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Small Is Beautiful . . . Board and Care Seeks Recognition; Representation

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By Pam McDonald

[This is the first of a two-part series describing a new association in California for small Board and Care owner-operators.]

In the early 1990s when California first required educational certification for assisted living administrators, groups seeking to train and represent them popped up and disappeared regularly. After about a decade, this activity stabilized and essentially stopped. But this year, a new California senior living association has been launched.

California Board and Care Association

Called the California Board and Care Association (CBCA), its aim is to improve and support the redheaded stepchildren of senior living – small, typically 6-bed, personal care homes. Officially designated in California as Residential Care Facilities for the Elderly (RCFEs), they are also called adult family homes, board and care, residential care, and personal care homes.

And while many people think “board and care” and “assisted living” are two separate levels of care, in actuality, they are more brother and sister than unrelated families. “We have a lot of work to do to raise awareness about board and care,” says Mylene Lee, President of CBCA. “The general public and, even many senior care professionals, don’t know much about who we are, what we do, or how we do it.

Assisted Living vs. Board and Care Homes

As in many other states, California’s assisted living (AL) communities and board and care (BC) homes are licensed and governed by the same state laws and regulations. They both serve seniors age 60+ and are non-medical facilities so they are not required to have nurses, certified nursing assistants or doctors on staff.

Communities referred to as "Assisted Living" usually have 50+ residents who live in private apartments with private bathrooms. Board and Care is typically a 3+-bedroom home with space for group activities and dining. Residents may have their own room, but often share a room and a bathroom.

AL and BC both serve seniors who prefer not to live alone or whose families prefer it. Both types provide the same basic services – rooms; meals; housekeeping; leisure activities; supervision, storage and distribution of medication; and assistance with activities of daily living, like dressing, bathing, hygiene, eating, and mobility.

The Statistics

In 2012, according to the National Center for Health Statistics, assisted living, which includes board and care, was the Number #1 source of long-term care services in the United States with 22,200 paid providers. Overall nearly 59,000 paid care providers served about 8 million residents. In addition to the 22,200 ALs, there are 15,700 nursing homes, 12,200 home care agencies, 4,800 adult day care centers, and 3,700 hospices.

The California HealthCare Foundation found that in 2013 there were 7,455 licensed RCFEs in the State with 145,225 beds. The percentage of these communities by size is:

1-6 beds  80%

7-14 beds  4%

15-49 beds  6%

50-99 beds  5%

100+  6%

While board and care has the most facilities, assisted living has the capacity to serve twice as many residents. The breakdown for capacity shows:

48% have 100+ beds

24% have 1-6 beds

18% have 50-99 beds

8% have 15-49 beds  

2% have 7-14 beds   

The monthly rates charged by AL and BC can also differ significantly. The California HealthCare Foundation noted that rates range from $933 per resident per month to $8,445 (with the median at $3,710). Unfortunately their report does not indicate if these rates are for rent and basic services only or whether they also include care. Nor does it provide averages for each type of care.

[Watch for Part 2 of this series coming soon!] For additional information, contact Mylene Lee at (916) 295-0135 or visit the California Board & Care Association CBCA page on Facebook.

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