RCFE / Assisted Living Fact Sheets:
What You Need to Know
About Residential Care Facilities

What is Residential Care for the Elderly?

Residential Care Facilities for the Elderly (RCFEs) serve persons 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 centrally store and distribute medications for residents to self-administer.

This level of care and supervision is for people 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 used to refer to this level of care are board and care homes, rest homes and assisted living facilities.

How Does a Residential Care Facility for the Elderly Differ From an Assisted Living Facility?

From a licensing standpoint, there is no difference. In California, facilities describing themselves as assisted living and offering personal care and supervision are licensed as Residential Care Facilities for the Elderly.

Residential Care Facilities for the Elderly are dominated by smaller (i.e., 6 to 15 beds), locally owned facilities with shared rooms.  "Assisted Living" is used to describe a philosophy of care (e.g., freedom to choose among service plans  and "aging-in-place") and as a marketing slogan. Assisted Living Facilities usually offer private apartments in larger, corporately owned facilities (e.g., 75 to 100 plus beds) with different fee options depending on the level of care needs.

Are Residential Care Facilities for the Elderly Regulated?

Yes. Residential Care Facilities for the Elderly or Assisted Living Facilities 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).

Senior housing complexes, retirement villages or retirement hotels that provide only housing, housekeeping and meals are not required to be licensed as Residential Care Facilities for the Elderly.

Can A Residential Care Facility for the Elderly Care for Persons with Dementia?

Maybe. Some facilities offer special services to persons with dementia if they meet certain licensing requirements. Make sure that the facility has experience in providing dementia care and meets all of the state licensing standards to provide dementia care.

Will a Residential Care Facility for the Elderly Accept or Retain Someone with Medical Care Needs?

It will depend on the type and severity of the medical condition(s) and whether the facility meets the state licensing standards for restrictive health conditions. Some medical conditions are not allowed in a Residential Care Facility for the Elderly (e.g., tube feeding, or treatment of open bedsores). Check the facilities’ license to see if they have met the requirements to serve persons who need help in leaving the building in case of emergency (i.e., non-ambulatory) or with certain medical conditions (e.g., hospice waiver).

What Does Residential Care for the Elderly or Assisted Living Cost?

The cost will depend on a variety of factors such as the type of accommodations (e.g., apartment, private room, shared room), the range of services needed, and the geographic area. The average monthly cost in California is from $2,500 to $3,000, with costs ranging from a low of around $900 a month for a resident on Supplemental Security Income (SSI) to over $5,000 a month. Specialized services like dementia or hospice care are more costly.

Who Pays the Bill for Residential Care for the Elderly or Assisted Living?

Most people must pay privately for care. Long-term care insurance only covers a very small percentage of people. Medi-Cal does not yet pay for Residential Care in California, except for an experimental program, the Assisted Living Waiver Pilot Project (ALWPP), in the counties of Los Angeles, San Joaquin and Sacramento. There is very limited public funding through Supplemental Security Income (SSI) for this level of care. Unfortunately, the SSI rate is so low that fewer and fewer facilities will accept persons on SSI. How Do I Find Out More About Residential Care for the Elderly?

You can contact the local District Office of Community Care Licensing to receive a listing of facilities. You can also inspect facility files that will contain the most recent inspection report and any citations for poor care. Some Ombudsman Programs also have listings, offer pre-placement services, and provide access to licensing reports.

Refer to CANHR's website for other RCFE fact sheets and for the Residential Care Guide -- a listing of all Residential Care Facilities for the Elderly in California. The Guide also provides comprehensive information on services, staffing and costs for a growing number of facilities that have responded to CANHR's RCFE Questionnaire.

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