Wheelchairs and Transfers in California Assisted Living

Yes. Using a wheelchair does not keep a person out of assisted living communities or board and care homes, licensed in California as residential care facilities for the elderly (RCFEs). The lists of restricted and prohibited health conditions in Title 22 do not name wheelchairs, walkers or help with transfers. Our guide to health conditions assisted living can accept covers those lists.

What the law looks at is fire safety: can this person get out of the building in an emergency without help? The answer decides which homes, and which rooms inside a home, may take your father.

Health and Safety Code section 13131 defines nonambulatory persons as people unable to leave a building unassisted under emergency conditions. The definition includes people who depend on mechanical aids such as crutches, walkers and wheelchairs. It also includes any person who is unable, or likely to be unable, to respond physically and mentally to a fire alarm signal or to a spoken instruction about fire danger. Title 22 repeats the definition for RCFEs.

The category is wider than most families expect. A person who walks with a walker counts. So can a person living with dementia who walks well but would not understand an alarm.

Title 22, section 87202, says every home must keep a fire clearance. Before it accepts or keeps a nonambulatory person, the home must notify the licensing agency and obtain the appropriate clearance from the local fire department or the State Fire Marshal. Section 87204 adds that rooms approved only for ambulatory residents may not be used by nonambulatory residents, and that a resident whose condition becomes nonambulatory may not stay in such a room.

The doctor's paperwork feeds into this. Under section 87458, the medical assessment done before admission states whether the person is ambulatory, nonambulatory or bedridden, and whether nonambulatory status comes from a physical condition, a mental condition or both.

The law separates three situations:

A transfer is the move from bed to chair, from chair to toilet, and back. Title 22, section 87459, requires a home to look at it before admission: whether the person needs help moving in and out of a bed or chair, and whether they walk with or without equipment or another person's help. Our guide to the care assessment explains how that appraisal sets the care level and the price.

The regulations do not set a limit such as one caregiver only, and they contain no section on mechanical lifts. Two general rules do the work. Section 87411 requires staff who are sufficient in numbers, and competent, to provide the services residents need at all times. Section 87615 says a person who depends on others to perform all activities of daily living may not be admitted or kept, unless the state grants an exception or a hospice care plan applies.

So the real answer comes from each home. A two-person transfer needs two caregivers every time, including in the middle of the night. One home may say no to a need that another home says yes to, and both can be within the rules. Our guide to staffing requirements explains what the law requires at night.

Transfers also touch the bedridden rules. Under section 1569.72, a person who cannot transfer to and from bed independently can fall within the definition of bedridden, which calls for a different fire clearance. If your mother needs full help to get out of bed, read our guide to bedridden residents before you tour.

Ask the doctor or physical therapist what kind of transfer help is needed, and write it down in their words. Homes will ask.

Title 22, sections 87303 and 87307, set minimums for every licensed home:

• Grab bars at each toilet, bathtub and shower that residents use.
• Slip-resistant mats, strips or flooring in every bathtub and shower.
• Bedrooms large enough for easy passage and for devices such as wheelchairs or walkers.
• Sturdy hand railings and good lighting on any stairway, incline, ramp or open porch that residents with poor balance or eyesight can reach.
• Night lights in hallways and in passages to shared bathrooms.
• Additional bathroom equipment, based on residents' needs, in homes that accommodate nonambulatory residents.

These are minimums. They do not promise a roll-in shower, wide doorways or a ramp at the front door, so look for yourself and bring the wheelchair on the tour. Lap trays, soft ties and bed rails are a separate subject with strict limits, covered in our guide to fall risk.

Every home must also have a written emergency plan that includes evacuation, under section 87212. Ask to see it, and ask:

• Is the home cleared for nonambulatory residents, for how many, and in which rooms?
• Is it cleared for bedridden residents?
• Can your staff do a two-person transfer or use a mechanical lift on every shift, including nights? Who trained them?
• Who supplies the lift, and is there an added charge for this level of help?
• Can the wheelchair reach the bathroom, the shower, the dining table and the patio?
• How would you get my father out of the building in a fire?
• At what point would you say his mobility needs are more than you can meet?

Hamssa Benrekia is a senior living placement specialist in Torrance who holds an RCFE Administrator Certificate. She helps families in the South Bay and Harbor area find licensed homes, including small homes through her board and care placement service, and she goes on the tours, where a doorway or a shower can be checked with the wheelchair in hand. She does not decide what a home may accept: the home, the doctor and the fire authority do. To talk about your parent's mobility needs, contact Hamssa. The California Assisted Living Placement Guide covers the rest of the decision.