–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.

County #

of Facilities

 # and %

of Facilities Closed

 Capacity of

Closed Facilities
# %
   
Alameda 444 175 39% 3,086
Alpine 0 0 0% 0
Amador 9 3 33% 14
Butte 50 16 32% 279
Calaveras 3 2 67% 52
Colusa 2 2 100% 30
Contra Costa 608 206 34% 3,308
Del Norte 0 0 0% 0
El Dorado 53 13 25% 91
Fresno 298 83 28% 1,113
Glen 9 1 11% 6
Humboldt 22 6 27% 216
Imperial 12 3 25% 24
Inyo 1 0 0% 0
Kern 195 59 30% 614
Kings 10 3 30% 16
Lake 9 5 56% 130
Lassen 1 0 0% 0
Los Angeles 2,320 846 37% 16,174
Madera 12 4 33% 70
Marin 73 21 29% 376
Mariposa 2 1 50% 4
Mendocino 25 8 32% 93
Merced 42 14 33% 171
Modoc 0 0 0% 0
Monterey 84 31 37% 1,058
Napa 55 17 31% 137
Nevada 13 4 31% 178
Orange 1,469 408 28% 9,421
Placer 285 79 28% 1,151
Plumas 1 0 0% 0
Riverside 826 308 37% 5,550
Sacramento 946 328 35% 4,909
San Benito 4 0 0% 0
San Bernardino 413 133 32% 1,859
San Diego 973 345 35% 5,930
San Francisco 98 38 39% 962
San Joaquin 155 55 35% 2,001
San Luis Obispo 167 54 32% 709
San Mateo 392 134 34% 1,959
Santa Barbara 183 59 32% 768
Santa Clara 401 135 34% 2,384
Santa Cruz 41 12 29% 351
Sierra 0 0 0% 0
Shasta 86 34 40% 307
Siskiyou 6 3 50% 260
Solano 214 77 36% 1,387
Sonoma 260 81 31% 1,314
Stanislaus 141 44 31% 1,004
Sutter 18 8 44% 246
Tehama 16 8 50% 160
Trinity 0 0 0% 0
Tulare 68 18 26% 424
Tuolumne 6 2 33% 96
Ventura 320 85 27% 1,625
Yolo 31 7 23% 136
Yuba 6 2 33% 54
Total: 11,878 3,980 34% 72,207

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.

 

County #

of Facilities

 # and %

of Facilities Closed

 Capacity of

Closed Facilities
# %
Alameda 371 95 26% 1,647
Alpine 0 0 0% 0
Amador 0 0 0% 0
Butte 75 35 47% 538
Calaveras 0 0 0% 0
Colusa 4 1 25% 20
Contra Costa 319 76 24% 981
Del Norte 8 4 50% 53
El Dorado 25 6 24% 139
Fresno 226 47 21% 896
Glen 0 0 0% 0
Humboldt 27 9 33% 109
Imperial 18 3 17% 22
Inyo 0 0 0% 0
Kern 189 31 16% 615
Kings 20 10 50% 82
Lake 13 4 31% 24
Lassen 8 2 25% 51
Los Angeles 2,327 558 24% 8,013
Madera 18 4 22% 38
Marin 74 9 12% 203
Mariposa 3 2 67% 9
Mendocino 16 2 13% 14
Merced 26 6 23% 59
Modoc 2 1 50% 4
Mono 0 0 0% 0
Monterey 53 11 21% 242
Napa 22 5 23% 63
Nevada 13 1 8% 6
Orange 599 136 23% 1,712
Placer 80 23 29% 318
Plumas 4 2 50% 18
Riverside 537 125 23% 1,463
Sacramento 501 138 28% 1,488
San Benito 10 3 30% 23
San Bernardino 515 114 22% 1,066
San Diego 783 173 22% 3,000
San Francisco 111 36 32% 560
San Joaquin 310 89 29% 1,317
San Luis Obispo 78 19 24% 297
San Mateo 173 29 17% 319
Santa Barbara 98 21 21% 165
Santa Clara 404 91 23% 1,411
Santa Cruz 44 9 20% 125
Shasta 131 42 32% 326
Sierra 0 0 0% 0
Siskiyou 5 2 40% 12
Solano 189 51 27% 441
Sonoma 147 40 27% 488
Stanislaus 107 27 25% 365
Sutter 24 4 17% 51
Tehama 53 13 25% 136
Trinity 3 1 33% 30
Tulare 179 37 21% 479
Tuolumne 10 3 30% 32
Ventura 138 26 19% 293
Yolo 21 3 14% 36
Yuba 24 2 8% 10
Total: 9,135 2181 23.9 29,809

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.

Summary

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.