What is the difference between a Residential Care Facility for the Elderly and a Skilled Nursing Facility?

Residential Care Facilities for the Elderly (RCFEs) are considered non-medical facilities, and are not required to have nurses, certified nursing assistants or doctors on staff. RCFEs provide room, meals, housekeeping, supervision, storage and distribution of medication, and personal care assistance with basic activities like hygiene, dressing, eating, bathing, and transferring. They must meet care and safety standards set by the State and are licensed and inspected by the Department of Social Services.

RCFEs with more than 16 beds are commonly referred to as “Assisted Living” facilities, and RCFEs with less than 6 beds are commonly referred to as “Board and Care” facilities.

Skilled Nursing Facilities (SNFs), on the other hand, are medical facilities that are required to provide 24-hour skilled nursing care. Unlike RCFEs, which only serve persons 60 years of age and older, SNFs can serve people of all ages. In California, “skilled nursing facility” is the formal title for a broad range of facilities also commonly referred to as “convalescent hospitals,” “nursing homes,” or “rehabilitation centers.”

California defines a general service SNF in the following way:

“A SNF is required to provide 24-hour skilled nursing care, as well as related or rehabilitative services. The typical resident is a person who is chronically ill or recuperating from an illness or surgery and needs regular nursing care and other health related services. Residents in SNFs are under the care of their personal physician or the facilities’ medical director. Each resident must have an individual plan of care developed by the physician, resident (or his/her representative) and facility staff. These facilities provide a protective environment with medical and social services for individuals whose care needs cannot be met at home or in a residential care setting. In addition, SNFs provide:

  • Dietary services
  • Social services
  • Pharmaceutical services
  • Recreational therapy services
  • Access to dental care
  • Emphasis on rehabilitation, such as gait training and bowel and bladder training
  • Specialized units for dementia residents
  • Administration of potent injectable medications and intravenous medications and solutions on a regular basis

SNFs may also provide ancillary services such as, physical, occupational, and speech therapies.”

In addition to general service SNFs, there are also:

  • Distinct Part Skilled Nursing Facilities (DP/SNFs): These SNFs are often housed within a hospital or on the same grounds as a hospital. Hospital residents may be transferred to the Distinct Part Facility when their care needs transition from primarily needing “acute” to needing “post-acute” skilled nursing and more intensive rehabilitative services. Most residents stay a short time, and then are discharged to either a SNF or back to their own home. A Distinct Part Facility provides the same services as a SNF as well as treatment for acute illness or injury and intensive rehabilitation services.
  • Intermediate Care Facilities (ICFs): A lower level of nursing home licensed by the California Department of Public Health to provide inpatient care to persons who do not require continuous nursing care, but do need nursing supervision and supportive care. Most ICFs are certified by Medi–Cal and qualify for its payments, although at a lower rate than skilled nursing facilities. Medicare does not certify or pay ICFs, although Medicare beneficiaries who reside in ICFs can use Medicare for covered health services, such as physician care.
  • Institutes for Mental Disease (IMDs): Provide care for residents with mental health disorders. In California, these skilled nursing facilities are designated as special treatment programs (SNF/STPs).
  • Continuing Care Retirement Communities (CCRCs): Provide housing (independent living), assisted living, and nursing care, usually in one location. Residents pay a large entrance fee at admission and sign a contract that entitles them to future care, sometimes for life. CCRCs are primarily regulated by the California Department of Social Services. Additionally, CCRCs that operate a skilled nursing facility must be licensed by the California Department of Public Health.

Medicare also uses the term "skilled nursing facility" for nursing homes that are certified to receive its payments. Medi–Cal uses a similar term, "nursing facility," for nursing homes that are certified to receive Medi–Cal payments. Most, but not all, licensed SNFs in California are certified to participate in Medicare and Medi–Cal.

The residential care and nursing home attorneys at the Southern California Nursing Home Law Group have extensive experience dealing with cases of neglect and abuse in RCFEs and SNFs alike. If you believe that your loved one was neglected or abused by nursing home or assisted living staff, then there may be a viable case under California law. Our nursing home lawyers can help. For a free and confidential evaluation of your specific case, call the Southern California Nursing Home Law Group at (866) 607-1325 or fill out an online questionnaire. Our nursing home attorneys would be happy to assist you.

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