Types of Elder Care Facilities

If you are just getting started exploring care options for a dependent adult or elder, the types of facilities and care options can be overwhelming. Care facilities in California are divided into two broad categories:

  • Community care facilities are licensed by the California Department of Social Services. They provide non-medical care and supervision.
  • Health care facilities are licensed by the California Department of Public Health. They provide medical care and supervision.

Below, you can learn more about the types of elder care facilities in California.

Skilled Nursing Facilities (SNFs or Nursing Homes)

Who skilled nursing facilities are for: Seniors and adults, usually with developmental or physical disabilities, who cannot live independently and require 24-hour skilled nursing care and supervision that cannot be provided by a caregiver at home or at an assisted living or RCFE facility.

What is a skilled nursing facility? A skilled nursing facility (SNF) or nursing home is a health care facility or a distinct part of a hospital which provides continuous custodial and supportive care to patients whose primary need is skilled nursing care on an extended basis. Nursing home residents may have chronic medical conditions like late-stage Alzheimer’s disease or an acute condition such as recovery and rehabilitation following major surgery.

Skilled nursing facilities offer the highest level of care among the many types of elderly care facilities, and they are the most regulated. These facilities provide 24-hour inpatient care and, at a minimum, include a physician, skilled nursing staff, dietary and pharmaceutical services, and an activity program. SNFs must have sufficient nursing and staff to meet the needs of each resident at all times. Additionally, California requires SNFs to provide a minimum of 3.2 hours of individual nursing care per resident per day.

California nursing home licensing: Skilled nursing elderly care facilities are licensed and regulated by the California Department of Public Health (CDPH). They must also be certified by the federal government to qualify for payments from the Medi-Cal and Medicare programs.

Find a licensed nursing home in California: The California Health Facilities Information Database (Cal Health Find) allows you to search for California nursing home care providers and view ownership, certification status, and performance history (such as state enforcement actions and deficiencies). You can also file complaints through this system. Nursing Home Compare is a federal government website managed by the Centers for Medicare and Medicaid Services. It also provides information on nursing homes in California that are Medicaid- and Medicare-certified with staffing information and ratings.

Complaints: Complaints about nursing homes can be made to the California Department of Public Health (CDPH) Licensing and Certification. You can file a complaint online.

Residential Care Facilities for the Elderly (RCFE)

Who RCFE facilities are for: Seniors and adults, usually with developmental or physical disabilities, who can’t live independently and need regular assistance, but are otherwise healthy and do not require 24-hour medical care.

What is a residential care facility for the elderly? An RCFE facility is a residential facility that provides non-medical assistance. A California RCFE is also known as assisted living or board and care, depending on the size. These elder care facilities have the same licensing requirements, but assisted living facilities are usually larger, corporation-owned, and provide private apartments. An RCFE is usually smaller. Board and care facilities are usually very small with less than ten beds.

Residential care facilities for the elderly serve residents 60 and older who are unable to live on their own but do not need 24-hour skilled nursing care. Adults under 60 may also be permitted at an RCFE if they otherwise meet admission requirements. Because they are non-medical, a California RCFE is not required to have nurses, CNAs, or physicians on staff.

An RCFE facility may provide the following:

  • Room
  • Meals
  • Supervision
  • Housekeeping
  • Medication storage and distribution
  • Personal care assistance with bathing, eating, hygiene, and transferring 

A residential care facility for the elderly can provide varying levels of care and supervision to each resident, as agreed to at time of the admission or as determined necessary at subsequent times of reappraisal.

Unlike a skilled nursing facility, an RCFE allows residents to maintain more freedom. Residents can make decisions and control their own finances and are usually allowed to leave the facility and return when they wish without unreasonable restrictions.

Most assisted living or RCFE facilities are paid for privately. Medi-Cal and Medicare do not pay for residential care, and SSI provides very limited funding.

