more independent senior. 

  • There are common activity areas such as home theater rooms, libraries, and musical events, providing opportunities to socialize and meet new friends. 

  • Meals are provided in communal dining areas* Help with housekeeping and laundry is available along with varying levels of assistance for activities of daily living, (ADL’s) when necessary. This style of living is not for everyone, as it is most like living alone. The care plan set for each person is determined at the time of move in/assessment and in some cases some seniors are not appropriate for this type of setting. 

  • There is almost always a community fee which is non-refundable and is sometimes equal to or greater than the first month’s rent. 

  • Each new resident must usually provide their own furniture and ancillary supplies. 

  • There are buses that transport to doctors appointments and to local stores and events should the senior be capable of doing these things on their own. All in all it is a great place to start when things are being identified that need attention, and the senior is still independent enough to do most of their daily tasks themselves.

Board and Care (B&C)

This is the highest level in assisted living/custodial care. 

  • There are usually no more than about 6 residents, in a more intimate setting of a Residential Home with very personalized care and interaction.

  • Most of these Board and Care homes are in residential neighborhoods much like the one you live in. There could possibly be one on your street.

  • They have (on premises) live in care staff. Some are owner operated, and some have owners and hired caregivers. 

  • They provide the most intimate care a senior could need. With a caregiver ratio of 2 to 6 and sometime 3 to 6, you have more one on one contact. * Most homes have private bedrooms with a communal dining area, and living area. It is very much like going to a B&B. 

  • The meals are home cooked fresh and prepared with the dietary needs of the client in mind. 

  • The cost of these facilities usually includes all ancillary supplies and laundry and cleaning.

  • The care staff/administrators provide transportation to and from Doctors appointments and usually stay with the senior when family cannot be there. The higher needs senior would be best suited for this type of facility, although some couples with varying degrees of need like this setting to stay together. There are specialized smaller facilities as well, where depending on diagnosis, physical abilities and mental capacity and our care managers can help identify the appropriate board and care for their specific need.

Services At-A-Glance

  • Conduct assessments to identify problems and provide solutions by offering both short term and long term care plans. Conduct extensive safety evaluation of home should patient return there.

  • Referrals and set up of no-cost/low cost home modifications.

  • Screen, arrange and monitor non-medical in-home help or other services.

  • Provide short or long term assistance for absent caregivers (living near or far away).

  • Review financial, legal or medical issues and offer referrals to specialists in that field.

  • Crisis Intervention with family members where family dynamic is of concern.

  • Offer counselling and support to families in need.

  • Provide Nursing wellness checks, and Medication set up for home bound clients.

  • Act as liaison to families (near or far) overseeing care and quickly alerting families to problems, by working within the scope of a written care plan, and finding solutions that might possibly mean changing the care plan.

  • Assist with transitioning an individual to or from home to retirement, assisted living, residential care home, or a nursing home when identified that safety dictates the need.

  • Help with relocation, moving set up and cleaning for sale of a home.

  • Provide consumer education and advocacy.

  • Provide assistance with application and follow through on Veterans Aid & Attendance pension program.

Moonlite Services

Determining the best care options for yourself or senior loved one can be tricky.  It is best to have a well thought out care plan in order way before a crisis occurs. Moonlite Geriatric Care Managers team up with you, your family, and medical professionals to determine the best options for care.  Though the first option is always to try to keep the senior “Aging in Place” in their home there may come a time when advanced care needs require movement to a safer setting providing the appropriate level of care.

Below is a list of our services. Click on the link of the category that you are interested in reading about to learn about the subject in more detail.

(916) 698-6182

Toll Free Outside Greater Sacramento Area  (855) 754-5483

Fax (916) 723-9396


Aging in Place Workshops

We offer trained professionals that can visit your church, community group, or class to present a FREE special Aging in Place Workshop series that covers:

  • Geriatric Care Management

  • Medicare Home Health

  • Medicare Hospice

  • Finance and Veterans Benefits

  • Elder Law & Estate Planning

  • Skilled Nursing

  • Durable Medical Equipment

  • Non-medical In-Home care

Activities & Personal Visits

We are able to offer:

  • One-on-one socialization for home-bound seniors 

  • Personal Visits

  • Doctor's appointment transportation

  • And much more...

Fee Structure

Although most of the services we provide are free to the client and their families, there are some services that are fee based. Please ask the care manager about these charges during your initial free assessment.

Contact Info
Moonlite Geriatric Care Management
P.O. Box 194 Citrus Heights, CA 95611
Tel: (916) 698-6182
Fax: (916) 723-9396

Toll free outside the greater Sacramento area: (855) 754-5483


Respite Placement Services

Temporary care given in the client's home, at an R.C.F.E or skilled nursing center, in order to provide family care-givers with a ‘respite, time-off".  These stays can be anywhere from 2 days to 30 days, depending on the facility and needs of the person. Moonlite’s care managers can assist with placement or finding care givers for short durations.

