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It’s surprising how little is known or understood about the Residential Care Home. Incredibly they are the backbone of assisted living and are certainly the work-horse of memory care. In California there is one license under Title 22 that governs all the large communities (Assisted Living/Memory Care), secure Memory Care communities, and the Residential Care Home (sometimes referred to as board and care). Typically, these small homes have six beds but sometimes as large as 12-14 beds. It’s a fantastic option when a high level of care is required. It is one of the best cost and care models available. Of course with over 6000 Residential Homes in just the state of California, all are NOT created equal or safe. Some points to consider when looking for care in your state.

1. Get help with your search. It’s a no cost service like using a realtor. Find a local Certified Senior Advisor (CSA) who specializes in placement with experience, and a good track record to help you with your search. A good expert works with all the communities, so they can offer many options, not just one. They will ask many questions to determine your loved one’s care needs, budget, geographic preference, and explore your family’s needs. They will also explain to you how the system works in your area, and be there with you every step of the way. A credentialed expert has been to all the communities they are recommending, so can give you first-hand knowledge of the community’s staff, administrator, cost, and even if homemade soup is on the menu. These “extras” are what make a good fit for the resident and family. If mom has to garden and be outside in the fresh air daily, then I’m going to direct you to a community with a large backyard that has fruit trees, fresh veggies growing, and maybe even above-ground planters that are easy to work with. Being content with the little things, knowing excellent care and fresh food is being provided, creates a winning solution for everyone. It’s what leads to a successful move.
2. All Residential Care Home have hospice waivers. Your loved one can go to “end of days” and not have to move. Depending on your area, a home can accept bed bound, catheters, diabetic care, wound care, feeding assistance, medication management, incontinence care, and of course full help with bathing, dressing, grooming, and transfers. Full care in essence is what residential care homes provide, so they are an excellent choice for a high level of care at the end of life. They are very experienced working with hospice (which is a Medicare benefit and can be used anywhere), and Home Health is always welcomed. They partner with Hospice and Home Health to complete the residents care as needed.
3. Some benefits of living at Residential Care Homes are freshly prepared daily meals, schedules based on your loved ones needs, and a quiet and calm atmosphere. Residential Care Homes excel at providing care for dementia, severe physical limitations (i.e. Parkinson’s, MS, ALS, Cancer), and residents who still want to feel like they are at home.
4. Many are owned by Registered Nurses, RNs. Often these specialized homes are used for care that larger communities aren’t able to provide, or have difficulty providing close attention of care the resident will require to mitigate falls. Families often need a bit of education on why mom or dad would actually do better in a Residential Care Home and not a large assisted living or memory care. If the resident can’t walk on their own or transfer from a bed to chair, or wheelchair to toilet on their own, they may be waiting around for care for a long time. Wait too long, residents get impatient and attempt to move on their own and that’s where falls occur, which means a trip to the ER and begins a cycle of decline. To be fair, the problem truly lies in the size of the community not the community itself. I have worked with lots of large communities and they definitely have a valuable role (different blog), but when a loved one is in decline or needs a lot of care, waiting for assistance can be detrimental to their safety. The staff to resident ratio is excellent at up to 2-3 caregivers (including the administrator) per six residents in this small environment.
5. Each Residential Care Home has its own personality and offers something special. Need a rose garden with an ocean view, I got that. Desire a high functioning all-ladies home, it’s out there. Man cave with a group of grumpy old men, no problem. Your mom loves live music weekly; I know just the place. Drives to the ocean, occasional trip to In N Out or a daily walk at the beach, let me show you the way. My point is “one size fits one,” so let an expert explain your options, and help guide you to the safest and happiest care that your family member can afford and will thrive in. Here’s to Aging Well.