Can a Person With Mental Illness Live in Assisted Living in California?

Yes. The acceptance rules for assisted living communities and board and care homes, licensed in California as residential care facilities for the elderly (RCFEs), are in Title 22, section 87455. The current text lists who may be accepted or kept, and it includes people who display what the regulations call behavioral expression, and people with a mild temporary emotional disturbance resulting from a personal loss or a change in living arrangement. The only people it bars outright are those with active communicable tuberculosis and those who need 24-hour skilled nursing or intermediate care.

You may still read, on older fact sheets and websites, that an RCFE cannot accept a person whose main need for care comes from ongoing behavior caused by a mental disorder that would upset the other residents. That wording is not in the current text of section 87455.

What remains is a judgment the home must make. Health and Safety Code section 1569.316 says that in determining a person's compatibility, the home shall consider at least two things: how far the person's personal and health care needs can be adequately met in that home, and whether there is a past history of violence or mental illness that would create a risk for the person or for other residents.

So the law gives no simple yes or no by diagnosis. One licensed home may accept a person that another declines, and both can be within the rules.

The National Institute on Aging describes depression as a serious mood disorder that affects the way a person feels, acts and thinks. It is common among older adults, but it is not a normal part of aging, and for most people it gets better with treatment. In older adults sadness is not always the main symptom: some people feel numb or lose interest in activities.

The National Institute of Mental Health (NIMH) describes bipolar disorder as a mental illness that causes clear shifts in mood, energy, activity levels and concentration, with periods of extremely up or irritable behavior and periods of feeling very down. It describes schizophrenia as a serious mental illness that affects how a person thinks, feels and behaves, in which people may seem to have lost touch with reality.

The first step is the same for all three: a doctor. If the symptoms are new, ask the doctor what could be behind them before you choose a home. Memory loss with behavior changes is a different subject, covered in our memory care guides.

Before admission, Title 22, section 87461, requires the home to assess the person's mental status to work out how much supervision is needed. It looks at whether the person:

• Tends to wander.
• Is confused or forgetful.
• Is capable of managing their own cash.
• Takes part in social activities or is withdrawn.
• Has a documented history of behaviors that may result in harm to self or others.

Expect direct questions about hospital stays, medications and past incidents. Section 1569.316 also requires a referring agency or facility to give the administrator the information it has about any history of dangerous propensity, though confidential information may not be released without the consent of the person or their authorized representative. Our guide to the care assessment covers the rest of the appraisal.

After move-in, the home must observe residents regularly for changes in physical, mental, emotional and social functioning and bring changes to the attention of the resident's physician and responsible person. When a resident's behavior has caused or may cause harm, section 87463 requires the home to write down what happened, what came just before it, and what it will do, and to use the least restrictive intervention that fits the person.

Not the home. An RCFE is a non-medical setting. Section 87455 allows it to accept people who receive medical care and treatment outside the home or from a visiting nurse, and the home must arrange, or help arrange, medical care and transportation to it. A move does not have to change the psychiatrist, therapist or clinic. Ask the home how it would get your relative to those visits.

Staff may help a resident take prescribed medicines under the rules in our guide to medication management. Residents keep the right, listed in Title 22, to receive or reject medical care or other services. A home cannot force a resident to take a medicine. Ask how it records refusals and who it tells.

Ask early what would make the home say it can no longer keep your relative. The grounds and notice periods are in our guide to eviction rules.

The Department of Social Services licenses several kinds of non-medical residential care for adults through its Community Care Licensing Division. The ones families ask about are described this way in state law and on the department's website:

An RCFE is built around people 60 and older. For a younger adult, see our guide to assisted living under age 60. A person who needs 24-hour skilled nursing care cannot be admitted to an RCFE. Ask the doctor which medical setting fits.

For a person thinking about self-harm, the National Institute on Aging says to tell someone who can help immediately: call the 24-hour 988 Suicide and Crisis Lifeline at 988, or call 911 or go to a hospital emergency room.

Be candid with a home. A move that fails after two weeks is harder on everyone than a no at the start. Ask:

• Have you cared for residents with this diagnosis, and are any living here now?
• Who on your staff has training in mental health conditions, and what was it?
• How do you help a resident keep psychiatric and therapy appointments?
• What do you do when a resident refuses medication?
• What do you do when a resident is very agitated or frightened, and when do you call 911?
• Would my father have a private room, and how do you handle conflicts between residents?
• What would lead you to say you can no longer meet his needs?

Hamssa Benrekia is a senior living placement specialist in Torrance who works with older adults and their families in the South Bay and Harbor area. Her work is with licensed RCFEs: assisted living communities, board and care homes, memory care and independent living. She does not place people in adult residential facilities, social rehabilitation facilities or psychiatric programs. What she can do is listen to your relative's situation and tell you candidly whether a home in her area is likely to be a fit, and which ones to ask. To talk it through, contact Hamssa. The California Assisted Living Placement Guide covers the rest of the decision.