California 'Levels of Care': A Residential Care Facility for the Elderly As an Alternative to Skilled Nursing Facility Care
If the patient is not receiving any skilled services and requires assistance with positioning, feeding, bathing, grooming, dressing, walking, and/or must be in a secured environment related to cognitive impairment, a 'lower level of care' such as a residential care facility for the elderly ('RCFE') often times known as a 'board and care' may be appropriate. It is very important to thoroughly investigate to ensure that the RCFE is capable of providing for an individual's needs such as secured doors and perimeters if required. It is equally important to be sure that an RCFE does not accept a patient whose level of care is too high and/or has medical conditions that are specifically prohibited such as patients who require skilled nursing care, who have serious bedsores, or who are bedridden. There are also many 'restricted' conditions that require on-going professional care from an outside licensed home health care agency if a patient is admitted to an RCFE.
A factor that heavily influences a family's decision regarding appropriate discharge might be financial. Most 'skilled' services are reimbursed by Medicare or Medicare Advantage plans, but 'custodial' services are not. Also, Medi-Cal might reimburse someone for long term custodial care in a nursing home if they qualify financially, but Medi-Cal does not pay for an RCFE. Many times this factor causes elderly persons who require physical assistance or who are suffering from dementia to be confined to a nursing home because Medi-Cal will not pay for custodial care in the RCFE environment.
Posted by: Denise A. Platt, RN, JD with Law Offices of Jody C. Moore, APC
