Closures of Adult Residential Care and Residential Care for the Elderly Facilities and the Unknown Impact on Homelessness in California: Problem will Likely be Exacerbated by COVID-19
–More than 6,000 of these care facilities have closed throughout California
since 2015 and the maximum number of individuals that
could be cared for was more than 100,000–
(see tables below for a breakdown by county)
— According to recent reports, these care facilities have experienced
COVID-19 outbreaks resulting in hundreds of residents
sickened and dozens dead from the disease–
Prior to the COVID-19 outbreak, operators of Adult Residential Care Facilities and Residential Care Facilities for the Elderly (Assisted Living Facility) licensed by the state were closing their facilities at an alarming rate. Because reimbursement rates for all the services required under licensing have fallen far behind inflation, operators are selling their properties for other residential or commercial development uses or converting their facilities to serve other populations for which they can receive higher reimbursement rates.
The closures of more than 6,000 Adult Residential Care Facilities and Residential Care Facilities for the Elderly (Assisted Living Facility) and the loss of a maximum number of individuals that could be cared for of more than 100,000, may have contributed to the significant increases of persons counted as homeless according to annual homeless counts. Other data to confirm increases is not yet available.
COVID-19 Pandemic is Compounding the Problem
The current pandemic caused by the 2019 Novel Corona Virus is compounding the problem. Assisted living facilities, or Residential Care Facilities for the Elderly, and the total count of COVID-19 positive cases which is in the hundreds, is being compiled by the California Department of Social Services. However, not all counties with positive cases are included. One media report noted that Los Angeles, Riverside and Santa Clara counties have suffered the brunt of COVID-19 outbreaks in these long-term care facilities for the elderly, with hundreds of residents sickened and at least two-dozen dead from the disease.
Recent Residential Care Facilities for the Elderly Closures
The Community Care Licensing Division of the California Department of Social Services (DSS) listed 3,980 closures of Residential Care Facilities for the Elderly between 2015 and March 2020 on their web site. Also, listed was the maximum number of individuals that could be cared for by each facility, which collectively was 72,207 individuals.
Residential Care Facilities for the Elderly have been defined by DSS as a
Residential care facility for the elderly (RCFE) 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. RCFEs are also referred to as assisted living facilities and board and care facilities. Persons under 60 years of age with compatible needs may be allowed to be admitted or retained in an RCFE, if certain conditions are met.
The following table notes the current number of Residential Care Facilities for the Elderly listed by DSS on their web site, the number and percent of facilities closed since 2015, and facility capacity, which is defined by DSS as “The maximum number of individuals that may be cared for by the facility” by county.
Table 1. Number of Residential Care Facilities for the Elderly, Number and Percent of Facilities Closed since 2015, and Facility Capacity, which is the Maximum Number of Individuals that May be Cared for by a Facility by County.
|# and % |
of Facilities Closed
San Luis Obispo
Recent Adult Residential Facility Closures
The Community Care Licensing Division of the California Department of Social Services (DSS) also listed 2,181 closures of Adult Residential Facility between 2015 and March 2020 on their web site. Correspondingly, the maximum number of individuals that could be cared for by each facility, which collectively was a total of 29,809 individuals.
An Adult Residential Facility is defined by DSS as a
A residential home for adults ages 18 through 59 with mental health care needs or who have physical or developmental disabilities and require or prefer assistance with care and supervision.
The following table notes the current number of Adult Residential Facilities listed by DSS on their web site, the number and percent of facilities closed since 2015, and facility capacity, which is defined by DSS as “The maximum number of individuals that may be cared for by the facility” by county.
Table 2. Number of Adult Residential Facilities, Number and Percent of Facilities Closed since 2015, and Facility Capacity, which is the Maximum Number of Individuals that May be Cared for by a Facility by County.
|# and % |
of Facilities Closed
|San Luis Obispo||78||19||24%||297|
Implications for Next Steps
Recent state legislation has included language to help stabilize board and care facilities/homes. The two main type of board and care homes licensed by the state are Adult Residential Care Facilities, which serves adults between 18 and 59 years old and Residential Care Facilities for the Elderly, which serves adults age 60 or older.
