Who ARFs serve: developmental, mental health and other adult populations

Title 22 §80001 defines an ARF as a facility of any capacity that provides 24-hour non-medical care and supervision to adults 18 through 59, and to people 60 and older only in line with §85068.4.

Under §85068.4, a licensee may admit or keep someone 60 or older whose needs are compatible with the other clients, if they need the same level of care and supervision and the licensee can meet their needs. The person's file must then include:

• a completed functional capabilities assessment;
• a needs and services plan that says how any age-related care needs will be met;
• a medical assessment signed by a physician within the last year;
• a letter of support from a conservator with placement authority, if there is one, and any letters of support from a placement officer, social worker or mental health professional.

The Department of Developmental Services (DDS) coordinates services for Californians with developmental disabilities through 21 community-based, non-profit regional centers. CDSS's consumer guide explains that regional centers provide diagnosis and assessment of eligibility, and help plan, coordinate and monitor services. Providers must be vendored by a regional center before they can provide, and be paid for, services to regional center clients.

Title 22 sets some rules specifically for regional center clients. For example, §85065.5 requires that when a client who relies on others for all activities of daily living is present, staffing for regional center clients be as specified by the regional center, but never less than one direct care staff member to three such clients.

CDSS also licenses specialized ARFs for adults with developmental disabilities:

• Enhanced Behavioral Support Homes, for adults who need enhanced behavioral supports, staffing and supervision;
• Community Crisis Homes, for adults who need crisis intervention and would otherwise be at risk of an institutional placement;
• ARFs for Persons with Special Health Care Needs, for up to five adults with special health care needs and 24/7 licensed nursing support.

CDSS says DDS-certified programs require a referral from a regional center. See homes serving adults with developmental disabilities.

CDSS's consumer guide notes that ARFs serving people with mental health needs are also known as board and care facilities, and can be a more permanent placement than a social rehabilitation program.

Two Title 22 rules matter here:

• Before accepting a client with mental illness, an ARF must have a written intake assessment prepared by a licensed mental health professional (§85069.3, quoting Health and Safety Code §1562.6).
• An ARF may not accept or keep anyone whose primary need is acute psychiatric care due to a mental disorder (§85068.4).

County mental health programs are the starting point for mental health services, and programs that need certification from the Department of Health Care Services may require a referral from a county Mental Health Plan. See homes serving adults with mental health needs.

CDSS lists physical disability among the needs ARF clients may have. Title 22 §80001 defines a nonambulatory person by reference to the Health and Safety Code: broadly, someone unable to leave a building unassisted under emergency conditions, including people who depend on aids such as walkers or wheelchairs. A facility may not operate beyond the conditions on its license, and rooms approved for ambulatory clients only may not be used by nonambulatory clients (§80010), so ask whether a home can serve nonambulatory clients if that applies.

Under §85068.4, an ARF may not accept or keep:

• people with health conditions the regulations prohibit (§80091);
• people who need inpatient care in a health facility;
• people whose needs conflict with other clients' needs or the program offered;
• people who need more care and supervision than the facility provides;
• anyone whose primary need is acute psychiatric care due to a mental disorder.

CCLD's record for each facility lists the populations it serves, using labels such as Developmentally Disabled (DD), Mentally Disabled (MD), Developmentally / Mentally Disabled (DD/MD) and Adults. Facility pages here show them under "Serves," and Facility Search can filter by them. A label tells you how the state's record categorizes the home, not how well it meets those needs, so confirm details with the facility and, where one is involved, your regional center or county program.

For help choosing among homes, see questions to ask when touring and ARFs and other options.