Can Physical Therapy and Home Health Come Into Assisted Living in California?

Assisted living communities and board and care homes, licensed in California as residential care facilities for the elderly (RCFEs), are non-medical. Their staff help with daily living and with taking medications. Skilled care comes from outside. Title 22, section 87455, says a home may accept people who receive needed medical care from a visiting nurse, and section 87609 says incidental medical care may be provided to residents through a licensed home health agency.

In practice that means nurses and physical, occupational and speech therapists. Hospice is a separate arrangement with its own rules and its own waiver. Other licensed practitioners may see residents in the home as well: section 87605 requires a home that permits health care practitioners to provide care to residents to post a notice that practitioners must show their name and license status on a name tag.

Health and Safety Code section 1569.725 and Title 22, section 87609, set the terms. The home must be able to provide the supporting care and supervision the resident needs while receiving home health care. It must tell the agency which duties the regulations bar its own staff from performing. And the home and the agency must agree in writing on who is responsible for what.

That written agreement has to state the services, how often and for how long, and include day and evening contact information for the agency and the way the two will communicate. Both sign it, and it goes in the resident's file.

Two more rules protect the resident. Before or within two weeks of admission, the home must arrange a meeting to write down the care the resident will receive, and Title 22 names a representative of the resident's home health agency among the people to include. And section 87609 says that using a home health agency does not expand the scope of care the home itself must provide.

Health and Safety Code section 1569.39 says a home that accepts residents with restricted health conditions must see that they receive the care their physician prescribes from appropriately skilled professionals acting within their scope of practice. It defines that as a person trained and licensed to perform the procedure, such as a nurse or a physical, occupational or respiratory therapist, who may work for a home health agency, the resident or the home. Under Title 22, tasks that belong to such a professional when the resident cannot do them alone include:

• Giving injections (section 87629).
• Caring for a healing wound or a stage 1 or 2 pressure injury, or supervising that care (section 87631).
• Inserting, removing and irrigating an indwelling urinary catheter (section 87623).
• Giving intermittent oxygen to a resident who cannot manage the equipment (section 87618).
• Helping with ostomy care, and teaching staff to change the bag (section 87621).
• Doing prescribed range of motion exercises for contractures, or instructing staff in writing to do them (section 87626).

Our guide to health conditions assisted living can accept lists every restricted and prohibited condition. For wounds in particular, see wound care in assisted living.

It can. As of 2026, Medicare says it covers home health services for a person who needs part-time or intermittent skilled services and is homebound. Homebound means both that leaving home is not recommended or takes help, such as a walker, a wheelchair, special transportation or another person, and that the person is normally unable to leave home and leaving takes a lot of effort. A doctor or other provider must see the person, confirm the need and order the care, and a Medicare-certified home health agency must provide it.

Medicare's own coverage page speaks of care in your home without defining home. The definition is in the Medicare Benefit Policy Manual, chapter 7, section 30.1.2, published by the Centers for Medicare and Medicaid Services. It says a patient's residence is wherever he or she makes a home, and that Medicare will cover reasonable and necessary home health care for people in an assisted living facility that is not primarily engaged in providing skilled or rehabilitation services. A hospital or skilled nursing facility does not count as a residence.

The same section adds a limit. Claims are to be denied for home health services that duplicate services the assisted living facility is required to provide under state licensing rules. Medicare lists help with bathing as a home health aide service, and help with bathing is also a basic service of a California care home, so ask the agency what Medicare will and will not cover for your parent.

The care home's monthly rate is separate from all of this: see does Medicare pay for assisted living. For the visits themselves, as of 2026 Medicare describes its coverage this way:

Medicare also says it does not pay for 24-hour care at home, or for custodial or personal care when that is the only care a person needs. If your parent has a Medicare Advantage plan, Medicare says to check with the plan about home health benefits.

The order comes from the doctor, not from the care home. Therapy often follows a hospital stay, as described in assisted living after a stroke, or supports a long-term condition such as Parkinson's disease. The steps:

1. 1

   The doctor orders it

   Medicare requires a doctor or other provider, such as a nurse practitioner, to see the person in person, confirm the need for home health care and order it.

2. 2

   An agency is chosen

   Medicare says the provider should give you a list of agencies that serve your area and must tell you if their organization has a financial interest in any of them. Ask the care home which agencies already visit its residents.

3. 3

   The agency and the home sign an agreement

   Title 22 requires a written agreement on services, frequency, duration and contact details, signed by both and kept in the resident's file. You can ask to see it.

4. 4

   Staff are trained where needed

   For a restricted health condition, staff who will help with the resident's care must first complete hands-on training from a licensed professional (section 87613).

Hamssa Benrekia worked in home health, hospice and palliative care before she started her placement agency in Torrance. She does not arrange home health or enroll anyone in a program, but she can tell you which licensed homes in the South Bay and Harbor area say they work with visiting nurses and therapists, and what to ask them: see assisted living placement. To talk it through, contact Hamssa, or start with the California Assisted Living Placement Guide.