Why are you seeing these four words at all?
Usually on paper. The letters turn up on a certificate framed in a hallway, on a discharge sheet, on an admission agreement somebody slides across a table with the pen already out. Nobody says them out loud. Discharge planners say board and care. Brochures say assisted living. Families say the place on Sepulveda with the roses. All three can be the same license.
Take the words apart and they are more useful than they look. Residential means people live there, in a home rather than a medical building. Care means personal care, the hands on help of a day, not health care. Facility is the state's word for the place, and it is the only one of the three that will not narrow anything down for you. That is the word the industry drops when it calls these places residential care homes.
If what you need is the practical version, a small home in Los Angeles and what one costs, read how to find a board and care home in Los Angeles instead.
What does the license let a home do, and where does it stop?
The line California draws is between personal care and skilled nursing, and it is a real line rather than a matter of degree. Inside it, an RCFE can do a great deal.
- Help with bathing, dressing, grooming and toileting, as often as somebody needs it
- Help with walking, transfers and repositioning, within the home's staffing and its fire clearance
- Meals, including diets adjusted for one person rather than for a menu, plus housekeeping, laundry and linens
- Supervision around the clock, which is not the same as a caregiver awake all night, so ask which one a home means
- Assistance with medications inside the limits of the license and the training of the staff
- Coordination with the people who visit, since physicians, home health, therapy and hospice all come to the house
What happens the night the home cannot legally help?
This stays abstract right up until it is not. Your father comes back from the hospital with a wound that has to be packed twice a day, or a new line, or a level of confusion that needs somebody within arm's reach for a week or two. The home has grown fond of him. If kindness were the test he would stay. The administrator has to tell you she cannot keep him, and a family in that moment usually hears it as a rejection.
It is not. She is describing the edge of the paper on her wall, and a home that quietly goes past it is risking the roof over the other five residents too. An operator who says yes to everything is not braver than the rest. She is the one to worry about.
Some things sit on top of the base license as separate approvals, and these are the ones families find out about late. Whether a home may keep a resident who cannot get out of the building on her own turns on its fire clearance, and clearances differ from home to home. Locked doors, delayed egress or a secured yard for dementia care take an approval of their own. So does keeping a resident who has gone on hospice. Ask a home which of those it holds, in those words, then check what you are told with Community Care Licensing, the division of the Department of Social Services that issues these licenses and takes the complaints about them.
Is a six bed house really the same license as a large community?
Yes. Identical license, identical rules, which is why the name is so little help to you. Told that a place is an RCFE, you know it is not a nursing home and you know somebody inspects it. You do not know whether the front door opens on somebody's living room or on a lobby. So ask for the licensed capacity. It is on the public record, nobody disputes it, and it sorts a house from a building in one question.
If you want to know how much is actually out there, How many licensed care homes there are in Los Angeles County, city by city takes the same state file and splits it by size and by place, which is the quickest way to see how much of this county is houses.
How is an RCFE different from a nursing home?
This is the confusion families arrive with, and it is an expensive one to carry into a decision, because the two are not one product at two prices. Different license, different people, different money.
| Where they differ | RCFE, residential care | Skilled nursing facility |
|---|---|---|
| Who licenses it | California Department of Social Services, through Community Care Licensing | California Department of Public Health |
| What the license is for | Personal care and supervision in a home setting, with help with medications inside the limits of the license | Nursing care ordered by a physician, plus therapy and medical oversight |
| Who gives the care | Caregivers, under an administrator. No nurse is required in the building | Licensed nurses, with certified nursing assistants |
| Where the public record lives | The CCLD Care Facility Search | Cal Health Find |
| How families usually pay | Private funds. Medicare does not pay for long term care here, and Medi-Cal generally does not pay room and board, though the state's Assisted Living Waiver can cover care services for eligible enrollees in participating homes | Medicare may cover a limited short stay after a qualifying hospital stay. Medi-Cal covers long term skilled nursing for people who qualify |
Payment rules change and every plan differs. Confirm your own coverage with the program rather than with an admissions office.
- Cal Health Find, California Department of Public Health, Center for Health Care Quality
What does the license not guarantee?
That a home holds one at all is worth something. It means an operator met the state's requirements and stays open to inspection and complaint, and it rules out the unlicensed house that is cheaper for exactly that reason. Start there. It costs nothing, and it occasionally ends a search on the spot.
