When living at home stops working, families often start with a list of nearby “assisted living” names and a few brochures. In California, most of those places hold the same type of licence, whether they are a large community with a dining room and a bus or a six-bed house on a residential street. Understanding that licence is the fastest way to compare them, and the state publishes much of what you need to know about each one for free.
This guide explains how Residential Care Facilities for the Elderly work in California, how to research one before you visit, and what to look for in the paperwork. It is general information, not legal advice.
What an RCFE Is
A Residential Care Facility for the Elderly (RCFE) is a home or community that provides housing, meals, help with daily activities and supervision to adults, generally aged 60 and over. RCFEs are licensed by the Community Care Licensing Division of the California Department of Social Services, under the California Residential Care Facilities for the Elderly Act and the regulations in Title 22 of the California Code of Regulations.
The same licence covers very different settings:
- Board and care homes, sometimes called residential care homes, are usually ordinary houses licensed for a small number of residents, often six or fewer. Staff-to-resident ratios can be favourable, and the setting is domestic, but activities and amenities are limited.
- Assisted living communities are larger buildings with apartments, common areas, scheduled activities and more staff, but each resident may get less individual attention.
- Memory care is not a separate licence. It usually means an RCFE, or a section of one, that advertises dementia care. Facilities that do must meet additional requirements for staff training, environment and disclosure.
What an RCFE Is Not
An RCFE is non-medical care. It is not a skilled nursing facility, and that limit shapes who it can accept and keep.
- Staff help with daily living: bathing, dressing, toileting, eating, moving around, and help with medications the resident takes themselves.
- Medical care is limited. Some health conditions can be managed in an RCFE only under specific conditions, often with an outside nurse or home health agency visiting. Others, such as needing round-the-clock skilled nursing, generally mean the person cannot stay.
- Hospice can come in. With the required approval, a resident receiving hospice care can usually remain in the facility, which matters for families who want to avoid a final move.
Ask every facility, in writing, what conditions would require a resident to leave. That is the question families most often wish they had asked.
Research Before You Visit
The Community Care Licensing Division runs a free facility search on the Department of Social Services website. For each licensed facility you can generally see:
- Licence status and licensed capacity, and who holds the licence.
- Inspection and complaint visit reports, with the dates of visits and what the licensing analyst found.
- Citations, which are classed by seriousness. A Type A citation relates to an immediate risk to residents’ health, safety or rights; a Type B citation relates to a potential risk.
How to read them:
- Look for patterns, not single items. One citation for a missing record is different from repeated citations for staffing, medication errors or unexplained injuries.
- Read substantiated complaints closely. They show what happened and how the facility responded.
- Check the dates. A problem from several years ago that was corrected is different from one last month.
- Confirm the licence matches the place. The address and capacity on the licence should match what you are being shown.
You can also ask your county’s Long-Term Care Ombudsman program, which visits RCFEs, whether there is anything about a facility a family should know. The ombudsman cannot recommend a facility, but can explain residents’ rights and what to look for.
What to Ask on the Visit
Visit more than once, including at a mealtime and, if you can, in the evening or at a weekend, when staffing is often thinnest.
- Who is on duty overnight, and are they awake? Ask how many staff cover how many residents at night.
- How are medications handled? Who sets them up, who gives them, and how errors are recorded.
- What training do caregivers have, particularly for dementia if that applies?
- How are care needs assessed, how often is the assessment repeated, and how does the price change when needs increase?
- What happens after a fall? Ask about the procedure and how families are told.
- What does the facility do when a resident’s needs exceed what it can provide? Ask how much notice is given and what help the facility gives with finding a new placement.
- Talk to residents and families you meet, and notice whether residents are engaged or simply parked in front of a television.
The Admission Agreement
California requires an RCFE to use a written admission agreement. Read the whole document before signing, and ask for changes in writing if something is unclear. Look for:
- What the basic rate includes, and which services cost extra. Care is often priced in levels or points, and moving up a level can raise the monthly cost substantially.