A one-time expenditure of $500 million is proposed to “shore up financially struggling board and care homes” in order “to preserve potentially hundreds of homes that are on the brink of closure because the state reimbursement rate is too low to cover their rising costs.” Providing a one-time expenditure of $500 million would help stabilize the facilities/homes and buy time for the state to authorize a new funding structure that would raise the state’s monthly reimbursement rate to cover the full array of services required under the board and care licensing arrangement. Licensed board and care operators are not free to raise their prices, which are set by the state.
Parallel Negative Impacts of Closures on Adult Residential Care and Residential Care for the Elderly Facilities and Homelessness
Parallel negative impacts of closures on both Adult Residential Care and Residential Care for the Elderly Facilities and homelessness involve A) limited number of existing beds; B) difficulty in siting new beds; C) taxing already overwhelmed public systems of care; and D) draining unprecedented state funding for new homeless housing and services.
A. Limited Number of Existing Beds
1. Open Adult Residential Care and Residential Care for the Elderly Facilities are being used to re-house displaced residents from closed facilities, which further limits housing options for homeless persons in need of specialized care;
2. Conversely, displaced Adult Residential Care and Residential Care for the Elderly Facilities residents from closed facilities can wind up competing with homeless persons in need of specialized care for the limited supply of temporary and permanent supportive housing.
B. Difficulty in Siting New Beds
1. Not only are board and care facility beds limited and lost, siting new beds in some communities may prove insurmountable due to NIMBYism and compounded by increasing land and construction costs;
2. Shelters, transitional housing, and permanent supportive housing for homeless persons have a long history of intense NIMBY opposition that would be compounded by siting new board and care facilities in some of the same communities. Increasing land and construction costs would also hinder siting.
C. Taxing Already Overwhelmed Public Systems of Care
1. Most communities already experience a number of homeless persons who repeatedly and excessively use public systems of care as their primary source of services and health care. Repeated use includes correctional, mental health, and substance use systems among others.
2. Displaced board and care residents from closed facilities who become homeless would likely increase the number of frequent users of health care and mental health public systems of care among others.
D. Draining Unprecedented Funding for New Homeless Housing and Services
1. Insufficient State of California funding to fully reimburse board and care facilities will likely overburden and limit the impact of the recent and unprecedented amount of funding allocated by the state for new homeless housing and services, which have been targeted for the increasing number of persons already living on the streets, which in turn includes those languishing while aging and/or with life-threatening illnesses;
2. Adult Residential Care and Residential Care for the Elderly Facilities residents with mental health care needs and/or disabilities who are displaced from closed facilities and who in turn become homeless, require a level of care and supervision that would likely drain the unprecedented funding coming from the state. The aforesaid funds are aimed at increasing permanent supportive housing and supportive services to obtain and maintain the housing targeted for the mentally ill who are already languishing while living on the streets.
The unprecedented amount of funding from the state includes funding sources for increasing permanent supportive housing for persons who are chronically homeless or at risk of chronic homelessness and in need of mental health services, e.g., the No Place Like Home Program. Another source for increasing permanent supportive housing is Housing for a Healthy California, which is for persons who are recipients of or eligible for health care provided through the California Department of Health Care Services, Medi-Cal program.
Unprecedented funding also includes the Homeless Emergency Aid Program, California Emergency Solutions and Housing Program, Homeless Housing, Assistance and Prevention Program, and the California Access to Housing Act. Assembly Bill 3300 is a recently submitted bill that would provide $2 billion annually for local flexible funding for housing and services.
The current Adult Residential Care and Residential Care for the Elderly facilities system is a non-sustainable business model for many of the facilities and absent corrective action, this housing resource will continue to erode and contribute to an already growing homeless population. The current pandemic caused by COVID-19 can only but exacerbate the problem of a non-sustainable business model. Stabilizing board and care facilities with a one-time expenditure of hundreds of millions of dollars will likely limit more closures in the immediate future and provide time for the state to authorize a new funding structure that would raise the state’s monthly reimbursement rate.
The parallel negative impacts on Adult Residential Care and Residential Care for the Elderly facilities and homelessness noted above would likely drain the unprecedented funding from the state for the current homeless population. Shoring up the current Adult Residential Care and Residential Care for the Elderly facilities system now, instead of later, would lessen the draining and expected benefits of the unprecedented funding for people experiencing homelessness.