When a loved one can no longer live at home independently, but does not need or want to move into a nursing home, other residential options do exist. Living arrangements that maximize a person’s independence while providing necessary support and care are available in many communities.

 Moving to a residential care facility is an enormous change in lifestyle. Whenever possible the decision should be discussed fully with the impaired person. In addition, other family members, a social worker, case manager or hospital discharge planner, financial planner, and spiritual advisor can be helpful in making sure that the person’s needs will be met and that the individual and family feel comfortable with the move.

 This fact sheet describes assisted living facilities (special senior residences) and residential living facilities (also known as board and care homes). These two options provide alternatives to more intensive and costly nursing home care.

 Assisted Living Facilities Assisted living facilities (ALFs) maximize independence by providing apartment-style living with services designed for older persons. ALFs are often marketed as “upscale” living. However, there is no standard definition for assisted living; consumers should be aware that facilities are unlicensed. Residences vary as to the type of services they provide. In general, ALFs fall into three categories:

 The hospitality model provides hotel-like services such as meals, housekeeping and laundry. These facilities are suitable for healthy older persons with minimal service needs.

 The personal care model provides personal care assistance for persons in frail health or in situations where the well spouse and the impaired spouse wish to continue living together, with onsite support services. It is important to find out if persons with degenerative conditions can continue to reside in the ALF if the condition worsens.

 The aging-in place model offers onsite care for chronic conditions. These facilities are equipped to provide skilled nursing services and can accommodate the changing needs of residents. In California, any facility which offers life-long care must have a “continuing care contract” certified by the state. Consumers should be aware that some continuing care retirement communities do not have state contracts and are not regulated.

 Assisted living facilities typically provide:

24-hour security
Emergency call systems for each resident’s unit
Housekeeping and laundry services
Transportation
Personal care assistance with bathing, grooming, dressing and toileting
Medication management
Social and recreational activities.

 Aside from standard safety and fire codes, there are no federal regulations on the operation of ALFs.

 Therefore, it is important to ascertain what services are available at a particular facility.

 Financing: ALFs tend to be relatively costly (about $2500 to $5,000 per month). Costs vary with the residence, room size, and services required by the resident. There may be supplemental costs for certain services.

 (Medi-Cal in California) does not reimburse for assisted living since the services are not medical in nature. As noted above, financing assisted living can be prohibitively expensive for many people.

 Residential Care Facilities (RCFs) are intended for individuals who are unable to live alone but who do not warrant skilled nursing services. They provide individual rooms, but not apartments. Unlike ALFs, RCFs must be state licensed.

 RCFs are also appropriate for mildly to end stage dementia . Most residential care facilities specialize in care of the aged, persons with Alzheimer’s disease, younger cognitively impaired or disabled individuals. A residential care home provides social interaction with others, activities, the presence of staff 24 hours a day in case of emergencies, and supervision for those with physical or cognitive impairments.

 RCFs provide assistance with personal hygiene, grooming, and bedside care, dressing, meals, and other typical daily activities including recreational and social activities. Housekeeping services are included. In addition, some RCFs offer optional services for an additional fee, for example, transportation to shopping centers or other outings, cable TV, newspaper delivery or religious services. Also Hospice Care for end of life care.

 In California, the state licenses RCFs in two ways: Adult residential facilities are licensed to house adults ages 18 to 59; residential care facilities for the elderly (RCFEs) are licensed to house adults age 60 and over. However, the owners or administrators of these facilities can make exceptions. By law, California RCFEs which care for persons with dementia must provide some means of effectively addressing the safety of confused residents who might wander away. Some facilities may now have secured perimeters including locked exits.

 Financing: RCFs generally have the lowest monthly cost as a facility class. However, RCF care cannot be paid for with Medicare or (Medi-Cal in California)In California, each resident in a residential care home has certain personal rights under Title 22 of the California Department of Social Services. Before signing an admissions agreement, check with the local Long-Term Care Ombudsman or Community Care Licensing (CCL), Department of Social Services to find out if there are any complaints or if any action has been taken against that RCF. CCL licenses and monitors California RCFs. They investigate complaints and have the authority to take punitive action, if necessary.

 RCFs differ from ALFs in several ways. RCFs offer rooms, where ALFs typically have apartment units. Also important is that RCFs are state licensed. Persons moving into an RCF must complete a pre-admission appraisal to assess the individual’s care needs.

 RCFs are subject to regulations for admissions agreements, theft and loss policies, as well as periodic inspections by the Department of Social Services. ALFs can provide more autonomy to healthier residents, but they are generally more costly than RCFs. Those persons with care needs may receive similar services to those offered by an RCF, but there is no government oversight. Since ALFs are not subject to licensing regulations, residents and their families should pay close attention to the policies in place at each facility, including grievance procedures and quality of care assurance.

 Once You’ve Narrowed the Choices

 After you’ve chosen a residence for your relative, you generally will meet with the administrator for the pre-admission appraisal. In order to determine the suitability of your relative for the residence, the facility staff should assess your loved one's capabilities, mental condition and social service needs. You may be asked to provide a completed physician’s evaluation form. The administrator should explain the policies and services of the facility and answer any questions that you or your relative may have.

 The admission process will involve filling out a number of forms. The most important of these is the admission agreement. Review it carefully. This agreement should include the following: a list of services provided and what, if any, additional services have been agreed upon; the source, rate and due date of payments; removal, discharge and refund policies; restrictions and liabilities; and visiting hours.

 Rates for most facilities vary by location, services offered and the amount of assistance your relative may need. Be sure to ask for an itemized list of all services being agreed upon and ask for the cost of additional or optional services (e.g., beauty and barber shop services)