What followed was a nine-month struggle that exposed a stark gap in how the state’s Medi-Cal program treats older adults depending on where they live — a gap that ultimately led to a new pilot program aimed at giving rural Californians more say in how and where they age.

John had moved back to the ranch to help his sister with daily tasks like bathing and dressing, but caring for her while also managing the property and his own work as a writer became unsustainable. The siblings agreed that Roselie, who qualifies for Medicaid, should transition into assisted living.

That’s when John discovered a frustrating reality: Medi-Cal does not fund assisted living care in Siskiyou County — or in 42 other counties across California. Only 15, mostly in urban areas, offer that option through what’s known as an assisted living waiver.

The disparity leaves many rural seniors with only one real alternative: a nursing home, even when their needs don’t require that level of institutional care, simply because they cannot afford to pay for assisted living privately.

“You’re wasting money by dumping somebody like my sister in a skilled nursing facility and lessening her quality of life and her chance at doing better,” John said. “By doing this, it makes no fundamental sense.”

**A statewide problem coming into focus**

California is bracing for a dramatic shift in its population — within a decade, one in four residents will be over 60. State officials have said they want to help older adults age in their own communities rather than in institutions. But whether that promise is fulfilled often depends on which managed care organization administers Medi-Cal benefits in a given county, and what services that plan chooses to offer.

Roselie is covered by Partnership HealthPlan, the dominant Medi-Cal managed care provider across a swath of Northern California, serving nearly a million residents. In 15 counties, it’s the only option available to Medi-Cal enrollees.

According to the California Department of Health Care Services, managed care organizations are “encouraged” — but not obligated — to offer optional benefits known as community supports, which can include help with the cost of assisted living, temporary rental assistance, respite care and in-home personal care. These fall under CalAIM, the state’s sweeping effort to modernize Medi-Cal. Even after related waivers expire at year’s end, these community support benefits are expected to continue.

Dustin Lyda, a spokesperson for Partnership, said the plan opted not to include an assisted living benefit due to cost concerns and a shortage of qualified facilities in the rural communities it serves. Any change, he said, would require evidence that assisted living leads to better outcomes than nursing homes. Still, he acknowledged the shortcomings.

“There’s definitely a lot more work that we need to do on our end to navigate the more rural areas,” Lyda said.

Maura Gibney, executive director of California Advocates for Nursing Home Reform, said the lack of options compounds an existing shortage in rural regions.

“There’s not a lot of options to begin with in rural counties,” Gibney said. “You take (the assisted living waiver) off a table, which already has a history of a long waiting list, and the options are pretty bleak.”

**Fighting for a place close to home**

John initially assumed his sister would have to leave Siskiyou County altogether, since it offers just one Medi-Cal-approved facility — a nursing home. Roselie had previously stayed at an assisted living facility in neighboring Shasta County and felt at home there, but Partnership doesn’t cover assisted living costs in that county either.

The plan instead offered to place Roselie in Sonoma County — roughly five hours from the family ranch. The Aiellos refused, worried the distance would cut Roselie off from the relatives she relied on for emotional support.

“If you remove her totally from a family contact, she would not be thriving right now. She needs to see family,” John said. “When there were resources available that fit her needs in Redding — that’s the closest point to her home county — why do I need to move her to Oakland, to Los Angeles, to San Diego?”

For nine months, John pushed back — sending emails, making calls, and enlisting Roselie’s doctor to advocate on her behalf, all while trying to secure her a spot at the Shasta County facility. The process took a toll on both of them.

“He was doing all of this to help me,” Roselie said. “Where was it going to end?”

**A system with built-in gaps**

Advocates say most people would rather remain in community settings than move into nursing homes, which tend to be significantly more expensive to operate. But nursing home capacity is limited and should be preserved for people who genuinely need round-the-clock medical supervision, Gibney said.

“We really try to help people look at the other options that exist for remaining in the community,” she said. “You’re going to have better health outcomes, better quality of care, if you can stay in the community and out of an institutional setting.”

