Senior Guidance

Residential Care



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Residential Care Facilities for the Elderly

Finding the right senior housing solution can be confusing these days.  There are so many different choices available that it’s easy to become overwhelmed. Some people are in need of nursing care so they look for nearby nursing homes, while others may prefer to look for assisted living facilities in their area. Some older adults who do not need any assistance services look for senior apartments close to where they live now. For many others, however, residential care facilities might be the perfect solution.

Residential Care Facilities for Elderly Adults (RCFE), might also be referred to as residential care facilities (RCF), board and care homes, rest homes, residential care homes, personal care homes, adult foster care homes, or adult family homes.  They are similar to components of continuing care retirement communities (CCRC).

What is a residential care facility?

Residential care facilities for elderly adults are facilities that are typically located in neighborhoods in residential homes.  There are usually shared living spaces, just like a home.  This means shared living and dining rooms, kitchens, and bathrooms.  Individual homes might offer either shared or private bedrooms.

They are usually locally owned and operated.  Some larger facilities offer individual rooms or apartments and are usually corporately owned.

These are not medical facilities.  They are not required to have nurses, certified nurses’ assistants, or doctors on staff.  Some facilities might arrange to have a nurse visit periodically, but it is not a typical state requirement.

Caregivers might live on the premises or there might be shift workers.  There is no requirement either way, so this is an important question to ask each facility considered.

Services Provided by Residential Care Facilities for the Elderly

Seniors move to residential care facilities when they are still independent but require help on a daily basis.  Residential care facilities provide room, board, housekeeping, supervision, and personal care assistance.  Assistive services typically include bathing, dressing, eating, mobility and laundry.

An important concern for seniors is transportation.  Many no longer drive, but still need to travel to events and doctor appointments.  Transportation is often offered, but this should be clarified with the individual facility when comparing.

Beyond assistive service, a residential care facility typically provides some sort of personal enrichment program.  This might be basic due to the size and budget, but it should at least include some sort of social activity.  Residential care facilities for the elderly typically house a low number of residents, so an extensive calendar isn’t often required to keep things organized, but there should be something to maintain and strengthen social contact and interaction of residents.

Residential care facilities for seniors are not medical facilities.  There are some medical conditions that are restricted.  Residents who require feeding tube or have open bed sores are prohibited from becoming or continuing to be residents of these residential care facilities.

Residential Care Homes vs Assisted Living

Residential care homes for elderly adults are in residential homes, so they are more home-like and family-like than assisted living facilities.  Residential care facilities for senior citizens typically house 6-15 residents.

Assisted living facilities are a type of residential care facility, but they are larger facilities and resemble larger capacity apartment buildings as opposed to a family-like home.  Assisted living facilities also typically have 24-hour staff on hand in shifts, rather than living on the premises.  Though not required, assisted living facilities are more likely to have medically trained staff compared to residential care facilities.  This is presumably due to breadth and budget allowed by the larger size of the facility.

Residential care facilities house residents who are unable to continue to live alone, but do not need 24-hour nursing care.  In this respect, residential care facilities and assisted living facilities are alike.  Neither type of facility is considered a medical facility.

With a larger budget and larger facility, assisted living facilities are more likely to offer a greater range of service to residents, and sometimes luxurious senior living.  These might include organized fitness classes or social groups.  Fewer residents live together in residential care facilities for elderly adults so organized activities don’t require a strict regimen.  A lower number of residents do not require as much diverse offerings as a larger facility.  Activities available at residential care facilities are more likely to be personally suited.

Residential Care Facilities vs Nursing Homes

A nursing home is much different from a residential care facility for aged adults.  Nursing homes are also commonly referred to as skilled nursing facilities.  They are considered a medical facility.  They resemble a hospital much more than a family home.  A nursing home will have 24-hour medical personnel available. If you or your loved one needs 24/7 skilled nursing care, then you should be looking for nursing homes near you.

Because nursing homes provide medical care, they are more likely to accept Medicare for medical services, unlike residential care facilities which are generally private pay.  Medical facilities that accept Medicare are obligated to meet the federal requirements.  This might provide some peace of mind for safety and uniformity, but it is also more expensive.  A nursing home will typically cost twice as much as a residential care facility on a monthly basis.

How much do Residential Care Facilities cost?

Just like any real estate investment, costs for residential care facilities for older adults are dependent on location.  Geography by state, as well as urban compared to suburban area can cause prices to vary greatly among different, but similar facilities.

Fee structure of residential care facilities are based on the type of care and services that are needed. 

The price range for senior residential care facilities spans from $1,500 to $4,500 per month.  The national average for a shared bedroom is $2,500 per month, while a private bedroom averages $3,500 per month.  Residents with dementia have additional costs.

The average U.S. mortgage is just over $1,200 per month.  Moving to a residential care facility will have a significant impact in a senior’s budget.  Although a residential care facility for elderly adults is a greater expense, it is still half the cost of the typical nursing home.

