What’s the difference between assisted living and a nursing home?
In California, assisted living and board and care are one license, the RCFE: a non-medical home. A nursing home is a medical facility, with nurses on site around the clock.
Checked against Title 22, the Health and Safety Code, Medicare.gov and CDSS recordsHow we check
- Assisted living and board and care
- One license, the RCFE: a non-medical home licensed by the Department of Social Services. 8,620 are licensed today.
- Nursing home
- A medical facility licensed by the Department of Public Health. Medicare pays for up to 100 days after a hospital stay, not for living there.
Sources: CDSS records, November 12, 2026 · Medicare.gov, 2026
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The rules this check uses
The law’s own words, with the day we last checked each one.
“Residential care facility for the elderly” means a housing arrangement chosen voluntarily by persons 60 years of age or over, or their authorized representative, where varying levels and intensities of care and supervision, protective supervision, or personal care are provided, based upon their varying needs, as determined in order to be admitted and to remain in the facility. Persons under 60 years of age with compatible needs may be allowed to be admitted or retained in a residential care facility for the elderly as specified in Section 1569.316.
The following persons may be accepted or retained by the licensee:
(1) Persons capable of administering their own medications.
(2) Persons receiving medical care and treatment outside the facility or who are receiving needed medical care from a visiting nurse.
(3) Persons who may need assistance with self-administration of medication as specified in Section 87465, Incidental Medical and Dental Care Services.
(4) Persons who display behavioral expression as defined in Section 87101, Definitions.
(5) Persons who may need assistance with managing money.
(6) Persons with mild temporary emotional disturbance resulting from personal loss or change in living arrangement.
(7) Persons who are bedridden provided the requirements of Section 87606 are met.
(8) Persons who are under 60 years of age whose needs are compatible with other residents in care, if they require the same amount of care and supervision as do the other residents in the facility.
(9) Persons who have been diagnosed as terminally ill and who have obtained the services of hospice, certified in accordance with federal medicare conditions of participation and licensure, provided the licensee has obtained a facility hospice care waiver in accordance with the provisions of Section 87632, Hospice Care Waiver, and hospice care is being provided in accordance with the provisions of Section 87633, Hospice Care for Terminally Ill Residents.
This section applies to the care of residents diagnosed with dementia. Mild cognitive impairment, as defined in Section 87101, Definitions, is not considered to be dementia.
Ensuring staff receive the following training as part of the training requirements specified in Section 87208 Plan of Operation:
(A) Dementia care, including, but not limited to, knowledge about hydration, nutrition, skin care, communication, therapeutic activities, behavioral challenges, the environment, and assisting with activities of daily living;
(B) Recognizing symptoms that may create or aggravate behavioral expression, as defined in Section 87101, Definitions, including, but not limited to, dehydration, urinary tract infections, and problems with swallowing; and
(C) Recognizing the effects of medications commonly used to reduce behavioral expression.
The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement, as defined in Section 87101, Definitions.
In order to accept or retain terminally ill residents and permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice care waiver from the Department.
Important! The licensee must have an approved hospice waiver or an exception from the department when accepting or retaining residents who receive hospice services.
“Nonambulatory Person” means a person who is unable to leave a building unassisted under emergency conditions. It includes, but is not limited to, those persons who depend upon mechanical aids such as crutches, walkers, and wheelchairs. It also includes persons who are unable, or likely to be unable, to respond physically or mentally to a sensory signal approved by the State Fire Marshal, or an oral instruction relating to fire or other dangers and, if unassisted, to take appropriate action relating to such danger.
All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal:
(1) Nonambulatory persons.
(2) Bedridden persons
Notwithstanding paragraph (2) of subdivision (a), bedridden persons may be admitted to, and remain in, residential care facilities for the elderly that secure and maintain an appropriate fire clearance. A fire clearance shall be issued to a facility in which one or more bedridden persons reside if either of the following conditions are met:
(1) The fire safety requirements are met. Residents who are unable to independently transfer to and from bed, but who do not need assistance to turn or reposition in bed, shall be considered nonambulatory for purposes of this paragraph.
(2) Alternative methods of protection are approved.
The licensee may provide care for residents who have any of the following restricted health conditions, or who require any of the following health services:
(1) Administration of oxygen as specified in Section 87618.
(2) Catheter care as specified in Section 87623.
(3) Colostomy/ileostomy care as specified in Section 87621.
(4) Contractures as specified in Section 87626.
(5) Diabetes as specified in Section 87628.
(6) Enemas, suppositories, and/or fecal impaction removal as specified in Section 87622.
(7) Incontinence of bowel and/or bladder as specified in Section 87625.