Still, the picture isn’t entirely one-sided. Dr. Kenneth Lam, a geriatrician and assistant professor at the University of Colorado Anschutz Medical Campus, noted that people in assisted living are sometimes hospitalized more often than nursing home residents, which can offset some of the anticipated savings.

“The evidence suggests that it’s a trade-off,” he said.

State officials confirmed that managed care contracts aren’t competitively bid, and plans aren’t required to offer specific community supports like assisted living assistance as a condition of their contracts.

“Whether a plan chooses to provide specific community supports is not a factor in contract renewal, which focuses instead on overall compliance with state and federal performance standards,” said Tessa Outhyse, a spokesperson for the Department of Health Care Services.

Partnership’s state contract, originally set to expire in December, has been extended to 2029 after California delayed its broader process for awarding managed care contracts. Lyda said demand for community supports, including requests for assisted living help, has been rising steadily. But even in counties where such benefits exist, waitlists can stretch on for months.

Statewide, the number of new enrollees approved for an assisted living waiver actually declined at the start of 2025, even as the waitlist kept growing. By September, more people were waiting for a waiver than were actually receiving one.

Gibney said the sequence itself can be part of the problem — many Medi-Cal recipients are advised to join the waitlist before they’ve even applied for the funding, adding to the delays. Some spend months waiting only to learn they don’t qualify.

“It’s a lot of shifting sand, that’s what people are finding themselves in the middle of,” Lam said. “They’re being told that they get to choose, but it’s a complex choice.”

**A new chapter for Roselie**

In March, Roselie finally moved into Sundial Assisted Living in Shasta County — the very facility she and John had hoped for from the start. Two months earlier, Partnership had agreed to cover her care, offering her a spot in a new pilot program launched July 1 that expands assisted living access to select members of its network. There’s no formal application process; eligible members are referred through healthcare providers or can request consideration directly.

The pilot is designed to test whether expanding assisted living coverage leads to better health outcomes and lower costs overall.

“Success would also be having these individuals being able to continue to receive care within their community setting, being in their home,” Lyda said. “We know that that is more impactful to health than being completely taken out of a familiar area.”

The transition hasn’t been simple for Roselie, who has been hospitalized twice since moving to Sundial and spent a brief stint back in a nursing home. But socially, she has flourished — making new friends, teaching card games to fellow residents, and receiving visits from caretakers and neighbors during her hospital stays.

“I’m looking at it like this: It’s a new adventure,” she said.

John remains uneasy about his sister’s health and whether Sundial will be a lasting solution. He’s relieved the fight paid off, but still troubled that it took so much effort to get there.

“I don’t understand why I was the guy fighting for everybody,” he said. “I’m just one person trying to support myself, trying to take care of a family member.”

Original source: CalMatters

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U.S. President Joe Biden and China’s Xi Jinping will meet at a historic country house and museum with lavish gardens for one-on-one talks aimed at improving relations between the two superpowers. The two leaders will meet Wednesday at Filoli, a secluded estate along Northern California’s coastal range.

It was built in 1917 as a private residence and later became a National Trust for Historic Preservation site. The estate is about 25 miles (40 kilometers) south of San Francisco, where leaders are gathering for the Asia-Pacific Economic Cooperation leaders’ conference this week.

The location for the meeting was disclosed by three senior administration officials who spoke on condition of anonymity to discuss a matter with security implications. Bonnie Glaser, managing director of the Indo-Pacific program at the German Marshall Fund, said the location likely has met Xi’s expectations for a private meeting with Biden away from the main summit venue. “It appears to be a quiet, secluded estate, where Biden and Xi can have an intimate conversation in a relaxed environment,” Glaser said. “Importantly, the venue is not connected to the APEC summit, so it provides the appearance that the two leaders are having a bilateral summit that is distinct from the multilateral APEC summit.”

Observers of China’s elite politics have said Xi wants to project himself to his domestic audience as equal with Biden and as commanding the respect of a U.S. president. The estate has more than 650 acres (2.6 square kilometers), including a Georgian revival-style mansion and a formal, English Renaissance-style garden.