Medicare is for medical expenses.  Medicare does not cover room and board costs.  Residential care facilities for elderly adults are not medical facilities.  It is very unlikely that Medicare will pay these costs.

Individually state-run Medicaid programs might provide assistance for RCFE’s or RCF’s.  Like Medicare, Medicaid does not pay room and board costs, but these state programs are often more flexible than Medicare.

Medicaid Waivers are offered by some states.  Medicaid Waivers can offer financial assistance for services provided outside of nursing homes.  State budget constraints usually cause enrollment caps and lengthy waiting lists.  Because there are no federal requirements, state set requirements and guidelines individually.  Some states define senior housing by the number of residents.  If a state doesn’t distinguish based on number of residents, it allows more flexibility of choice in using these waivers.

Nursing Home Diversion Programs exist in some states.  Nursing homes used to be the primary senior housing option, but previous generations have learned that these costs can quickly deplete a retirement fund.  There are now more choices for senior housing including residential care facilities, and some states provide citizens with flexibility in seeking care and lowering costs, while still meeting seniors’ needs.

The Veteran’s Administration provides assistance for aging veterans.  The VA will not pay for room and board, but it will provide assistance by providing services.  This might include a nurse coming to a residential care facility for elderly adults to provide services that are not otherwise provided by the home.  This can allow a senior veteran to stay at home longer and delay a move to a more advanced facility such as a nursing home.

How to choose a Residential Care Facility

Choosing a home is a personal decision.  There are so many pieces of the puzzle that must fit together to make a home.  Many people will ask “How do I find a residential care facility near me?” Often the location of family or medical services make choosing the city and location a primary concern when looking for residential care homes near you.

Factors in a decision of location might also be the desire to be in a warm climate for comfort or enjoyment of hobbies such as golf.  Access to cultural attractions or entertainment venues might also factor into a decision between an urban or suburban setting.

A doctor can provide a list of needs for seniors.  This is based on the current physical condition and medically likely needs that can be anticipated.  This list usually makes up the primary requirements for a residential care facility for elderly adults.

What are the senior’s preferences?  This will make a list of wants. 

It’s suggested that at least several residential care facilities are visited and compared before making a decision.  Having the list of needs and wants pre-determined can help to assess and compare facilities objectively.

You can contact your state’s department of aging for helpful resources and information about available facilities and recommendations.

Evaluating Residential Care Facilities

You shouldn’t judge a book by the cover.  That saying holds true for residential care facilities.  Another cliché is “it’s what’s on the inside that counts, not the outside”.

The exterior of a residential care facility might not be sparkling new, but that is rarely the deciding factor in choosing a facility.

The primary criteria should be the experience of caregivers and their backgrounds.  Caregivers interact with residents extensively every day.  Do they smile and are they happy people?  Do they communicate easily and effectively with residents?

What is the staff-to-resident ratio?  This provides a measure of the individual attention provided to residents.

Do caregivers live in the home?  There might be a promise of 24-hour access to help, but is that promise of awake staff?  A caregiver living in the residential care facility is on hand, even if they are asleep.

Is there an RN on site?  Is there an RN advisor?  Does an RN visit the residential care facility periodically?

What is the appearance of the current residents?  Are they appropriately clothed and clean?

What does the activity calendar look like?

Are pets allowed or is there a resident animal for all residents to care for?  Pets are shown to assist seniors avoid loneliness and improve optimistic behaviors.

How are services handled?

Who manages and reviews daily health of residents?  Are there care plans established per resident?

Who makes doctor appointments?

Can spending money be managed by staff?

Residents with dementia need a secure perimeter to avoid wandering.  How does staff know when a resident leaves the home?

What are the meal options?  Will the home accommodate special requests?

What is the monthly rate?  What is included in those charges?

How does billing work?

Does the residential care facility accept long-term care insurance for payments?

After all the evaluating and all the questions, it comes down to where do you fit in best?  After all, this will be a home, probably for several years.  You want those years to be as happy and enjoyable as possible.

Residential care facilities can provide a senior with a family-like home.  They can be less disruptive to daily life and activities and are often more flexible than other facilities.

Because of its small group of adults as residents, elderly adults residential care facilities can become like a family for seniors.  Residents see each other often in the common areas of the home.  Residents often have common concerns and aging issues, and this can create a tight bond and camaraderie among residents in the home.

Moving to a residential care facility for older adults can be stressful on a senior.  Aging forces us to realize our mortality and it can commonly lead to depression in seniors.  Family members might also feel guilt that they are unable to provide care themselves.

Ensuring that a senior has a safe home is essential.  Making sure that adequate care is provided is also important.  Knowing that a senior has the ability to have a home, friends, activities, and enjoyment can provide peace of mind.

A residential care facility can provide security, adequate care, and personal enrichment and enjoyment for a senior.  Its services provided within a family-like home with consistent friendly caregivers make it a unique solution to the senior housing dilemma.