(8) Injections as specified in Section 87629.
(9) Intermittent Positive Pressure Breathing Machine use as specified in Section 87619.
(10) Stage 1 and 2 pressure injuries as specified in Section 87631(a)(3).
(11) Wound care as specified in Section 87631.
Ensure that facility staff who will participate in meeting the resident's specialized care needs complete training provided by a licensed professional sufficient to meet those needs.
(A) Training shall include hands-on instruction in both general procedures and resident-specific procedures.
(B) Training shall be completed prior to the staff providing services to the resident.
Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly:
(1) Stage 3 and 4 pressure injuries.
(2) Gastrostomy tubes.
(3) Naso-gastric tubes.
(4) Staphylococcus aureus (“staph”) infection or other serious infection.
(5) Residents who depend on others to perform all activities of daily living for them as set forth in Section 87459, Functional Capabilities.
(6) Tracheostomies.
Facilities that have satisfied the requirements of Section 87632, Hospice Care Waiver, are not required to submit written exception requests under this section for residents or prospective residents with restricted health conditions under Section 87612 and/or prohibited health conditions under Section 87615 provided those residents have been diagnosed as terminally ill and are receiving hospice services in accordance with a hospice care plan as required under Section 87633, Hospice Care for Terminally Ill Residents, and the treatment of such restricted and/or prohibited health conditions is specifically addressed in the hospice care plan.
As specified in Section 87209, Program Flexibility, the licensee may submit a written exception request if he/she agrees that the resident has a prohibited and/or restrictive health condition but believes that the intent of the law can be met through alternative means.
No resident shall be accepted or retained if any of the following apply:
(1) The resident has active communicable tuberculosis.
(2) The resident requires 24-hour, skilled nursing or intermediate care as specified in Health and Safety Code Sections 1569.72(a) and (a)(1).
Except as otherwise provided in subdivision (d), no resident shall be admitted or retained in a residential care facility for the elderly if any of the following apply:
(1) The resident requires 24-hour, skilled nursing or intermediate care.
(2) The resident is bedridden, other than for a temporary illness or for recovery from surgery.
Checked against Title 22, the Health and Safety Code, Medicare.gov and CDSS recordsHow we check
What does RCFE mean?
RCFE stands for residential care facility for the elderly. It is a home where people 60 and older live and get care and supervision: help with bathing, dressing, medicines and meals. Health and Safety Code §1569.2(o)(1) Younger people with compatible needs may live there too. Health and Safety Code §1569.2(o)(1)
An RCFE follows a social model, not a medical one. It does not have to employ nurses. Its staff must be enough in number, and trained, to meet the residents’ needs. Title 22 §87411(a)
A care home may not admit or keep someone who needs 24-hour skilled nursing care. Health and Safety Code §1569.72(a)
Are assisted living and board and care different?
Not in law. Both hold the same RCFE license; the names describe size. 6,924 of 8,620 licensed homes (80%) are licensed for six or fewer residents, and are often called board and care. 1,368 are licensed for 16 or more, and usually call themselves assisted living (CDSS records, November 12, 2026).
The rules are the same at any size, with one difference at night. A home for fewer than 16 residents must have a qualified person on call on the premises. A home for 16 to 100 must have one awake. Title 22 §87415(a) Read Board and care or assisted living for the rest.
What is a nursing home?
A nursing home, or skilled nursing facility, is a medical facility licensed by the California Department of Public Health. Most are certified by Medicare and Medi-Cal. Licensed nurses care for residents around the clock.
People go to one for rehab after a hospital stay, or to live when they need nursing care every day. Medicare’s Care Compare lists California’s nursing homes, with their inspections.
Which one does your family member need?
Most help with daily life can be given in a care home: bathing, dressing, medicines, money, and care for memory loss. Title 22 §87455(b) Some health needs require an approval on the home’s license, such as hospice care. Others require a fire clearance, such as care for someone who cannot leave the building alone in an emergency. Title 22 §87202(a) Title 22 §87101(n)(2)
A care home may not admit or keep someone who:
- needs 24-hour skilled nursing or intermediate care; Title 22 §87455(c) Health and Safety Code §1569.72(a)
- has active tuberculosis that can spread; Title 22 §87455(c)
- has one of the conditions Title 22 lists, such as stage 3 or 4 pressure injuries, a feeding tube, a tracheostomy, or a staph or other serious infection. Title 22 §87615(a)
There are two ways a care home may keep someone with a listed condition. The resident may be on hospice, in a home with the state’s hospice care waiver, with the condition in their hospice care plan. Title 22 §87616(c) Or the state may grant the home a written exception. Title 22 §87616(a)
A care home may care for some other conditions once a licensed professional has trained its staff. They include oxygen, a catheter, insulin injections, incontinence and wound care. Title 22 §87612(a) Title 22 §87613(a)(2) Ask each home about them.
