RCFE vs. Assisted Living: What Is the Difference in California?

RCFE is the state's licensing term for a home that provides housing, meals, care and supervision to older adults. The California Department of Social Services issues the license through its Community Care Licensing Division, which also inspects the homes and investigates complaints.

The department's consumer guide says RCFEs are also known as assisted living facilities or board and care facilities. So when a family says board and care homes and a regulator says RCFEs, they are talking about the same license. Most residents are 60 or older.

Housing that offers only a room, housekeeping and meals, with no care or supervision, does not have to hold this license. That is the usual line between an RCFE and independent living.

Every RCFE, whatever its size, must provide a set of basic services. The state's consumer guide lists them:

• Care and supervision
• Safe and healthful living accommodations
• Three balanced meals a day plus snacks, including modified diets a doctor has prescribed
• Personal help as needed with dressing, eating, bathing and taking prescribed medications
• Regular observation of the resident's physical and mental condition
• Arrangements to meet health needs, including arranging transportation
• A planned program of social and recreational activities

An RCFE is licensed for non-medical care. According to California Advocates for Nursing Home Reform (CANHR), these homes are not required to have nurses, certified nursing assistants or doctors on staff, and state rules set no fixed staff-to-resident ratio. Staffing must be enough to meet residents' needs.

Some health care can still come to the resident. The state guide says a licensee may allow incidental medical services from a licensed home health agency when certain conditions are met. CANHR notes that some homes also have state permission to care for residents on hospice, and that some offer dementia care if they meet the licensing requirements for it.

There are limits. CANHR lists tube feeding, treatment of open bedsores and a need for 24-hour nursing care as conditions that are not permitted in an RCFE. Whether a home can accept or keep a person with other health conditions depends on the condition and on the home. A doctor's assessment and a frank talk with the home come before any move.

One more term to know: memory care. CANHR points out that it is a marketing term and not a separate license. Our guide to memory care versus assisted living covers what to ask.

The state guide notes that some licensees care for six residents or fewer and others care for more than a hundred. Skilled nursing facilities sit outside this license altogether. They are health facilities licensed by the California Department of Public Health.

Because the license is the same, the differences are practical ones. CANHR describes the smaller homes as mostly locally owned, often with shared rooms, while larger communities usually offer private apartments, tend to be corporately owned, and often have different fee options depending on the care needed.

Night coverage is one concrete difference in the rules. CANHR's summary of the regulations says a home with 15 or fewer residents must have one qualified person on call and on the premises at night, while a home with 16 to 100 residents must have one person awake and on the premises with another on call.

In a small home, your mother would share a kitchen table with a handful of housemates. In a large community, your dad might have his own apartment, a dining room and an activity calendar. Neither is better by definition. The state guide suggests weighing size and layout, the other residents, staffing, the menu and how close the home is to family.

Whatever the size, confirm the license and read the home's record before you tour. Our guide on how to check an RCFE license walks through the state's public search, and the tour checklist covers what to look at in person.

Hamssa Benrekia is a senior living placement specialist in Torrance who holds an RCFE Administrator Certificate. She starts with a conversation about your relative's care needs, health conditions, preferences and monthly budget, then puts together a short list that may include a board and care home, an assisted living community or both. She refers families only to homes licensed by the State of California that she has toured herself, after checking each one’s licensing record for citations and complaints. To talk it through, contact Hamssa.