Can a Bedridden Person Live in Assisted Living in California?

The starting point in Health and Safety Code section 1569.72 is no. It says no resident shall be admitted or retained in an assisted living community or board and care home, licensed in California as residential care facilities for the elderly (RCFEs), if the resident is bedridden, other than for a temporary illness or for recovery from surgery.

The same section then opens a door. Bedridden persons may be admitted to, and remain in, RCFEs that secure and maintain an appropriate fire clearance. The Legislature also wrote that the section is to be interpreted flexibly, so that bedridden persons can avoid institutionalization and be admitted to, and safely remain in, community-based residential care homes.

So the question for a family is practical: does this particular home hold the clearance, and is it willing and staffed to give this level of care? A home is never required to accept a particular person.

It does not mean spending most of the day in bed. Section 1569.72 defines bedridden as requiring assistance in turning and repositioning in bed, or being unable to independently transfer to and from bed, except in a facility with appropriate and sufficient care staff, mechanical devices if necessary, and safety precautions, as determined by the director of the Department of Social Services in regulations.

The statute draws one more line. Residents who are unable to independently transfer to and from bed, but who do not need assistance to turn or reposition in bed, are considered nonambulatory when the fire clearance is decided. Nonambulatory is a lower category, explained in our guide to wheelchairs and transfers.

Who decides? The statute gives the determination of bedridden status to the Director of Social Services or a designated representative. In daily practice the first record is the doctor's: Title 22, section 87458, requires the medical assessment done before admission to state whether the person is ambulatory, nonambulatory or bedridden.

Title 22, section 87202, requires a home to notify the licensing agency and obtain an appropriate fire clearance before accepting or retaining a bedridden person. The clearance comes from the city or county fire department or district, or from the State Fire Marshal. Section 87606 repeats the requirement for any bedridden stay other than a temporary illness or recovery from surgery.

Under section 1569.72, the fire clearance is to be issued if the fire safety requirements are met or if alternative methods of protection are approved. For homes that care for six or fewer people, a local fire official may not impose requirements stricter than the State Fire Marshal's regulations for that type of home, or the local requirements for any other single family dwelling, whichever is more strict.

Notice is a separate duty, and it applies however long the person will be bedridden. Every home that admits or keeps a bedridden resident must notify the local fire authority, no later than 48 hours after the admission or retention, of the estimated length of time the resident will remain bedridden.

If there is a dispute about what the fire rules require, the home, the resident or the resident's representative, or the local fire official may ask the Office of the State Fire Marshal for a written opinion. The statute gives the Fire Marshal 45 days to issue it.

A home without a bedridden fire clearance can still keep a resident who becomes bedridden for a short time. This is the sequence in section 1569.72 and Title 22, section 87606:

1. 1

   The resident becomes bedridden

   A flu, a fall or a surgery leaves your mother unable to turn in bed or get out of bed without help. The home may keep her during a temporary illness or recovery from surgery.

2. 2

   No later than 48 hours after: notice to the fire authority

   The home tells the local fire authority that a bedridden resident is in the building and gives the estimated length of time.

3. 3

   Up to 14 days: temporary illness

   The statute defines a temporary illness as any illness that persists for 14 days or less.

4. 4

   More than 14 days: notice to the state and a physician's statement

   The home must notify the Department of Social Services in writing and send a physician's written statement that the illness or recovery is temporary, with an estimated date it will end or the resident will no longer be confined to bed. The home also gives the fire authority the revised estimate.

5. 5

   The department decides

   The resident may stay if the department determines that her health and safety are adequately protected in that home and that transfer to a higher level of care is not necessary.

The statute adds that none of this expands the scope of care an RCFE may provide. A person who needs 24-hour skilled nursing care may not be admitted or kept under any of these rules.

Title 22, section 87606, sets conditions for any home that accepts or keeps bedridden residents:

• A plan of operation that states how the home will meet the health, safety and care needs of bedridden residents.
• An emergency and disaster plan that addresses fire safety precautions specific to evacuating bedridden residents.
• Resident records that show the home is meeting each bedridden resident's needs.
• Staff records that document training specific to the care of bedridden residents.
• A register of residents with a room locator, available to emergency personnel on request, whose location staff know at all times.

Other limits still apply. Stage 3 and 4 pressure injuries are prohibited health conditions, and so is depending on others to perform all activities of daily living, unless the state grants an exception or a hospice care plan covers the condition. See health conditions assisted living can accept and our guide to wound care. Section 87606 also says the licensing agency may require the relocation of a bedridden resident whose needs are not being met or are beyond what the home can provide.

Hospice changes the picture for many families. Title 22 says residents receiving hospice care who are bedridden may live in the home if it meets section 87606, and the hospice statute keeps the duties to notify the fire authority and to hold the fire clearance. Our hospice board and care page covers that situation.

Ask the doctor to describe, in writing, what help your parent needs in bed and getting out of bed. Then ask each home:

• Do you hold a fire clearance for bedridden residents, and for how many?
• Which rooms are approved for bedridden residents?
• Who turns and repositions residents, how often, and who does it at night?
• What training have your staff had in caring for bedridden residents?
• Do you hold a hospice care waiver?
• If my father becomes bedridden after moving in, what would you do in the first 48 hours and after 14 days?

If the answers show that your parent needs more than an RCFE can give, our guide to when assisted living is not enough covers the next options.

Hamssa Benrekia is a senior living placement specialist in Torrance with a background in hospice, palliative care and home health. She helps families in the South Bay and Harbor area find licensed homes, many of them small homes through her board and care placement service, and she can tell you which homes she knows say they care for bedridden residents. The home, the doctor, the fire authority and the state decide whether a person may be admitted. To talk through your situation, contact Hamssa, or start with the California Assisted Living Placement Guide.