Residential Care Facilities for the Elderly (RCFE) Facilities in California (Previously called Board and Care Homes)

March 12, 2012 California Senior News

Small, private, residential care facilities for the elderly, licensed for 6 or less individuals, are one of the most popular and friendly senior care solutions in California.  Of all the residential care facilities in California, over 90 percent, are of the private single-family home variety.  These facilities have the advantage of offering personal care services to elderly or disabled individuals in private, state-monitored and licensed, neighborhood single-family homes that offer a more personal and homelike atmosphere for their clients. These homes generally provide non-medial custodial care – most not offering such services as injections, catheters or colostomy care unless licensed for and appropriate staff is maintained for such services.

Residential Care Facility Offering Medical Care

There are cases where these small homes offer medical services dependent on the severity of the medical condition(s) and whether the facility meets the state licensing standards for restrictive health conditions.  If a licensed LVN or RN nurse is on staff in the private home where care is given, then the home is able to offer limited medical care for such things as injections, catheters or colostomies, but the majority of facilities do not maintain such skilled nursing employees.

There are some patients with medical conditions that are not allowed to be cared for in a Residential Care Facility for the Elderly in California.  Such serious medical conditions that require continuous skilled monitoring and attention such as bedsores or tube feeding are out of the scope of care for these facilities.

Above and beyond these issues, it is important to check the facilities license  to see if the operators have a non-ambulatory care waiver (service to individuals requiring help leaving the facility in an emergency) or hospice care waiver (dealing with end-of-life care), to facilitate these type of patient needs.

Same Licensing Criteria as Larger Facilities

In California, the same regulations and licensing criteria apply to these private homes as do the larger facilities that offer assisted care living in the state of California.  All of these facilities are licensed and supervised by the California Department of Social Services, Community Care Licensing Division.

The Difference between Residential Care Facility for the Elderly and an Assisted Living
Facility

As far as licensing is concerned in the State of California, there is no difference. Facilities that define themselves as “assisted living” and that offer personal care and supervision are licensed as Residential Care Facilities for the Elderly (RCFE). Residential Care Facilities for the Elderly are typically neighborhood, single family homes with shared rooms to six or fewer individuals.

Assisted Living Facilities typically refer to apartments or multi-unit buildings in larger, corporate owned facilities with upwards of 100 beds or more.  These facilities may offer various fee options depending on the level of care needed. There may be graduated care offered at the facility with various levels of freedom-of-living and care depending on the patient’s needs and the aging-cycle limitations.  Many times, the term “Assisted Living” is used to describe a marketing model of care with the client’s ability to choose among different levels of care service plans.  This is also commonly referred to as “aging-in-place.”

More Affordable and Homelike Environment

Private, neighborhood residential care homes have become more popular over the last several decades due to the fact they are more affordable than larger, more impersonal senior and disabled care facilities in the state.  Given the fact that care is provided at these facilities in a homelike setting, tends to create a more comfortable, safe feel while empowering a senior or disabled person’s dignity, independence and decision making ability.

History of Home-based Residential Care Homes in California

Home-based, private residential care facilities in the state of California were initially named Board and Care Homes.  It was not until the early 70’s, as additional bed requirements were needed, the idea of non-institutional, home-based private care homes came to light.  These private homes would offer a better solution to the large institutions in many ways.  With escalating care costs, the thought was providing elderly and the developmentally and mentally disabled with a less expensive and more personal and homelike care facility. Although the name Board and Care Homes is still occasionally used today, these private homes are properly labeled RCFE’s (residential care facilities for the elderly) by the State of California.

Alzheimer’s and Dementia Care at RCFE’s

Some facilities offer special services to persons with Alzheimer’s disease and dementia if they meet certain licensing requirements. It’s important to check if the facility has experience in providing dementia care and meets all of the state licensing standards to provide dementia or Alzheimer’s care. These small and personal facilities throughout the state can be ideal for Alzheimer’s and dementia patients as the setting and care tends to not be as impersonal, large and overwhelming to these memory-challenged patients.   The fact that a small patient clientele of fewer than 6 is maintained in a RCFE’s home and that the typically limited caregiver’s faces are familiar helps promote a sense of safety and assists in limiting the mental load on a dementia or Alzheimer’s patient.  This tends to foster more normalcy and consistency, thereby reducing patient stress and anxiety levels.

Activities at RCFE’s

Although there may be more limited activities in these smaller facilities than the large institutions, the use of community resources such as social day care programs are typically encouraged and help provide stimulation and socializing activities for these patients in RCFE homes.

Costs of RCFE’s in California and Who Pays

For the small, residential senior and disability care homes, the cost savings are significant.  Most senior and some disabled individuals do not require the advanced care of a full-service nursing home.  Typically, RCFE’s will cost approximately half that of a full nursing home institution.  While the prices vary depending on each individual’s care needs, home’s attributes, city, neighborhood location and general niceties, or whether the room is a private or shared room, monthly costs can be anywhere from $1500 to $3000 or more a month with an average cost of $2500 a month.  Some of the more elegant and full-featured homes with high-end meals and comprehensive program and activity involvement can cost as much as $5000 a month.  Specialty services involving dementia or Alzheimer’s patients will typically cost more.

Supplemental Security Income and Small Care Homes

Most individuals must pay privately for their care in these homes.  If the person has long-term care insurance, they may be covered but typically this is only a small percentage of patients.  For those on Supplemental Security Income (SSI), only a few of the facilities licensed for 6 of fewer patients will accept these individuals unless there is additional supplementation from family members of a few hundred dollars a month for their services.  Medi-Cal, in most cases does not pay for this type of residential care but has a pilot program in certain counties of California called the Assisted Living Waiver Pilot Project (ALWPP).  But this is currently limited to a few counties such as Fresno, Los Angeles, Riverside, Sacramento, San Bernardino, San Joaquin and Sonoma Counties.  One of the main purposes of the pilot program was to enable low-income, Medi-Cal eligible seniors and/or persons with disabilities, who would otherwise require nursing facility services, to remain in or relocate to the local community. The program was approved by the Centers for Medicaid and Medicare and was converted into a five-year federal waiver program as of March 1, 2009.