ARF vs. RCFE vs. other options for adults with disabilities

CDSS describes ARFs as providing 24-hour non-medical care and supervision for adults 18 to 59. Title 22 §80001 defines an ARF the same way and allows people 60 and older only under §85068.4, which requires their needs to be compatible with the other clients and the facility to be able to meet them. CDSS says clients may have a mental, physical or developmental disability.

Care and supervision in an ARF can include help with dressing, grooming, bathing and hygiene; help with taking medication and central storage of medications; arranging medical and dental care; house rules for clients' protection; supervising schedules and activities; managing clients' money or property; and monitoring food intake or special diets (CDSS consumer guide, citing §80001).

An ARF may not accept or keep someone whose primary need is acute psychiatric care, who needs inpatient care in a health facility, or who needs more care and supervision than the facility provides (§85068.4). An ARF licensee may allow incidental medical services from a home health agency when specific conditions are met.

CDSS's guide notes that ARFs serving people with mental health needs are also known as board and care homes, and can be a longer-term placement.

The main difference between an ARF and an RCFE is age. An ARF is licensed for adults 18 to 59, while an RCFE (Residential Care Facility for the Elderly) is a housing arrangement mostly for people 60 and older.

Both provide 24-hour non-medical care and supervision and both are licensed by CDSS, but under separate Title 22 chapters: Chapter 6 for ARFs and Chapter 8 for RCFEs. Someone 60 or older can live in an ARF only under §85068.4, so for most older adults an RCFE rather than an ARF is the setting designed for them.

Our sister site RCFE.io covers RCFEs the same way this site covers ARFs.

Social Rehabilitation Facilities (SRFs) are licensed by CCLD and run a mental health program certified by the Department of Health Care Services (DHCS). CDSS says they provide 24-hour non-medical care in a homelike setting, with counseling, psychiatric services and vocational help, and are limited to 16 beds. They come in three kinds:

• Short-term crisis residential programs, generally stays of under 14 or under 30 days;
• Transitional residential programs, designed for three to twelve months;
• Long-term residential treatment programs, which may not extend beyond 18 months.

For people who don't meet the requirements for an SRF, or need a more permanent home, CDSS points to ARFs. Programs that need DHCS certification may require a referral from a county Mental Health Plan.

The Department of Developmental Services (DDS) coordinates services for people with developmental disabilities through California's 21 regional centers. Providers must be vendored by a regional center to provide and be paid for services. CDSS describes three specialized ARF types:

Enhanced Behavioral Support Homes (EBSH)

ARFs providing 24-hour non-medical care to adults with developmental disabilities who need enhanced behavioral supports, staffing and supervision.

Community Crisis Homes (CCH)

ARFs providing 24-hour non-medical care and crisis intervention for adults with developmental disabilities who would otherwise be at risk of an institutional placement, focused on stabilization and a move to long-term placement.

ARFs for Persons with Special Health Care Needs (ARFPSHN)

Homes for up to five adults with developmental disabilities who have special health care needs, with 24/7 licensed nursing support.

CDSS says programs certified by DDS require a referral from a regional center. See who ARFs serve for more on these populations.

• Adult Day Programs provide non-medical care and supervision to adults 18 and over for less than 24 hours a day, in a community setting.
• Residential Care Facilities for the Chronically Ill care for adults with HIV disease or AIDS, and for some people with a terminal illness, according to CDSS.
• Skilled nursing facilities must provide 24-hour skilled nursing care, according to the California Department of Aging, and are licensed by CDPH rather than CDSS, so they are not on this site.

CDSS's advice is to start with the type and level of care needed, then preferences such as size, layout and location. It also stresses working with your placement agency or advocate, since some programs need a referral:

• Regional centers provide diagnosis and assessment of eligibility, and help plan, coordinate and monitor services for people with developmental disabilities.
• County mental health programs are the starting point for mental health services; DHCS runs an ombudsman for people who need help getting them.
• Each county has Adult Protective Services, which CDSS describes as helping dependent adults who cannot meet their own needs or are victims of abuse, neglect or exploitation.

Once you have a short list, search ARFs near an address or browse by county, and read each home's inspection reports. Facility Search can filter by the populations a home serves.