The mansion and grounds are open daily, but the site is currently closed for three days for holiday decorating, its website says. “A place like this allows them to get away, not just from the media, but from a lot of the other things that encourage conflict,” said Jeremi Suri, a professor of public affairs and history at the University of Texas at Austin. “If they like each other, they are likely to start trusting each other and to communicate better.” Suri says this is what happened with U.S. President Ronald Reagan and Mikhail Gorbachev, the last leader of the Soviet Union before it was dissolved.

The two met at a secluded chateau in Reykjavik in 1986, sat by a fireplace and walked outdoors wearing heavy coats, forging a relationship, Suri said. “We need leaders who can break through the fear,” he said. San Francisco socialite William Bowers Bourn II named Filoli by taking the first two letters of key words of his personal credo, according to the estate’s website: “Fight for a just cause. Love your Fellow Man. Live a Good Life.”

The venue is available for private events, weddings and commercial filming and photography. The gardens feature in Jennifer Lopez’s film “The Wedding Planner.”

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SAN FRANCISCO (AP) — U.S. President Joe Biden and China’s Xi Jinping will meet at a historic country house and museum with lavish gardens for one-on-one talks aimed at improving relations between the two superpowers.

The two leaders will meet Wednesday at Filoli, a secluded estate along Northern California’s coastal range. It was built in 1917 as a private residence and later became a National Trust for Historic Preservation site. The estate is about 25 miles (40 kilometers) south of San Francisco, where leaders are gathering for the Asia-Pacific Economic Cooperation leaders’ conference this week.

The location for the meeting was disclosed by three senior administration officials who spoke on condition of anonymity to discuss a matter with security implications.

Bonnie Glaser, managing director of the Indo-Pacific program at the German Marshall Fund, said the location likely has met Xi’s expectations for a private meeting with Biden away from the main summit venue.

“It appears to be a quiet, secluded estate, where Biden and Xi can have an intimate conversation in a relaxed environment,” Glaser said. “Importantly, the venue is not connected to the APEC summit, so it provides the appearance that the two leaders are having a bilateral summit that is distinct from the multilateral APEC summit.”

Observers of China’s elite politics have said Xi wants to project himself to his domestic audience as equal with Biden and as commanding the respect of a U.S. president.

The estate has more than 650 acres (2.6 square kilometers), including a Georgian revival-style mansion and a formal, English Renaissance-style garden. The mansion and grounds are open daily, but the site is currently closed for three days for holiday decorating, its website says.

“A place like this allows them to get away, not just from the media, but from a lot of the other things that encourage conflict,” said Jeremi Suri, a professor of public affairs and history at the University of Texas at Austin. “If they like each other, they are likely to start trusting each other and to communicate better.”

Suri says this is what happened with U.S. President Ronald Reagan and Mikhail Gorbachev, the last leader of the Soviet Union before it was dissolved. The two met at a secluded chateau in Reykjavik in 1986, sat by a fireplace and walked outdoors wearing heavy coats, forging a relationship, Suri said.

“We need leaders who can break through the fear,” he said.

San Francisco socialite William Bowers Bourn II named Filoli by taking the first two letters of key words of his personal credo, according to the estate’s website: “Fight for a just cause. Love your Fellow Man. Live a Good Life.”

The venue is available for private events, weddings and commercial filming and photography. The gardens feature in Jennifer Lopez’s film “The Wedding Planner.”

Find your latest news here at the Hemet & San Jacinto Chronicle

The post Lush, private Northern California estate is site for Xi-Biden meeting appeared first on The Hemet & San Jacinto Chronicle.

SAN FRANCISCO (AP) — Fire crews from across the state were being deployed to Northern California, where hot, windy conditions Wednesday renewed the threat of fire in the region where massive blazes already have destroyed hundreds of homes and killed or injured dozens of people this year.

Most of the huge fires that erupted over the past eight weeks are now fully or significantly contained and skies once stained orange by heavy smoke are blue again. Containment means that firefighters have lines holding in a fire, though it doesn’t mean a fire has stopped burning.

