California Assisted Living by the [Law] Book

Community Care Licensing within California’s Department of Social Services has oversight responsibility for Residential Care Facilities for the Elderly (RCFEs) as assisted living is formally called. It licenses and regulates this care option based on a number of laws but primarily on Title 22 of the Code of Regulations. To obtain and maintain licensure, RCFE must:

• promote resident’s independence and self-direction and
• protect personal rights.

They also must provide:

• safe and healthul living accommodations and services
• three nutritionally well-balanced meals and snacks made available daily
• personal assistance as needed with activities of daily living, such as dressing, bathing, grooming, eating and assistance with medications
• regular observation of residents’ physical and mental condition
• arrangements to meet health needs, including arranging transportaion
• social and recreational activities appropriate to residents’ interest and capabilities

Regulations governing assisted living recognize that people are likely to have chronic health conditions as they age. Title 22 sets forth what conditions are prohibited and allowed in RCFEs as follows:

PROHIBITED

• Stage 3 and 4 pressure sores (dermal ulcers)
• Gastrostomy care
• Naso-gastric tubes
• Staph infection or other serious infection (including TB)
• Residents who depend on others to perform all activities of daily living for them
• Tracheotomies.

Allowed

RCFEs can accept and retain persons who are:

• receiving medical care or treatment
• capable of self-transferring from one location to another
• needful of prescribed or as needed medication reminders
• capable of personal activities of daily living with assistance
• forgetful or physically limited
• experiencing temporary emotional disturbance due to loss or change

The regulations also require that residents be mentally and physically capable of providing self-care for their health conditions or ensure that appropriate skilled or licensed health care providers meet their medical needs. RCFEs can, but are not required, to accept and retain persons with the following health conditions once stated and specific additional criteria are met:

• bladder/bowel incontinence
• colostomy/ileostomy
• contractures
• diabetes
• fecal impactions
• healing or surgical wounds
• indwelling urinary catheter
• injections
• intermittent positive pressure breathing machines
• oxygen administration
• PRN (or as needed) medications
• protective supervision, and
• transfer dependency.

Each community must establish whether or not it will allow the above conditions and then apply admission policies in accordance with that decision.