What is an RCFE? Assisted living and board and care in California

What the letters RCFE stand for

RCFE stands for residential care facility for the elderly. It is a license issued by the Community Care Licensing Division (CCLD) of the California Department of Social Services (CDSS). The state describes an RCFE as a housing arrangement for people 60 and over where 24-hour non-medical care and supervision is provided.

The rules for RCFEs come from the California Health and Safety Code and from Title 22 of the California Code of Regulations. CCLD issues licenses, inspects homes, investigates complaints, and requires background checks for staff. Moving into an RCFE is a voluntary choice, made by the resident or by a guardian, conservator, or other responsible person.

Assisted living and board and care are the same license

Families hear many names: assisted living, board and care, residential care, care home. In California, assisted living facilities and board and care homes are both licensed as RCFEs. The name on the sign does not change which state rules apply.

What does change from home to home is size and setting. Some licensed homes care for six residents or fewer. Others care for more than a hundred people. Size and layout shape how a place feels, so it can help to visit both a small home and a larger one before you decide.

Some RCFEs are part of a continuing care retirement community, which can also include independent living and skilled nursing in one setting. The skilled nursing part of those communities is licensed separately by the California Department of Public Health.

Who lives in an RCFE

Most RCFE residents are 60 or older. A younger person can be accepted if their needs are compatible with the other residents and they need the same amount of care and supervision.

Residents usually need some help with daily life but not round-the-clock nursing. Under state rules, a home may accept or keep people who:

• Take their own medications, or need help taking them.
• Get medical care outside the home or from a visiting nurse.
• Need help managing money.
• Are bedridden, if the home meets extra requirements for their care.
• Are terminally ill and receiving hospice care, if the home has a hospice waiver from the state.

What every RCFE must provide

State rules list basic services that every licensed RCFE must provide. A home does not have to accept every person who applies. But once it accepts a resident, it is responsible for meeting the needs found in that person's pre-admission appraisal. Not every home can provide specialized care, such as dementia or hospice care, so ask.

• Care and supervision.
• Safe and healthful living space.
• Three nutritionally balanced meals and snacks each day, including low-salt or other diets a doctor orders as medically necessary.
• Help with daily activities such as dressing, eating, and bathing, and help with taking prescribed medications.
• Regular observation of each resident's physical and mental condition.
• Arrangements to meet health needs, including arranging transportation.
• A planned activities program with social and recreational activities suited to residents' interests and abilities.

What an RCFE is not

An RCFE is not a nursing home. A skilled nursing facility is a health facility that provides continuous skilled nursing care. It offers 24-hour inpatient care that includes physician, skilled nursing, dietary, and pharmacy services. In California, skilled nursing facilities are licensed by the California Department of Public Health, not by CDSS.

An RCFE gives non-medical care. A home cannot admit or keep a resident who needs 24-hour skilled nursing or intermediate care. State rules also list some health conditions an RCFE may not care for, and others it may manage only when specific requirements are met.

Some medical help can still come to an RCFE. Residents may arrange care from a licensed home health agency, such as nursing or therapy visits, when the rules allow it.

How to confirm a home is licensed

Some people try to provide care without a license. A license is required to provide care or supervision to people who are not relatives, with limited exceptions. Licensed homes must post their license where the public can see it.

You can look up any home on the state's Care Facility Search. It shows the license status, capacity, visits, citations, and recent inspection and complaint reports. Our guide to checking a license and inspection reports walks through each part.