What Does a Residential Care Facility for the Elderly Owe Its Residents?

If you have placed an elderly loved one into a residential care facility, you may be concerned about their well-being. This is normal, but it’s important to be informed about what exactly a residential care facility owes its residents and patients in terms of health and safety.

A Residential Care Facility for the Elderly (RCFE) is a type of long-term care facility designed to provide housing, supervision, and assistance with daily living activities for elderly individuals who may require some level of support, but do not need the intensive medical and nursing care provided in nursing homes.

Residential care facilities for the elderly (or RCFE) are also known as assisted living facilities or “board and care” homes. These can include large facilities as well as those with as few as six beds. They differ from nursing homes in that they provide:

… non-medical care and supervision for persons 60 years or older who may need assistance with activities of daily living. RCFE residents should not require on-going medical assistance from facility staff. RCFEs may also serve persons under the age of 60 who have similar needs. RCFEs may care for individuals who have dementia if the facility is adequately equipped and staff are trained and sufficient to meet the needs of all residents.

It’s important to note that places like senior housing complexes or retirement villages are not required to be licensed as RCFEs.

As you can see, an RCFE is not the same as a nursing home and does not provide medical care. RCFE living can range from a private bedroom, a shared bedroom, or a full apartment. Nursing homes (also called skilled nursing facilities) generally operate under a different set of rules.

What makes RCFEs different than nursing homes and what services do they provide?

The difference between a Residential Care Facility for the Elderly (RCFE) and a nursing home lies primarily in the level of care provided and the types of services offered. Following is a breakdown of the main distinctions:

Level of care

RCFEs provide housing, meals, personal care assistance, and supervision for elderly individuals who require some assistance with activities of daily living (ADLs), such as bathing, dressing, and medication management. However, RCFEs generally do not provide skilled nursing care regularly.

Nursing homes offer 24-hour skilled nursing care and medical services for individuals with complex medical needs. Residents in nursing homes often have chronic health conditions, require ongoing medical supervision, and may need assistance with tasks like wound care, medication administration, and physical therapy.

Staffing and services

Staffing in RCFEs typically includes caregivers who assist residents with daily living activities, medication reminders, housekeeping, and meal preparation. While some RCFEs may employ nurses or have access to nursing services, the level of medical care provided is generally lower as compared to nursing homes.

Nursing homes have a higher ratio of licensed nurses and certified nursing assistants (CNAs) who provide skilled nursing care, administer medications, perform medical treatments, and monitor residents’ health status. These facilities offer a range of medical services and therapies to meet the needs of residents with complex health conditions.

Regulatory oversight

RCFEs are regulated at the state level and must comply with licensing requirements and regulations that govern issues such as staffing ratios, resident rights, safety standards, and quality of care. Regulations for RCFEs may vary from state to state.

• The California Department of Social Services (Community Care Licensing Division) is responsible for licensing all RCFEs throughout the state.
• In Arizona, it is the Arizona Department of Health Services.
• In Kentucky, it is the Kentucky Board of Licensure for Long-term Care Administrators.
• Finally, in Louisiana, assisted living is overseen by the Louisiana Department of Health (Health Standards Section).

Nursing homes are subject to federal regulations established by the Centers for Medicare & Medicaid Services (CMS). These regulations set standards for staffing, quality of care, infection control, resident rights, and more. Nursing homes must meet specific criteria to participate in Medicare and Medicaid programs.

Are RCFEs understaffed?

By all accounts, the majority of them are. Agency Forward reports:

In the United States, 99% of nursing homes and 96% of assisted living facilities are grappling with severe staffing shortages. Since March 2020, the nursing home sector has witnessed a reduction of approximately 235,000 employed workers, and 52% of assisted living providers report that their workforce situation has worsened as of late.

The effect of understaffing in RCFEs and assisted living facilities can have catastrophic consequences for the residents of the home.

The Washington Post notes:

…many facilities across the nation are now held by investors under pressure to produce profits for shareholders. In some places, a bare-bones approach to staffing and pay has produced a chaotic environment where medications are missed, falls and bed sores go unnoticed, residents are abused and confused seniors wander away undetected, according to a review of 160,000 state inspection reports and interviews with more than 50 current and former employees of assisted-living businesses and relatives of current and former residents.

What issues does understaffing lead to?

Understaffing in RCFEs and assisted living facilities can lead to a variety of issues that affect the quality of care and the overall well-being of residents. Some of the key issues associated with understaffing in assisted living include:

• Decreased quality of care: Understaffing often means that there are not enough caregivers available to attend to the needs of residents promptly and effectively. This can result in delays in assistance with activities of daily living, inadequate supervision, and rushed care, ultimately affecting the quality of care provided.
• Increased risk of medical errors: When staff members are overworked and stretched thin, they may be more prone to making mistakes in administering medications, providing simple treatments, or addressing medical emergencies. This can lead to medication errors, improper wound care, and other medical complications that jeopardize the health and safety of residents.
• Neglect and abuse: Understaffing can create an environment where residents are more vulnerable to neglect and abuse. Overworked and stressed caregivers may be more likely to neglect residents’ needs or, in some cases, exhibit abusive behavior toward them. Without adequate supervision and oversight, instances of neglect and abuse may go unnoticed or unaddressed.
• Increased risk of falls and accidents: Residents in assisted living facilities may require assistance with mobility and fall prevention measures. Understaffing can make it difficult to provide necessary support and supervision, leading to an increased risk of falls, accidents, and injuries among residents.
• Limited social engagement and activities: Adequate staffing is critical for organizing and facilitating social activities and programs for residents. Understaffing can result in fewer opportunities for social interaction, recreational activities, and outings, which can negatively impact residents’ mental and emotional well-being.
• Negative impact on staff morale: Working in an understaffed environment can take a toll on the morale and well-being of caregivers. They may experience high levels of stress, burnout, and job dissatisfaction, which can make staffing shortages worse, as employees may leave their positions or seek employment elsewhere.
• Reduced resident satisfaction: Residents in assisted living facilities may experience decreased satisfaction with their living environment and the care they receive when facilities are understaffed. Long wait times for assistance, limited opportunities for social engagement, and other consequences of understaffing can contribute to residents feeling neglected and unhappy with their overall experience.

Understaffing in assisted living facilities can have serious implications for the quality of care, resident safety, and staff well-being. It underscores the importance of addressing staffing issues to ensure that residents receive the support and attention they need to maintain their independence and quality of life.

Was your loved one injured due to neglect in a residential care or assisted living facility? Please don’t hesitate to call the nursing home attorneys at Garcia & Artigliere. With over 30 years of experience, we have the resources and know-how you need to secure compensation for your loved one’s injuries and losses. To discuss your case, fill out our contact form or call our office to arrange a free, no-obligation case review today. We have offices in Phoenix, Long Beach, Los Angeles, Louisville, and New Orleans.