Skilled Nursing Centers (SNF)

There is little information about Skilled Nursing Centers for seniors and their families, so we will attempt to explain the differences here. Skilled nursing facilities usually have two types of care. 

The first is Short term Skilled Rehab:

  • Paid for by insurance, Medicare, supplemental insurances etc.

  • These stays usually are precipitated by a ‘Three Day Qualifying stay’ in an Acute Care Hospital. Most times the senior has fallen and broken a hip or some other body part and they need surgery and then some ‘rehab’ to be able to do their activities of daily living with little or no assistance. When this happens, the hospital will set up your stay at the skilled nursing facility and you would be transferred to a SNF for a short term stay for physical therapy, occupational therapy or some other medical need. 

  • A short term stay is usually between 7 and 21 days. Once you have met the Medicare guideline criteria for independence with your ADLs, Medicare Stops paying, and you will be discharged to home or a community based facility i.e. the ALF or B&C. This is where Moonlite would work with you to discharge safely to home or RCFE. Skilled centers also do Long Term Custodial care, but in a different part of the building. This is when you are done with rehab services and you cannot go Home alone or to a RCFE. You would either pay privately (the Skilled center) or go on Medi-cal (low income supplement) and you would live in the skilled environment. Medicare Does Not Pay for this.

Skilled Nursing/ Long Term Convalescent Care (not to be confused with Short term Skilled Nursing Rehab)

Most people think (thought) that this is the only type of facility to go to when Custodial Care is mentioned…Including most Doctor’s and nurses in hospital settings. They don’t realize that the RCFE has taken great strides with the levels of care they can provide and the fact that the cost is significantly less than that of the skilled facilities. Traditionally this was the only place seniors had available when their care at home was too much for their loved ones. But about 18 years ago R.C.F.E.’s came into being and the convalescent home has become less used for the care of seniors who have no medical needs and more of a place for seniors needing some sort of Medical management, i.e. regular injections, feeding tubes, breathing tubes, etc…or where income restraints don’t permit placement into RCFE or in home care…

Independent Living Facilities (for seniors)

Moonlite’s care managers realize that all seniors don’t always need in-home care, an assisted living facility, or that some seniors just don’t want ‘strangers in their home’. For these spry seniors, who may only need regular meals or housekeeping there is another choice.

  • Some senior complexes provide lovely apartments for seniors

  • 2 to 3 meals a day

  • Housekeeping services

  • Transportation to stores and doctors appointments. 

This can be an excellent way to provide the basics without giving up independence. Some seniors and their families opt to make this a first step, where the senior can start to down size and adapt to another style of living. Because they are so similar to Assisted Living communities, when the need for assisted living becomes apparent, the senior has an easier time with that transition. In fact quite a few assisted living communities have both Independent and Assisted, which makes the transition even easier. Moonlite’s Care Managers can assist with placement into these communities as well. Please speak with your care manager about this option.

Hospice Placement and Coordination Services

Hospice is a program offered to all senior who are on Medicare, and who meet the criteria. Most people are afraid to address the issues surrounding End of Life planning. Our Geriatric Care managers are trained in Hospice Medicare guidelines and in identifying patients who meet criteria for the Hospice benefit. 

When your Care Manager sets up a care plan with you, they will: 

  • Ask you about your end of life plan

  • Explain your benefits and rights pertaining to Medicare.

  • They can also coordinate benefits with your doctor to get this process started should it be the right time to do so.your family.  

You will need someone on your team that knows how all the pieces of this puzzle fit together and exactly how to get exactly what your family needs. 

VA Benefit Assistance 

Did you know that there are financial benefits available for veterans and/or their surviving spouses that will help pay for Assisted Living facilities, Board & Care homes, and In-Home care?

The Veterans Aid & Attendance pension program was established in 1954 under section 38 USC, to assist qualified veterans, and or their surviving spouses, to receive financial benefits outside the traditional Veterans residential system.  This is a mandatory pension and is not subject to partisan spending or discretionary Federal budget cuts.  Whether you are considering a move into a senior community, or need help staying at home, your military service could qualify you for significant benefits.  Your Moonlite Geriatric Care Manager can assist you with completing the paperwork and submitting it to insure the approval process goes smoothly.  Be sure to let us know of your veteran status.

Photo Credit - Patrick Doheny


  • Seniors Rights

  • Medicare guidelines

  • APS (Adult Pretection Services )

  • Veterans Benefits

  • Medi-cal benefits

Photo Credit – David Shankbone
Photo Credit – Jaynie Guarnieri Dame
Photo Credit – Jaynie Guarnieri Dame