Written by: patrick on June 10, 2010 @ 12:30 am
We hear a lot about Board & Care home in our industry and we have talked about them to some extent here, but what really are Board & Care Homes? After all, there is actually no term Board & Care in the legal vernacular of the state. So do they even exist and if so, what are they? This will be the topic of this article and it should prove to be illuminating and help us understand the vital role of Board & Care in the California continuum of care.
So it will be easier if we start general and become specific. All title 22, assisted living, in California are licensed as “residential care facility for the elder”, or RCFE. A mouthful and sometimes misleading, this name covers assisted living homes, apartment style communities, and secure dementia units. Skilled nursing facilities are not assisted living and therefore not included. They are not licensed title 22 assisted living. All assisted living in California is RCFE.
While this naming system may be convenient, it is not helpful for classification. In fact, there are three distinct types of assisted living; community living, home living and dementia care. Community living is also known as apartment style assisted living. Dementia care or memory care is high level care in a secured environment. Home living, or Board & Care, is exactly as its name implies. Assisted living set in a residential single family detached home. It is this intimate style of assisted living that we explore today.
Board & Care homes can be confusing but they are licensed, California assisted living communities. In fact, the license received by these homes is essentially the same as received by the larger communities, except in the number of residents they may accept. Usually licensed for no more than six, they can, in fact go higher, but this requires drastic modifications to the structure. So, with a staff of usually two or three full time caregivers and a max of only six residents, we find that Board & Care homes offer the highest ration of staff to resident in the industry.
Board and Care can be the perfect setting for a senior requiring a high level care, whether due to physical or mental condition. In explaining Board & Care living, I always tell my clients, “a Board & Care home is where we go when we need a caregiver within voice distance of us, twenty-four hours a day.” These homes are excellent for the very frail, who may not be able to safely do any ADLs, or those with cognitive impairment, who require constant supervision. They are not for people who are still independent or who only require minimal help with ADLs.
Let’s talk about specifics of all Board & Care homes. All are required to lock up and dispense medications. Residents are not allowed to keep meds in their rooms, not even over-the-counter. These homes are considered, for licensing purposes, secured facilities. This is achieved by alarming all doors and, of course, the high level of staff. That means they are allowed to have any type of cognitive impairment. Residents can have either private rooms or share, to save money, and some rooms even have private baths.
Board & Care homes are the best at providing help with ADLs or Activities of Daily Living. They can help with bathing, dressing, toileting, everything. They are not, at this time, allowed to help with medical procedures that require an invasive action. For instance, they can help with preparing for testing blood sugar and administering insulin, however, they are not allowed to actually break the skin. If a resident requires injections, they must self administer, or it must be administered by an outside agency, like home health, which is usually covered by medical insurance.
These homes are not for people who still maintain a high level of independence. They are very slow placed environments with basic activities. People looking for a high level of activities or independence are better served at the apartment style assisted living. By design, the care is invasive, involved in every part of the day, from morning to bedtime, and even during the night. Remember, there is always care staff within voice distance. Non-ambulatory and incontinent residents are well served by the high level of care, as are people who need constant supervision.
Remember to focus on the type of care provided by these homes. In many cases, they are called on to provide end-of-life care, and what a wonderful option compared to skilled nursing. Loving full time care, provided in a warm home, instead of an institution. We are lucky to have access to so many wonderful Board & Care homes here in California and specifically, Orange County.
So we come to the end of our overview on the Board & Care home. Our next article will dig deeper into this subject, identifying populations that are best served by these homes. Until that time, Kindest Regards.
Tags: Assisted Living, assisted living education, assisted living homes, assisted living services, Board & Care, orange county assisted living
Catogories: Assisted Living Information, From the President, assisted living education
Is the ratio of 1 staff to 2 residents a state or county requirement?
Is this ratio required DAY & NIGHT?
thanks
that is true. home care services under the warmth and comfort of one’s home generates a lot better treatment than confine inside the cages of room facility which treats their health condition. chances are, better productivity of health with a voluntary attitude to be one’s true self with all the love ones around him/her.
Unfortunately, this comment is not entirely correct. I have a feeling that this comment is spam but I felt compelled to answer because it brings up two important points. First, staying at home is not always the best option for a senior. In fact, they may be robbing themselves of a chance to socialize and live life without fear. At statistically relevant number of seniors who stay at home are in isolation. Even with a part time caregiver, they are not receiving interaction with their peers. This is not healthy. Sure if a spouse is still at home, or other family members living their or in close proximity, a home caregiver can be a wonderful addition to an otherwise healthy life. If, however, in home care giving is being utilized so the senior can stay isolated in a dark cave of memories, the senior is not being well served.
Second, in California, assisted living is, by definition, non-medical. Therefore, when our commenter says, “confine inside the cages of room facility which treats their health condition”, they are erroneous. Assisted Living provides for assistance with activities of daily living in a warm, social environment. Perhaps our commenter is simply confused. Luckily he has found our site and continue to educate himself.
Hello Matt, and thank you for your question. It is a good question. In fact, it is an excellent question that cuts directly to the heart of assisted living. The state of California only requires that the facility be “adequately staffed” and must be staffed “24 hours per day”. So, for example, in a facility licensed for six people, the state only requires one caregiver on premises but there must be a caregiver on premises 24 hours a day. That is the minimum requirement. Luckily for us, as consumers, the assisted living industry, specifically in California, has become so competitive, that there are NO six bed facilities (that I know of) that would dare have this type of ratio. They simply would not get residents.
So, with that, what do we see? Well, the average six bed facility in Orange County California (Board & Care) will have two care staff on duty at all times and most will have a third on to help during the peak hours of the day. This is where we see the desirable one to two ratio, caregiver to patients. And desirable it is, considering the alternatives.
But now, let’s discuss “on duty”. In assisted living, a facility is designated as staffed if a care giver is on property. Period. That means that if one caregiver is sound asleep at a six bed facility, the state of California states that the facility is adequately staffed and the staff is considered “on duty”. Even at the average “good” six bed facility we will find that, at night, the caregivers do sleep when the residents sleep. One of attractive things about these six bed homes is that the caregivers LIVE there with the residents; hence they sleep at night. Now again, this is completely legal, and in most cases perfectly safe and adequate. They are there and ready to assist and senior that may have an issue at night. Most homes even have a system where the senior can “ring” the care staff if they need them during the night. Of course, this type of assisted living is created in a single family detached home, so if something happens during the night, the care staff is going to hear it and investigate.
The time when this is NOT appropriate is if a resident has issues that keep them up at night or conditions that require constant supervision through the night. A resident with “Sundowners Syndrome” would not do well at one of these traditions Board & Care homes. In these cases we look for facilities that have “awake staff”. There are such facilities but they are more rare as it cost more to provide this service.
I hope this helps, Matt. Thanks again for the great question!
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