Residential Care Facilities for the Elderly

Two reports discuss the RCFE industry and facilities, supply and demand trends, cost-effectiveness arguments, national and California quality assurance and data systems, and recommendations for piloting demonstration projects.

January 2002

Nationwide, more than 1.5 million individuals, mostly elderly, live in some form of supportive housing, with more than 800,000 residing in licensed facilities (such as foster family homes, small family homes, group homes, social rehabilitation facilities, and residential care) and an equal number estimated to be living in unlicensed facilities, including rooming homes, single-room occupancy hotels, and group quarters with fewer than seven unrelated individuals.

These facilities not only provide residents with shelter, but also meals, cleaning, and laundry services. Most licensed facilities also offer help with transportation and shopping, supervision (but not administration) of medications, assistance in obtaining medical and social services, and limited help with activities of daily living such as bathing, dressing, grooming, eating, and transfers into and out of chairs and beds. A few facilities also have licenses and/or regulatory waivers to provide additional services for residents with special needs, such as those who need oxygen or have cognitive impairments.

Surprisingly little is known about this industry that provides vital services to more than one million individuals who are among the oldest and frailest members of society. Answers are largely unavailable to basic questions such:

  • What is the quality of services provided by these facilities? Who provides the services and are they meeting the needs of residents?
  • Are these facilities cost-effective? In other words, are the costs of care associated with residential care more than offset by "savings" elsewhere, such as reductions in the need for more expensive nursing home services, or avoidance of acute health episodes that result in costly emergency room visits or hospitalizations?

A Primer on Residential Care Facilities for the Elderly (RCFE) sheds some light on these issues by reviewing the available evidence. But because available data are limited, the report also includes a set of recommendations for policymakers to consider in order to address the information gaps that exist today. The primer was adapted by the California HealthCare Foundation from the full report (also available below), Residential Care for the Elderly: Supply, Demand, and Quality Assurance, by Robert Newcomer, Ph.D., and Robert Maynard, M.B.A.