RCFE license and regulations: Residential care facilities for the elderly are licensed and regulated by the California Department of Social Services.

Find a licensed RCFE facility: The California Department of Social Services lists all licensed residential care facilities for the elderly on its website.

Complaints: The CDSS Community Care Licensing Division (CCLD) handles complaints against RCFE facilities. You can file an online complaint with the CCLD.

Assisted Living Facilities

Who assisted living facilities are for: Seniors and adults, usually with developmental or physical disabilities, who can’t live independently and need regular assistance, but are otherwise healthy and do not require 24-hour medical care.

What is an assisted living facility? California assisted living provides supervision and non-medical residential care for the elderly with no requirements to have CNAs, nurses, or physicians on staff. By comparison, skilled nursing facilities (or nursing homes) provide 24-hour medical care and supervision and must meet nursing and physician staffing requirements. California assisted living facilities usually serve residents who are 60 and older and unable to live on their own independently, but otherwise in good enough health that they do not require 24-hour skilled nursing care. Adults under 60 may also live in assisted living facilities if they meet admission requirements.

Assisted living facilities in California may provide the following:

  • Room
  • Meals
  • Supervision
  • Housekeeping
  • Medication storage and distribution
  • Personal care assistance with bathing, eating, hygiene, and transferring

Assisted living can provide varying levels of care and supervision to each resident. The level of care and supervision is generally agreed upon at admission and may be updated regularly.

Assisted living in California may be known as a residential care facility for the elderly (RCFE) or board and care. It can also be part of a Continuing Care Retirement Community (CCRE) which provides independent living, assisted living, and skilled nursing care in the same facility so residents can receive the care and supervision they need as their health changes.

California assisted living regulations: Assisted living facilities in California are licensed and regulated by the California Department of Social Services.

Find a licensed RCFE facility: The California Department of Social Services lists all licensed assisted living facilities on its website.

Complaints: The CDSS Community Care Licensing Division (CCLD) handles complaints against RCFE facilities. You can file an online complaint with the CCLD.

Independent Living Facilities (Retirement Communities)

Who are independent living facilities for? Retired seniors who can live independently and do not need assistance with daily activities of living, supervision, or 24-hour medical care.  

What is an independent living facility? Independent living facilities are better known as retirement communities. Independent living means residents do not need or receive supervision, medical care, or assistance with activities like bathing, dressing, and housekeeping.

Many independent living facilities or retirement communities offer a range of amenities that support an active lifestyle including clubhouses, swimming pools, golf courses, social programs, and fitness programs. They may also offer services like housekeeping – but these services are the resident’s convenience, not because the resident is unable to do them.

Some independent living communities are age-restricted, better known as 55+ communities.

Continuing Care Retirement Communities (CCRCs) are a type of retirement community that provide a continuum of care: independent living, assisted living, skilled nursing care, and sometimes dementia/memory care. This allows residents to remain in the community and receive increasing amounts of support, medical care, and supervision as needed.

Independent living facilities are often organized as condominium associations and governed by California condo laws. Because they do not provide the assistance and supervision of an assisted living facility, or the medical care of a skilled nursing facility, they are not regulated by the Department of Social Services or Department of Public Health.

Adult Day Program (ADP)

What are Adult Day Programs? Adult day care programs in California provide day care services and programs to seniors who need some level of supervision and assistance with activities of daily living.

An adult day care facility does not provide medical care and only provides activities, services, care, and supervision on a less than 24-hour basis. The program provides an alternative to a skilled nursing facility for those who don’t need 24-hour skilled nursing care and provides a respite to working and full-time family caregivers.

Typically, seniors attend an adult day care in their community 2-5 days per week based on the needs of the senior and the family. Programs are usually 4-8 hours per day but some facilities offer extended hours. All adult day care programs in California provide or can help with transportation arrangements.

