RCFEs by the Numbers
What are RCFEs?
Residential Care Facilities for the Elderly (RCFEs), which encompass Assisted Living, Memory Care, and Continuing Care Retirement Communities (CCRCs), are essential components of California’s care continuum, helping to care for a significant portion of the state’s growing older population.
RCFEs provide 24-hour care and supervision in a residential setting for older adults who need assistance with activities of daily living (ADLs) but do not require around-the-clock nursing care. Communities meeting additional staff training, programming, and physical plant requirements to provide housing and services to residents living with dementia are commonly known as Memory Care communities. Assisted Living can also be found in a CCRC as part of a continuum of care typically provided in one location along with independent living and skilled nursing.
RCFEs are licensed by the Department of Social Services (DSS) and are governed by a robust set of laws and regulations. The regulatory framework is designed to promote resident independence and self-direction to the greatest extent possible in a residential, non-medical setting.
According to DSS1, California currently has over 7800 licensed RCFEs that can provide a home and care for more than 210,000 residents. Based on projections by the California Department of Finance2, that accounts for 24 percent of the state’s 85-plus population.
Eighteen percent of California’s RCFEs are licensed to care for 16 or more residents; these communities serve 81 percent of the state’s RCFE residents. Eighty-one percent of RCFEs are small communities licensed to serve up to 15 residents; this type of RCFE serves 19 percent of California’s residents.
About 660 California RCFEs are members of the California Assisted Living Association (CALA), which helps support the delivery of quality service and care by providing tools and resources, continuing education, and advocacy. CALA-member communities serve about thirty percent of the state’s RCFE residents.
What do RCFEs provide?
Services may include:
- Assistance with ADLs: eating, bathing, dressing, toileting, mobility, etc.
- Medication management
- Social and recreational activities
- Housekeeping services
- Dementia care
- Health-related services
These services are provided in a variety of communities, including family-owned-and-operated communities, providers who serve seniors in several communities within California, and providers who offer services in communities in multiple states. These senior housing options are non-institutional, home-like settings that promote maximum independence and dignity for each resident and encourage family and community involvement.
What do residents think?
ProMatura, a global market research firm, conducted the first-of-its-kind study of California’s residents and family members3. The study, commissioned by CALA, revealed the positive impact that California’s Assisted Living and Memory Care communities are having in the lives of residents. An overwhelming majority of residents—98 percent—said the staff members in their communities were friendly, 95 percent said they were comfortable with the people who work and reside in their community, and 94 percent said they receive the help they need and the privacy they want. When asked whether they felt safe and secure in their community, 95 percent of residents agreed. In conclusion, the study found that RCFEs provide a high quality of life for residents by meeting their needs with respect and care.
What does it cost?
According to a 2021 Genworth report4, Assisted Living in California costs an average of $5250 per month. Costs vary by community type, location, apartment size, and the services needed by each resident. A base fee may cover all services, or there may be additional charges for special services. All fees are identified in the admission agreement.
One difference between CCRCs and other senior housing models is the structure provided by the CCRC contract. While residents of other housing types usually pay monthly fees, CCRC residents typically pay both an entrance fee and a monthly fee, which is tied to current services and anticipated future care.
The typical payer source is the resident or family. Some use long-term care insurance, Veteran’s Benefits, or SSI/SSP. In California, a limited number of older adults in 15 counties are able to receive care through a Medi-Cal Assisted Living Waiver Program.
Current law requires admission agreements to disclose pricing structures and reasons rates may go up. Communities must also provide written disclosure of their prior rate increase history for the past three years. Disclosure of the reasons for a rate increase, along with the amount of the increase, are required at least 60 days in advance. These laws help ensure that consumers understand the cost of care and have adequate notice of changes.
How is it growing?
In response to the aging of the population and consumer demand, the capacity to care for residents has grown steadily. Since 2007, DSS5 reports that RCFEs in California added the capacity to care for an additional 40,000 seniors. The number of small communities caring for up to 15 residents has decreased by about eight percent, and the number of communities caring for 16 or more residents has increased by about 18 percent.
According to the California State Plan on Aging6, California is home to more than seven million people age 60 or older. By 2060, that population is expected to reach 14.7 million, an increase of 88 percent from 2016. In addition, the population of Californians 85 and older is expected to grow from about 600,000 in 2010 to over 2.25 million in 2050. As those numbers increase, so too will the demand for the type of quality care and services found in California’s Assisted Living, Memory Care, and Continuing Care Retirement Communities.
1Residential Care Facilities for the Elderly data download. California Department of Social Services, January 2023.
2State Population Projections (2010-2060): Total Population by Age. California Department of Finance, January 2018.
3California’s Assisted Living Communities Provide Quality of Life to Residents and Family Members. ProMatura, 2016.
4Genworth Cost of Care Survey 2021. Genworth Financial, 2021. Accessed January 9, 2023.
5Community Care Licensing Division (2005-2018): RCFE/CCRC Facility List, requested via mail. California Department of Social Services.
6California State Plan on Aging: 2017-2021. California Department of Aging, 2017.