Which Health Conditions Can Assisted Living Accept in California?

Assisted living communities and board and care homes, licensed in California as residential care facilities for the elderly (RCFEs), provide care and supervision, not nursing care. Health and Safety Code section 1569.72 says no resident may be admitted or kept if the person requires 24-hour skilled nursing or intermediate care. Our guide to assisted living vs. a nursing home covers that line.

Inside that limit, the rules are broad. Title 22 says a home may accept people who manage their own medications or need help taking them, people who get medical care outside the home or from a visiting nurse, and people with health conditions that need what the regulations call incidental medical services. A licensed home health agency may provide them under a written agreement with the home.

The regulations then sort specific conditions into two lists: restricted and prohibited. A home is never required to accept a particular person, so the lists tell you what a home may do, not what every home will do.

Title 22, section 87612, lists the restricted health conditions. A home may care for a resident with one of them, but only under the conditions in the section written for that condition. The table summarizes the main ones.

Three requirements run through the list. Before admitting a resident with a restricted condition, the home must see that the staff who will help have hands-on training from a licensed professional. It must keep the physician's documentation of the condition. And unless the resident can do the care alone, the skilled tasks belong to what the law calls an appropriately skilled professional. Health and Safety Code section 1569.39 defines that as a person trained and licensed to perform the procedure, such as a registered nurse, licensed vocational nurse or therapist.

Title 22, section 87615, says a person with one of the following may not be admitted to or kept in an RCFE. The section uses the words "including, but not limited to", so the list is not complete.

A separate section adds two more limits: a home may not accept or keep a person with active communicable tuberculosis, or a person who needs 24-hour skilled nursing or intermediate care.

Being bedridden is handled differently. Section 1569.72 defines it as needing help to turn and reposition in bed, or being unable to get in and out of bed without help. A home may admit or keep a bedridden person if it has the right fire clearance, and it must notify the local fire authority no later than 48 hours afterward. Without that clearance, the law allows a bedridden stay only during a temporary illness, defined as 14 days or less, or recovery from surgery. A longer stay needs written notice to the department with a physician's statement.

• Stage 3 and 4 pressure injuries.
• Gastrostomy tubes, a kind of feeding tube.
• Naso-gastric tubes.
• Staphylococcus aureus (staph) infection or another serious infection.
• Depending on others to perform all activities of daily living.
• Tracheotomies.

Yes. Under section 87616, a home may send the Department of Social Services a written exception request for a resident with a restricted or prohibited condition. The request includes current medical reports and the home's plan for meeting the person's health needs. The home applies, not the family, and the department decides.

Hospice is the other route. A home that holds a hospice care waiver does not need a separate exception for a resident who is terminally ill and receiving hospice, as long as the hospice care plan addresses the treatment of the restricted or prohibited condition. See hospice in assisted living for how the waiver works, or our page on finding a board and care home for someone on hospice.

Health changes, and the rules apply to keeping a resident as much as to admitting one. A home must update its appraisal when there is a significant change in condition and tell the resident's doctor and representative. Our guide to the care assessment explains that process.

If a resident develops a condition the home cannot legally care for, the Department of Social Services can issue a health condition relocation order. The regulations require a written relocation plan aimed at reducing stress on the resident, with a time frame of no more than 30 days. The resident, or the resident's representative, may ask for the order to be reviewed by an interdisciplinary team. That request must be in writing and given to the home within three working days of receiving the order.

This is a different process from an eviction by the home, which has its own notice rules, explained in assisted living eviction rules. The Long-Term Care Ombudsman or an elder law attorney can explain a resident's options.

California Advocates for Nursing Home Reform notes that a home must tell residents in writing, at or before admission, about any limits on who it can keep, whether set by the state or by the home. Read that document, and ask:

• Which restricted conditions do you care for now, and who does the skilled tasks?
• Do you have a nurse on staff, or do you rely on home health agencies?
• Do you hold a hospice care waiver?
• Is the building cleared for residents who cannot walk or who are bedridden?
• At what point would you say my mother's needs are more than you can meet?

Hamssa Benrekia is a senior living placement specialist in Torrance with a background in hospice, palliative care and home health. When she talks with a family about a parent's health conditions, she can point to licensed homes in the South Bay and Harbor area that say they care for those needs, and go on the tours with you. She does not decide what a home may accept: the home, the doctor and the state do. To talk it through, contact Hamssa, or start with the California Assisted Living Placement Guide.