Table of Content
Overall, less than 10 percent of board and care homes were attached to nursing homes (Exhibit 3-3). Virtually no small homes reported affiliation to a nursing home compared to almost one-third of the large homes. However, licensed homes in States with limited regulations are twice as likely to be attached to nursing homes (see Table A-9). Less than 20 percent of all facilities were nonprofit, with licensed facilities being less likely to be nonprofit than unlicensed homes. Specifically, only 15 percent of small licensed homes were nonprofit compared to almost 40 percent of small unlicensed homes (Exhibit 3-2).
In Section 3, Section 4, and Section 5 of the report we sometimes reference specific appendix exhibits. We hope that this comprehensive presentation of the descriptive results will provide the reader with an overall picture of board and care facilities, their similarities, and their differences. Resident activity level within the home provides some insight into the degree to which facility residents interacted with each other. Only 6 percent of residents reported no involvement with facility activities, while over half of the residents were involved in some type of activity either all or most of their waking hours (Exhibit 6-10). Exhibit 6-4 and Exhibit 6-5 also summarize the significant levels of functional impairment among residents. Seven percent were bedfast or chairfast, and 15 percent used a wheelchair as a primary model of locomotion.
Residential Care Facilities for the Elderly (RCFE)
ASPE placed a high priority on the need to evaluate board and care quality for several reasons. The first thing to remember is that when looking for a board and care home in your particular state, this type of home might go by a different name. If you can’t find what you are looking for under the term board and care, try residential care homes or group homes. Talk with your loved one’s healthcare providers to get some recommendations. Board and care homes will be much smaller and average between two and ten residents. However, some of these homes may provide limited personal care, making it very important to find out exactly what you can expect before making a decision.
Also, with a smaller home, you will still have a smaller staff to resident ratio. Having fewer people to keep track of and monitor can be a benefit. Staff can notice changes or problems and act on them, whereas in assisted living, someone can get lost in the crowd. It may be a potentially less traumatic move since your loved one is moving from one home to another, so the adjustment may not be as intense. In most cases, board and care will be less expensive than assisted living.
8 Regulatory Environment
Instead, some board and care facilities maintain a person on premises 24/7, but whether that person can sufficiently attend to all the residents’ needs can only be assessed on a case by case basis. To file a complaint regarding a state licensed community care facility or child care facility visit our Complaint Hotline Page for contact information and more. In a residential care setting an elderly person still has the ability to carry on as normal a life as they wish or are able. They can go shopping, have friends and family visit whenever they want, go for walks, dine out, etc. Residential care can be a very dignified and cost effective way of dealing with not being able to live independently.
Sixteen percent of the residents used antidepressants, while slightly fewer, 14 percent, used anxiolytics, sedatives, or hypnotics. Half of the residents who used psychotropic drugs did not use mental health services in the previous year; one-fourth of these users had no psychiatric history. Although 28 percent of the operators of small facilities reported earning less than $15,000 annually, only 7 percent of operators of large facilities reported this salary (Exhibit 5-13). However, more operators of small facilities than large facilities reported incomes greater than $75,000 annually (12 vs. 2 percent). About one-fourth of direct care operators were also licensed nurses.
RCFE Staff Training Requirements
Although licensed home operators in a limited regulatory environment were more likely to report always eating with residents, family were more likely to always eat and live in licensed homes in the more extensively regulated States. These homes were usually a family business, although not necessarily a family home. Overall, operators and/or their families lived in almost two-thirds of the facilities (see Table A-12). Because a large proportion of board and care residents take prescription medication, it is particularly important for facilities to have appropriate medication management practices. Licensed and unlicensed homes reported significantly different practices. Regardless of size, licensed homes were more likely to allow at least some residents to manage their own medications (Exhibit 3-5).
Some homes also housed residents with significant health problems and functional impairments. Almost 30 percent of the homes reported having one or more residents who stayed in their room all day in bed or in a chair because of health problems, and almost 60 percent of the homes reported having residents with urinary incontinence. Board and care is a transition for many people between home and assisted living, hoping that someone can stay there for the long term.
And a counselor will explain what is available in your area and provide you with a select list of homes that meet your needs and budget. If only one member of a couple applies for licensing, both members of the couple or household are liable for accidents and injuries. By submitting this form, you agree to SeniorGuidance.org's Terms of Use, Privacy Policy and agreement to be contacted by us, or our partner providers, using a system that can auto-dial.
Visit the facility a couple of times (i.e., weekday, weekend, day, night). We don’t recommend spending a few nights at the facility unless the owners encourage you to do so. Most seniors that move, especially from a location where they’ve lived for a few years, will not like the new facility. The better alternative is to build a two or three-month out clause into the lease. This is when you put a clause into a lease allowing the new resident to leave with minimal penalties after a few months. Seniors can adjust to a new home, but it usually takes a couple of months.
Based on answers to these seven questions the average staff score was 66 percent. Well-trained and knowledgeable staff are essential to provide high-quality care. The average staff knowledge scores ranged from 14 to 66 percent on three different measures. Staff scored lowest on questions about the normal processes of aging and highest on questions about basic care and medications monitoring. Facilities scored the lowest on components contributing to facility safety. The average facility safety score was 58 percent, indictating that about one-third of the safety features measured were absent from the average facility.
Many seniors are attracted to board and care facilities because they offer similar services to larger assisted living facilities at lower prices. However, because they are largely unregulated, what they promise to deliver and what they actually deliver can be very different. That means they may provide great services to a group of residents that share similar care needs but would have trouble addressing the need of a different class of residents. If your facility is small and uses only a few caregivers, losing one key employee can immediately affect the quality and continuity of service. Residential care is very cost effective as well, on the average about half the cost of nursing home care.
On major area of concern relates to staff qualifications and medication usage in board and care homes. As noted in Section 3.6, virtually all homes reported providing medication storage or supervision. In addition, three-quarters of the residents reported receiving assistance with medications, and many were taking psychotropic drugs (see Section 6.3 and Section 6.8). Despite this, only 21 percent of the homes had any licensed nurse on staff (Exhibit 3-9). This included full- or part-time nursing staff and registered nurses , as well as licensed practical or vocational nurses (LPNs/LVNs).
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