Download Learn How Skilled Nursing is Different from Assisted Living

A Comparison
Skilled Nursing and Rehabilitation &
Residential Care for the Elderly
RESIDENTIAL CARE FACILITIES FOR THE
ELDERLY (RCFEs)
California Association of Health Facilities
SKILLED NURSING AND REHABILITATION
Also known as:
Also known as:
Residential Care Homes – usually six beds
- Board and Care Home
- Retirement Home
- Rest Home
or
Assisted Living – Larger settings with more beds
- Residential Care Facilities for the Elderly (RCFEs)
generally six to 100 beds
- Continuing Care Retirement Communities ( CCRCs)*
- Memory Care – Senior living communities that specialize
in memory care – for early stage dementia
Skilled Nursing Facility** (SNF) – usually 99 beds
- Nursing Home
- Skilled Nursing & Rehab Center
- Convalescent Hospital
These facilities offer non-medical care including private and
semi-private rooms, meals, housekeeping and assistance
with eating, bathing, dressing, hygiene and medication
delivery, but no nursing services
Subacute Care – Specialized medical unit within a nursing
facility for medically complex patients including those on
ventilators. Higher RN staffing requirements
Memory Care Units within Nursing Homes – Specialized
care tailored for the needs of seniors with advanced
Alzheimer’s or other forms of dementia
DP/SNF – A skilled nursing facility that is a distinct part of
a hospital
SNF/STP – Special Treatment Program. Specialized skilled
nursing services for chronic mental health patients in a
secured environment
In-Home or Custodial Care – In home, non-medical
assistance with personal care, domestic activities and
transportation provided by individuals who are not licensed
IMDs – Institution for Mental Disease including acute
psychiatric hospitals, psychiatric health facilities, SNF/STPs
and mental health rehabilitation centers (MHRCs)
Funding Source: Mostly private
Funding Source: Mostly Medi-Cal
Medicare and Medi-Cal do not pay for assisted living, with
some exceptions. Limited Medi-Cal funds for custodial care
Majority of care funded by Medi-Cal. Limited Medicare
funding for short-term rehabilitation. Limited VA benefits
Model of Care: Social
Model of Care: Medical
Staffing – No requirement for licensed health professional
Staffing – Mandatory staffing requirements; Licensed nurse
on site 24/7. RNs, LVNs, certified nursing assistants and
physical therapists present
Medication management – Licensed nurse administers
medications with pharmacist and physician oversight
Licensed by – California Department of Public Health
Inspections –– Every 12 months or less and unannounced
Regulations – Most highly regulated healthcare setting with
hundreds of state statutes and federal regulations
Penalties – Subject to federal civil monetary penalties
Fines up to $10,000 per day and $100,000 per instance
Medication management – Unlicensed staff oversees
delivery of medication – not permitted to dispense
Licensed by – California Department of Social Services
Inspections – Site inspections every five years
Regulations – Minimal state licensing compliance
requirements
Penalties – Not subject to federal civil monetary penalties
Maximum state penalty – $150 per violation
*Confusion often arises because some residential-based housing models, like CCRCs, offer various levels of health care
support in a single location, allowing the resident to initially reside in an independent setting and move
to a more dependent and regulated level of care as needed. Most residents are private pay and a limited number of homes
accept SSI/SSP benefits.
**The typical nursing home resident comes to the skilled facility directly from the hospital following a scheduled surgery (hip
or knee replacement) or an unexpected medical emergency (stroke or heart attack) or because of a dementia-related illness.
For more information visit www.cahf.org
Updated 2/21/14