Residential Care Facilities

What is a Residential Care Facility?

Residential care facilities are small private accommodations, usually with 20 or fewer residents (though some might house as few as three or four people) that are staffed around the clock, delivering non-institutional, home-based services to seniors who do not need 24- hour nursing care. In addition to providing meals, these facilities offer personal care assistance with such activities as grooming and toileting. 

In California, Residential Care Facilities for the Elderly (RCFE) serve people 60 and older. They provide room, board, housekeeping, supervision, and personal care assistance with basic activities like personal hygiene, dressing, eating, and walking. Facilities usually store medications centrally and distribute them to residents to self-administer.

This level of care and supervision is for those who are unable to live by themselves but who do not need 24-hour nursing care. They are considered non-medical facilities and are not required to have nurses, certified nursing assistants or doctors on staff. Other terms for this level of care are Assisted Living Facilities (ALF), board and care homes, rest homes and Continuing Care Retirement Communities (CCRCs) that provide personal care and supervision.

RCFEs or ALFs must meet care and safety standards set by the state and are licensed and inspected by the Department of Social Services, Community Care Licensing (CCL).

Residential care facility terminology can vary depending by state. For instance, the term “board and care home” is often used in California. Other names include Residential Care for the Elderly (RCFE), personal care home, sheltered housing, homes for adults, domiciliary care, adult foster care or senior group homes. Although some states broadly define residential care to include assisted living, and there isn’t always a noticeable regulatory difference between the two, an assisted living community is considered by many to be a distinct form of senior living.

Many residential care facilities are former single-family residences located in suburban neighborhoods that were converted into multi-unit dwellings and equipped and adapted for seniors. Rooms may be private or shared, while bathrooms, living and dining rooms are shared. 

No Nursing Staff

As far as medical care goes, residential care facilities may offer residents medication management, as well as help scheduling and keeping medical appointments. These facilities, though, do not typically keep nurses or certified nursing assistants on staff. 

Limited Recreational Activities

RCFs provide access to limited recreational activities like bingo games or movie nights. They may also use community resources such as adult day care programs for their residents. 

A residential care facility is likely to be a less expensive alternative to an assisted living community. 

Other Senior Housing Facility Types

Intermediate-Care Facilities (ICFs)

ICFs provide room and board along with regular medical, nursing, social and rehabilitative services for people not capable of full independent living.

• Regulation – licensed and Medi-Cal and/or Medicare certified by the California Department of Public Health (CDPH)
• Payment – funded primarily by Medi-Cal, with additional funding through Medicare and/or private payment

Intermediate Care Facilities for the Developmentally Disabled (ICFs/DD)

Known at the federal level as ICFs/MR (mental retardation), these facilities provide services for people of all ages with mental retardation and/or developmental disabilities. ICF/DDs have 16 or more beds. 

ICF/DD-H (Habilitative) and -Ns (Nursing) have 15 or fewer beds and average six beds in a home setting. 

ICF/DD-CN (Continuous Nursing) is a 10-facility waiver pilot program providing licensed vocational or registered nursing on a 24-hour basis for 4-15 clients in a home-like community-based setting.

• Regulation – Licensed and Medi-Cal-certified by CDPH. The Department of Developmental Services and Regional Centers are responsible for placement and quality assurance.
• Payment – Nearly 100% Medi-Cal funded.

Institutes for Mental Health (SNFs/STP)

Designated in California as “special treatment programs,” these facilities provide extended treatment periods for people of all ages with chronic mental-health problems. Many of the clients are younger than 65. Specialized staff serve clients in a secured environment.

• Regulation – Licensed and Medi-Cal-certified by CDPH. Local mental health departments are responsible for placement and program content.
• Payment – A combination of state and county funding.

Home and Community-Based Care

Adult Day Health Care (ADHC)

ADHCs provide some medical care, as well as physical, occupational and speech therapy.

• Regulation – Licensed and Medi-Cal-certified by CDPH. These programs also receive oversight from the Department of Aging.
• Payment – Primarily Medi-Cal.

Community Care Facilities

Community care facilities also includes Residential Care Facilities for the elderly (RCFE) and Adult Residential facilities (ARFs).  ARFs may serve persons with developmental disabilities who are clients of regional centers via the Home and Community Based Services Waiver.

• Regulation – Licensed by the Department of Social Services, Community Care Licensing Division.
• Payment – Funding through the home and community-based Medi-Cal waiver program. Regional Center funding for the developmentally disabled, or private pay.

Congregate Housing

Housing with a common living area and non-medical support services, meeting the basic needs of older people.

• Regulation – Dept of Social Services, Community Care Licensing Division.
• Payment – Grants provided through the Federal Government (Housing & Urban Development). Some funding through SSI/SSP for those eligible.