Board and Care Homes
Board & care homes (B&C) offer the same types of services as the larger communities, but service is provided in a small residential setting. The intimate setting afforded by board and care homes allows for closer oversight of residents and is accompanied by a higher staff to resident ratio. They share the same Residential Care Facilities for the Elderly (RCFE) license as the big buildings. Both are regulated and monitored by the California Department of Social Services.
In California, board and care homes operate in residential neighborhoods and generally have a limit of six residents. Some operators convert existing houses into B&C homes. Others are purpose built. Driving down the street, you probably would not know that a house is operating as a board and care provider. From the outside, the home looks just like any other on the street, except of course, for the ADA compliant entrances and walkways.
Board and care homes range from three to six bedrooms offering both private and shared rooms. Not all houses have private bathrooms. Rooms with private baths can be more expensive and often depend on whether the house was purpose-built or a retrofit of an existing structure.
The benefit of a B&C is the small size and higher staff ratio. In Los Angeles, the good homes have at least two caregivers for every six residents. A more fragile resident or one needing close 24-hour supervision benefits from this type of environment since it provides the closest thing to having a private caregiver without the cost.
Houses have different arrangements for staffing. There seems to be an equal split of B&C homes with on-site live-in caregivers and those that have caregivers working in shifts. In a few instances, the owners of the home live on premises and have designated certain rooms for the care of residents, perhaps using the downstairs for the residents and maintaining their own quarters on the second floor.
Is Board and Care the Same as Assisted Living?
Both board and care homes and the larger assisted living facilities like Sunrise Senior Living or Brookdale Senior Living share the same Residential Care Facilities for the Elderly (RCFE) license. They are both assisted livings regulated and monitored by the California Department of Social Services. From a licensing perspective, the only difference between the two is the number of residents permitted to live in the facility and whether the facility can be in a residential neighborhood.
Who Should Live at a Board and Care?
Board and Care homes are most appropriate for residents needing a lot of hands-on physical care or those who do not benefit from the dining rooms, movie theaters and activities of larger communities. In the Los Angeles area, the majority of B&Cs cater to residents with mid to late-stage dementia and conditions that make the individual no longer able to ambulate.
Board and Care Homes vs Nursing Homes
Many seniors as they age, and have increasing needs, require help with what is known as Activities of Daily Life (ADLs). ADLs include:
- Personal hygiene – bathing/showering, and grooming
- Dressing – choosing clothes and physically dress and undress oneself.
- Eating – the ability to eat independently
- Maintaining continence – being able to mentally and physically toilet. This includes the ability to get on and off and cleaning oneself.
- Transferring - being able to stand from a sitting position, as well as get in and out of bed.
- Mobility - the ability to walk independently from one location to another.
- Medication Management – Ordering, managing and ingesting medications on a schedule on one’s own.
Assistance with ADLs can be performed by caregivers or CNAs. It does not require a skilled professional such as a nurse or doctor. Seniors who need this type of custodial care for their ADLs usually do best in a home-like assisted living environment rather than in a medical-style nursing facility. Those whose needs may require round-the-clock 24-hour supervision find that a board and care style of assisted living may be most suited to their needs.
How Much do Board & Care Homes Cost?
Board & Care homes may be slightly less expensive than the larger communities. Whereas the large properties charge a base rate plus a separate rate for care, board and care pricing is all-inclusive. Prices may be as low as $4000/month for a shared room in the San Fernando Valley to $9000/month for a private room with private bath in the Santa Monica or Westwood area. Board and care homes are not covered by Medicare. In limited instance, Medi-Cal may cover costs but, in general, it is best to assume that care homes are private pay.
What to Look for in a Board and Care Home
There are over 2000 board and care homes in the Greater Los Angeles area, and they run the gamut in quality. Of all the types of senior care, board and care homes are where it is best to use a trained professional in your search. Senior Living Advisors, sometimes called Senior Placement Experts are specialists in identifying good board and care homes. Their services are offered at no charge to the family. In Los Angeles, Assisted Living Locators is one of the most highly regarded, using a multi-level review process to compile a roster of quality care homes to meet different requirements, costs, and care needs.
Independent living communities in Los Angeles provide housekeeping, meals and social activities but no supervision or medical care.
Many people don't need to leave home, but do need assistance with daily activities like shopping, cleaning, and health care. It's important to find someone you trust to help.