But the gains made by thousands of firefighters assigned to the blazes that have scorched more than 4.1 million acres this year could be hampered if new fires ignite, said Daniel Berlant, assistant deputy director with the California Department of Forestry and Fire Protection, known as Cal Fire.

“If a new fire breaks out, that fire will be able to grow very quickly under these conditions,” Berlant said.

The National Weather Service issued a red-flag warning for extreme fire danger from 5 a.m. through Friday morning. With bone-dry humidity and wind gusts possibly hitting 55 mph, Pacific Gas & Electric, the largest utility in the nation, warned that it may cut power starting Wednesday evening to as many as 54,000 customers in 24 counties.

Preemptive electricity cuts are a strategy aimed at preventing fires from being started by power lines that have been damaged or knocked down amid high winds. PG&E equipment sparked several massive blazes that destroyed tens of thousands of homes and killed more than 100 people since 2017.

“We really view it as a last resort option,” said Mark Quinlan, the company’s incident commander.

The utility also has deployed generators and other measures to keep electricity flowing in some areas that might loose power during the outages, Quinlan said.

About 33,000 homes and businesses could begin losing power at 6 p.m., mainly in the Sierra Nevada foothills and northern San Francisco Bay Area, followed by 21,000 other customers two hours later in other portions of the Sierra and the Bay Area, along with portions of California’s central coast, PG&E said.

The figures for affected customers range from more than 11,300 in Butte County, 6,000 in Santa Cruz County and around 5,400 customers in Alameda County, according to the utility.

Denise Bethune lost her home of 12 years last month after a blaze razed her tiny foothills community of Berry Creek, about 160 miles (260 kilometers) northeast of San Francisco in rural Butte County. The night before, PG&E cut off power and she and her husband couldn’t use their well to get water and hose down their home.

Bethune, who has multiple sclerosis, said cutting power is a double-edged sword because it can help prevent fires from starting but it causes other issues.

“Whenever there is a power outage, my main concern is the heat because I can’t handle it without air conditioning due to my medical needs,” she said.

Since being displaced, Bethune, her husband and three dogs have been living in a trailer they parked on her son’s orchard near the city of Chico that has its own power source.

All power should be restored by late Friday night, the utility said.

The outages would include regions already hit by massive wildfires this year and in recent years. The Glass Fire that ravaged the Northern California wine country of Napa and Sonoma counties was surrounded Wednesday after destroying more than 1,500 homes and other buildings.

PG&E said it could cut power to more than 9,200 customers in Napa and around 1,800 in Sonoma.

Farther north, the Zogg Fire in Shasta and Tehama counties was fully contained. Four people died in that blaze. PG&E said nearly 6,000 customers could lose power in Shasta and Tehama counties.

More than 8,500 wildfires have burned more than 6,400 square miles (16,000 square kilometers) in California since the start of the year, most since mid-August. Thirty-one people have died, and more than 9,200 buildings have been destroyed.

Numerous studies have linked bigger wildfires in America to climate change from the burning of coal, oil and gas. Scientists have said climate change has made California much drier, meaning trees and other plants are more flammable.

PG&E said last month that it is using smarter and shorter power shutoffs after receiving widespread criticism from the public and regulators last year when it turned off electricity to 2 million people to prevent its equipment from sparking wildfires.

PG&E’s aging equipment sparked the deadly 2018 fire that destroyed much of the town of Paradise and killed 85 people.

The utility pleaded guilty in June to 84 felony counts of involuntary manslaughter — one death was ruled a suicide — and paid $25.5 billion in settlements to cover the losses from that and other recent power line-sparked catastrophes.

Expert say nine out 10 wildfires are caused by people either accidentally or deliberately. On Tuesday, federal prosecutors said they charged Eric Michael Smith, 38, of Redding, with arson in several fires set on federal land.

According to court documents, Smith set four fires in the Shasta-Trinity National Forest between June 23 and July 29. The blazes were quickly extinguished. If convicted, Smith faces up to five years in prison and a $250,000 fine.

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