What it will not tell you is who is awake at three in the morning, whether two people are on hand the night your mother cannot be lifted by one, or what language the evening shift speaks. None of that is in the file, and all of it decides whether a placement lasts. The questions that get you the rest go further into what you have to ask because the record cannot say.
Where do I look an RCFE up?
The record is public and free. The lookup is the CCLD Care Facility Search, run by Community Care Licensing, and the CDSS facility search page explains what it holds. Search by license number when you have one. Skilled nursing is not in there, since it is a different regulator. That lookup is Cal Health Find, published by CDPH.
Reading what comes back is a skill of its own, and every field on it gets mistaken for something it is not. How to check an RCFE license before you move in walks through the record field by field. What the state publishes changes, so go to the state's own site for the current version rather than trusting anyone's summary of it.
- CDSS facility search, California Department of Social Services
- CCLD Care Facility Search, California Department of Social Services, Community Care Licensing Division
- Cal Health Find, California Department of Public Health, Center for Health Care Quality
How is Senior Placement Agency LA paid?
Families pay us nothing. When someone moves into a home we introduced them to, that home pays us a referral fee. Worth knowing as you read this: a move happening is worth something to us, and staying put is not.
So use it. Ask us which homes we hold no agreement with. Ask what is wrong with the ones we like. An advisor who cannot answer the second question is not being much use to you.
Keep reading
- How to find a board and care home in Los Angeles, and what one costs
- How many licensed care homes there are in Los Angeles County, city by city
- How to check an RCFE license in California before you move in
- What a care home license does not tell you, and what to ask instead
- Board and care compared with a larger assisted living community
- Assisted living compared with a nursing home, and how to tell them apart
- Nursing home and skilled nursing placement in Los Angeles
Tell us what is actually happening
If you are holding a list of licensed homes and cannot tell which of them could take your father, that is the call to make. Tell us what he needs on his worst day, not his best one, and we will tell you which sizes and which settings are even in play. It costs families nothing.
Questions families ask us
- What does RCFE mean?
- It is an abbreviation of Residential Care Facility for the Elderly, which is the name California gives to the license covering non medical residential care for older adults. The Department of Social Services issues it through its Community Care Licensing Division. Families almost never use the phrase. Hospital staff, operators and state inspectors use the four letters constantly, which is usually where a family first meets them.
- Are RCFEs and assisted living the same thing?
- Assisted living is a market word and RCFE is a license. A California community that advertises assisted living is in nearly every case licensed as an RCFE, and so is the small home on a residential street that advertises nothing at all. The wording tells you how a place presents itself. The license category and the licensed capacity tell you what it is.
- Is an RCFE a nursing home?
- No, and this is the most expensive confusion a family can carry into a decision. An RCFE is licensed by the California Department of Social Services for personal care, meaning help with bathing, dressing, meals, supervision and medications within the limits of the license. A skilled nursing facility is licensed by the California Department of Public Health for nursing care ordered by a physician and given by licensed nurses. Different department, different staff, different money.
- Why does one license cover both a house and a large building?
- Because the category was written around the kind of care rather than the size of the place. One license and one rulebook for a house on a residential street and for a community with a front desk, which is tidy for the state and no use at all to a family trying to picture where their mother would sleep. So the license settles what a home may and may not do, and nothing whatever about how big it is. That sits in a different field of the same public record.
- Can an RCFE give my mother her medications?
- Within the limits of the license and the training of the staff, yes, and how far that reaches varies from home to home. Ask the administrator what her staff is trained and permitted to do, ask about injections specifically, and ask who checks the medication record and how often. Medication handling is one of the areas Community Care Licensing writes homes up for, so ask about it directly rather than in general terms.
- What happens if my father needs more care than an RCFE can provide?
- The home has to tell you, and it is a licensing obligation rather than a decision about your family. Sometimes the gap is filled by a visiting service, such as home health or hospice coming into the house, and the person stays where he is. Sometimes it cannot be, and the next setting is a skilled nursing facility. Ask every home where its ceiling sits before anyone moves in, because finding out during a crisis costs a family a second move.
- How do I confirm a home really holds an RCFE license?
- Ask the operator for the license number before you tour, then look the number up yourself in the Community Care Licensing facility search published by the Department of Social Services. Use the number rather than the name. Homes get renamed, several carry similar names, and one licensee may hold licenses on separate houses on separate streets, all of which a number settles in a single search.