Someone who stays in bed may live in a care home that has a fire clearance for it. Health and Safety Code §1569.72(c) A short illness of 14 days or less does not count. Health and Safety Code §1569.72(d)(1)
Your family member’s doctor’s report and the home’s own written appraisal decide whether a home can meet their needs. Title 22 §87457(c)
Which costs more?
A nursing home costs more than assisted living in California, in CareScout’s 2025 survey of monthly medians.
| Care home (RCFE) | Nursing home | |
|---|---|---|
| Licensed by | Department of Social Services | Department of Public Health |
| Care | Non-medical: care and supervision | Medical: nurses around the clock |
| Monthly median, 2025 | Assisted living, private one-bedroom: $7,000 | Shared room: $12,167; private: $15,178 |
| Medicare | Does not pay to live there | Up to 100 days after a hospital stay |
| Medi-Cal | The Assisted Living Waiver, for care, in participating homes | Long-term care, for people who qualify |
| Find one | Find homes (the directory) | Care Compare (Medicare.gov) |
No survey we found gives a California figure for board and care alone. Each home sets its own price.
Licensed care homes near you
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What does Medicare pay?
Medicare does not pay to live in either one. After at least 3 days as a hospital inpatient, it can pay for up to 100 days of skilled nursing care. 42 CFR §409.30(a)(1)
- Part A deductible, each benefit period
- $1,736Medicare.gov, 2026
- Days 1–20
- $0Medicare.gov, 2026
- Days 21–100
- $217 a dayMedicare.gov, 2026
- Day 101 on
- All costsMedicare.gov, 2026
Your family member does not have to be getting better. Medicare covers skilled care that improves their condition, maintains it, or slows its decline.
What does Medi-Cal pay?
In a nursing home, Medi-Cal can pay for long-term care for people who qualify. In a care home, its Assisted Living Waiver pays for care, not room and board, in participating homes in 15 counties. 1,065 licensed homes are on the DHCS list on file with us. Read Paying for care in California, step 2.
What are the drawbacks of assisted living?
Families weigh four, all facts of the license:
- Cost. Medicare does not pay to live there; unless a program helps, the resident pays the monthly rate.
- No nurse required. A care home does not have to employ nurses; nurses come from outside, such as home health or hospice. Health and Safety Code §1569.39(a)
- No fixed staff ratio. California sets no daytime ratio for care homes. Staff must be enough to meet residents’ needs, and the night rule depends on size. Title 22 §87411(a) Title 22 §87415(a)
- Needs can outgrow the home. If a reappraisal finds a need the home cannot meet, it may give 30 days’ written notice. Title 22 §87224(a)
Before the move, the home must tell the person moving in, in writing, what needs it cannot meet. Health and Safety Code §1569.269(a)(15)
How do I check a license?
Search any home by name or license number. Its page shows the license status, its capacity, its approvals and its state reports, each with a date. How to check a care home’s license
Questions families ask · 5
What disqualifies someone from assisted living in California?
Needing 24-hour skilled nursing, active tuberculosis, or one of the conditions Title 22 lists, such as a feeding tube. A home may keep someone with a listed condition only on hospice under the state’s waiver, or with a written exception from the state.
Can a care home take someone with dementia?
Yes. Any licensed home may care for a resident with dementia, and it must follow Title 22’s dementia rules. Read Memory care in California.
Is a nursing home the same as skilled nursing?
Yes. Both names mean a skilled nursing facility: a medical facility licensed by the Department of Public Health.
Does Medicare pay for assisted living?
No. It can pay for a short skilled nursing stay after a hospital stay.
What does RCFE stand for?
Residential care facility for the elderly: California’s license for assisted living and board and care.
Next, step 2 of 6: Ways to pay for care
- Paying for a care home in California
Most residents pay privately: about 17% had any care paid by Medicaid in 2022 (CDC). The California median for assisted living was $7,000 a month in 2025 (CareScout).
- Medi-Cal’s Assisted Living Waiver
Medi-Cal can pay a participating home for care, not rent, in 15 counties. 15,910 people were waiting in March 2026 (DHCS).
- SSI in a care home
SSI/SSP pays $1,626.07 a month in a licensed care home in 2026. A home that accepts it may charge $1,444.07 for basic services.
- When the money runs out
A home may give 30 days’ notice once the basic rate is 10 days late. Ask before moving in whether it will take SSI or Medi-Cal later.