- How and when rates can rise. The law requires advance written notice of rate increases; the agreement should state the notice period.
- Refunds, including what happens to prepaid fees if the resident moves out, goes into hospital or dies.
- The reasons and process for eviction. An RCFE may end an admission only for reasons the regulations allow, and with written notice. A clause giving the facility broad discretion is worth questioning.
- Who is signing and in what capacity. If you sign for a parent, sign as their agent under a power of attorney, not as a personal guarantor, unless you intend to be personally responsible for the bill. Our guide to power of attorney and conservatorship explains the documents.
- Arbitration clauses. Some agreements ask residents to give up the right to go to court. In general, agreeing to arbitration should not be made a condition of admission; ask whether it is optional.
How Families Pay
Most RCFE care in California is paid privately, and costs vary widely by region, setting and care level. Monthly costs in the range of several thousand dollars are common, with memory care usually higher. Ask each facility for its full rate sheet.
Other sources to check:
- Long-term care insurance. Many policies pay for care in a licensed RCFE. Our guide to long-term care insurance claims explains benefit triggers and how to file.
- Medi-Cal’s Assisted Living Waiver. In participating counties, the Assisted Living Waiver (ALW) can pay for care services in a participating RCFE for eligible Medi-Cal members, though the resident usually still pays room and board, and there has often been a waiting list. Our guide to Medi-Cal waivers beyond IHSS covers how to apply.
- SSI and the state supplement. A resident on SSI living in a licensed board and care home may receive a higher combined SSI and State Supplementary Payment amount set for non-medical out-of-home care, and many small homes accept that payment as the full monthly rate. Ask the facility directly whether it does.
- Veterans’ benefits. A veteran or surviving spouse who needs help with daily activities may qualify for a pension with an Aid and Attendance addition that can help pay for care. A county veterans service office can help with the application at no charge.
- Medicare does not pay for room, board or personal care in an RCFE. It continues to cover doctors, hospital care, hospice and qualifying home health visits.
When You Are Not Sure a Move Is Needed
A move is often triggered by one crisis, such as a fall or a hospital stay, rather than by a settled decision. If the person wants to stay at home and the need is mainly help with daily activities, more hours of in-home care may be an option worth pricing against a facility. IHSS, respite programs and private caregivers can sometimes cover the gap. Our guides to respite care and the first week after a hospital discharge set out those options.
Finding a caregiver for the particular hours a family needs is often the hardest part of keeping someone at home. Care Royal (from the same team as Unified Savers) is building a marketplace where families and independent caregivers can find each other directly. It is at the waitlist stage and not yet open for bookings, so for care needed now, licensed home care agencies, the county IHSS office and your local Area Agency on Aging remain the routes available today.
When Something Goes Wrong
- Raise it with the administrator in writing first, and keep a copy.
- Contact the Long-Term Care Ombudsman. Ombudsman representatives advocate for residents of RCFEs and nursing homes and can investigate complaints. The statewide CRISISline, 1-800-231-4024, is answered at all hours.
- File a complaint with Community Care Licensing. Anyone can complain to the regional licensing office about a facility, and complaints can lead to an unannounced visit and a published finding.
- Report suspected abuse or neglect. In an RCFE, suspected abuse is reported to the ombudsman or local law enforcement. Our guide to Adult Protective Services and mandated reporting explains who must report and how.
The Short Version
Assisted living and board and care homes in California are usually both RCFEs, licensed by the Department of Social Services to provide non-medical care. Look up each facility’s inspections and citations on the state’s free facility search before you visit, ask in writing what would require a resident to leave, read the admission agreement for rate increases, refunds, eviction terms and arbitration, and sign as an agent rather than a guarantor. Long-term care insurance, the Assisted Living Waiver, SSI and veterans’ benefits may help pay. The Long-Term Care Ombudsman is free and is the first call when something goes wrong.
This guide is general information, not legal advice. Rules and programs change; confirm details with Community Care Licensing, the ombudsman or an elder law attorney before relying on them.