Levels of Senior Care in California

The names are confusing because families, marketers and the state use different words for the same thing. This table lines them up. The sections below explain each one.

Independent living goes by many names: senior apartments, retirement communities, retirement hotels. What they share is that the resident manages their own daily life. California Advocates for Nursing Home Reform (CANHR) notes that senior housing complexes and retirement villages that provide only housing, housekeeping and meals are not required to be licensed as RCFEs.

Many of these places offer social activities and transportation, but they do not supervise residents or help with personal care. Independent living suits a person who is tired of keeping up a house but does not need hands-on help. If care is needed later, the resident arranges it separately or moves. See independent living placement for how that search works.

In California these three share a license. The California Department of Aging explains that the term assisted living facility covers board and care homes, which are often six-bed homes in residential housing, as well as much larger facilities. Those serving mainly adults 60 and over are licensed as residential care facilities for the elderly, or RCFEs.

An RCFE provides non-medical care and supervision. The department lists the usual services as help with bathing, dressing, grooming and moving about, meals, housekeeping and laundry, transportation, activities, assistance with medication and supervision. CANHR adds that RCFEs are not required to have nurses or doctors on staff. The Community Care Licensing Division of the California Department of Social Services licenses and inspects them.

The difference between an assisted living community and a board and care home is size and setting, not the license. A large community usually offers private apartments, a dining room and a full activity calendar. A board and care home is a house on a residential street with a handful of residents. Our guide to RCFE vs. assisted living goes deeper.

Memory care is not a legal term in California. CANHR calls it a marketing term and advises families to find out what additional services a home provides and whether it meets state standards for dementia care. The Department of Aging says an RCFE may care for people who have dementia if it is adequately equipped and its staff are trained and sufficient. See memory care vs. assisted living.

A skilled nursing facility, often called a nursing home, convalescent hospital or rehabilitation center, is a medical facility. The California Department of Aging says it is required to provide 24-hour skilled nursing care along with related or rehabilitative services. The typical resident is chronically ill or recovering from an illness or surgery, and is under the care of a physician.

The California Department of Public Health licenses skilled nursing facilities. A facility that accepts Medicare or Medi-Cal residents must also be certified to federal standards. That is a separate system from the one that oversees RCFEs, with different rules, different inspectors and different ways of paying. Our guide to assisted living vs. a nursing home in California compares the two.

A continuing care retirement community, or CCRC, puts several levels on one campus. The California Department of Social Services describes a continuing care contract as providing housing, residential services and nursing care, usually in one location and usually for the resident's lifetime. Residents typically pay a large one-time entry fee plus a monthly fee.

Every provider offering these contracts must hold a certificate of authority and an RCFE license, and a community that offers skilled nursing must also hold a skilled nursing license from the Department of Public Health. Because the contract is long and the money involved is large, it is worth having an attorney and a financial adviser read it before anyone signs.

Not every level of care means moving. Help at home and daytime programs can come before a move, and sometimes take its place. The California Department of Aging says people typically attend a day center two to five times a week, for four to eight hours a day.

Hospice is different again: it is a service, not a place. The department says it can be provided at home, in a skilled nursing facility, or in an RCFE that has state approval.

The department describes two kinds of agency that send help to the home, and two kinds of licensed daytime program:

• Home care agencies provide non-medical help with personal care and daily chores. They must be licensed by the Department of Social Services, and their aides must have training, a criminal background clearance and a tuberculosis examination.
• Home health agencies provide medical care at home and must be licensed by the Department of Public Health.
• Adult day programs offer personal care, supervision, activities and meals for less than 24 hours a day, under Department of Social Services oversight.
• Adult day health care adds skilled nursing, therapy and social services for adults at risk of needing institutional care. The Department of Aging lists itself as the state oversight agency.

Hamssa Benrekia is a senior living placement specialist in Torrance. She helps families in the South Bay and Harbor area of Los Angeles County find licensed assisted living communities, board and care homes, memory care and independent living. She does not place people in skilled nursing facilities or arrange home care, though she can explain how the levels differ. If you are unsure which level fits your parent, contact Hamssa to talk it through, and see the California Assisted Living Placement Guide for what comes next.