Adult day care programs range a great deal from one center to the next: some are focused on younger adults with developmental disabilities or serve a community population with a similar ethnic or cultural background. Services and programs may include:

  • Arts and crafts
  • Singing
  • Games
  • Social activities
  • Meals
  • Age-appropriate fitness activities
  • Dietary counseling
  • Physical, speech, and occupational therapy
  • Social work or case management

There is a unique sub-type of adult day care: Alzheimer’s Day Care Resource Centers. These centers are designed to provide specialized day care programs to seniors with Alzheimer’s disease or dementia. The California Department of Aging offers grant funding to 36 Alzheimer’s Day Care Resource Centers in California to help meet the physical and social needs of people in the community with dementia while reducing nursing home placement and acute care costs by helping seniors live at home as long as possible.

Adult day care licensing: Adult Day Programs (ADPs) are licensed by the California Department of Social Services as community care facilities.

Find California adult day care programs: The California Department of Social Services website lists all adult day care programs.

Complaints: The CDSS Community Care Licensing Division (CCLD) handles complaints against adult day programs. You can file an online complaint with the CCLD.

Adult Day Health Care (ADHC) or Community-Based Adult Services (CBAS)

What is an adult day health care facility? Adult Day Health Care (ADHC), now known as Community-Based Adult Services (CBAS) is one of two forms of licensed adult day services.

Community-Based Adult Services provides services to adults with disabilities and older adults to prevent or delay unwanted institutionalization and restore or maintain their ability to self-care. CBAS is a Medi-Cal Managed Care benefit and provides services such as:

  • Meals
  • Personal care
  • Social services
  • Individual assessments
  • Professional nursing services
  • Physical, speech, and occupational therapy
  • Mental health services
  • Nutritional counseling
  • Transportation to/from the CBAS center

The program is designed to work in partnership with the participant’s family and/or caregiver, personal care physician, and the community.

Adult day care licensing: Adult Day Programs (ADPs) are licensed by the California Department of Social Services as community care facilities.

Find California adult day care programs: You can search for CBAS centers through the California Department of Aging.

Acute Care Facilities (Hospitals)

What is an acute care facility? An acute care facility is a health facility having a duly constituted governing body with overall administrative and professional responsibility, and an organized medical staff that provides 24-hour inpatient care, including the following basic services:  medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services.

Acute care facility licensing: All acute care facilities in the State of California are governed by the Department of Public Health’s Center for Health Care Quality (CHCQ), which is responsible for the regulatory oversight of health facilities to secure safe, effective, and quality healthcare for all Californians. CHCQ evaluates health care facilities for compliance with state laws and regulations, and also investigates complaints and ensures health facilities’ compliance with federal laws and regulations.

Complaints: Complaints about an acute care facility can be made to the California Department of Public Health (CDPH) Licensing and Certification. You can file a complaint online.

Intermediate or Step-Down Facilities

An intermediate or step-down facility is defined as a facility which is organized, operated, and maintained to provide for the monitoring and care of patients with moderate or potentially severe physiologic instability requiring technical support but not necessarily artificial life support.

A step-down facility can be used after a hospitalization for a patient who is not strong enough to return home, or to stabilize a patient’s condition before they transition to a nursing home. These facilities are also called subacute, sub-intensive, semi-intensive, or transitional units. Most are operated as a separate unit in a hospital or nursing home. They also typically have a greater patient-to-nurse ratio.

Hospice Care

What is hospice care? Hospice care is a specialized form of interdisciplinary health care often described as end-of-life care. Hospice is designed to provide palliative care, not treat the cause of a patient’s condition, to alleviate the physical, emotional, social, and spiritual discomforts of a patient at the end of their life. Hospice facilities provide supportive care to the primary caregiver and the family of the hospice patient. Hospice care should meet all of the following criteria:

  • Considers the patient and the patient’s family, in addition to the patient, as the unit of care.
  • Utilizes an interdisciplinary team to assess the physical, medical, psychological, social, and spiritual needs of the patient and the patient’s family.
  • Requires the interdisciplinary team to develop an overall plan of care and to provide coordinated care that emphasizes supportive services, including, but not limited to, home care, pain control, and limited inpatient services. Limited inpatient services are intended to ensure both continuity of care and appropriateness of services for those patients who cannot be managed at home because of acute complications or the temporary absence of a capable primary caregiver.
  • Provides for the palliative medical treatment of pain and other symptoms associated with a terminal disease, but does not provide for efforts to cure the disease.
  • Provides for bereavement services following death to assist the family in coping with social and emotional needs associated with the death of the patient.
  • Actively utilizes volunteers in the delivery of hospice services.
  • To the extent appropriate, based on the medical needs of the patient, provides services in the patient’s home or primary place of residence.

California hospice regulations: Facilities, agencies, and health care professionals that provide hospice services are regulated and licensed by the California Department of Public Health (CDPH), Center for Health Care Quality (CHCQ), which is responsible for the regulatory oversight of health facilities to secure safe, effective and quality healthcare for all Californians. CHCQ evaluates facilities, agencies, and health care professionals for compliance with state laws and regulations, and also investigates complaints and certifies their compliance with federal laws and regulations.

Find hospice care: The California Department of Public Health’s Cal Health Find Database lists all licensed hospices.

Complaints: The CDPH Licensing and Certification Division handles complaints and reports of misconduct or abuse by hospices. You can file a complaint online or by mail, fax, or phone to the district office with oversight authority.

In-Home Health Care

What is in-home health care? In-home health care is a service which provides personal care and medical services based upon a plan of treatment prescribed by a physician and/or surgeon who is licensed to practice medicine in the state. In-home health care is provided by a person certified by the state department as a home health aide. On the other hand, services that do not include personal care services based upon a prescribed treatment plan may be provided by a person who is not a certified home health aide.

California in-home health care regulations: Facilities, agencies, and health care professionals that provide in-home health care services are regulated and licensed by the California Department of Public Health (CDPH), Center for Health Care Quality (CHCQ), which is responsible for the regulatory oversight of health facilities to secure safe, effective and quality healthcare for all. CHCQ evaluates facilities, agencies, and home health care professionals for compliance with state laws and regulations. The agency also investigates complaints made against these facilities, agencies, and health care professionals, as well as oversees their compliance with federal laws and regulations.

Find licensed in-home health care providers: The California Department of Public Health’s Cal Health Find Database lists all licensed home health agencies.

Complaints and questions: The CDPH Licensing and Certification Division handles complaints and reports of misconduct or abuse by home health aides (HHAs). You can file a complaint online or by mail, fax, or phone to the district office with oversight authority.

Intermediate Care Facilities for Developmentally Disabled Adults

In California, intermediate care facilities (ICFs) for individuals with developmental disabilities are health care facilities that provide 24-hour residential services. There are three types of ICFs:

  • ICF/DD (Developmentally Disabled) – Provides 24-hour personal care, habilitation, developmental, and supportive health services to residents who primarily need developmental services but have a recurring, intermittent need for skilled nursing services.
  • ICF/DD-H (Habilitative) – Provides 24-hour personal care, habilitation, developmental, and supportive health services to 15 or fewer residents who have recurring, intermittent needs for skilled nursing services, but are certified by a physician and surgeon to not require the availability of continuous/24-hour skilled nursing care.
  • ICF/DD-N (Nursing) – Provides 24-hour personal care, developmental services, and nursing supervision to 15 or fewer residents who recurring, intermittent needs for skilled nursing care but are certified by a physician and surgeon to not require continuous/24-hour skilled nursing care. These facilities serve people who are medically fragile and have developmental disabilities or significant developmental delay that may become a developmental disability without treatment.

Intermediate nursing care facilities are licensed by the Department of Public Health’s Center for Health Care Quality (CHCQ). Complaints can be made online to the CDPH’s Licensing and Certification Division.


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