Types of Assisted Living Facilities: RCAC and CBRF Can Be More Alike than You May Think

Understanding the various distinctions between assisted living facilities becomes a high priority when a loved one suddenly requires supportive care. The reality of assisted living in Wisconsin is when you have seen one assisted living facility; you have seen just one assisted living facility.  Through legislation, the State of Wisconsin has created three types of assisted living:  Adult Family Homes (AFH), Residential Care Apartment Complexes (RCAC) and Community Based Residential Facilities (CBRF).  Although Adult Family Homes are very distinctive because they are designed for 4 or fewer people, RCACs and CBRFs can be very alike or very different.

It’s a common misunderstanding that RCACs have fewer staff or care for a less acute individual.  Both RCACs and CBRFs can, if they choose, care for people with very complex needs assuming that they have the trained staff needed to meet the needs of their residents

The Regulatory Distinction

Although there are both significant and subtle differences in the administrative rules for RCACs and CBRFs, the primary difference in the rules as they relate to caring for older adults surrounds the issue of competence.  In order to move into a RCAC, a person must be competent upon admission. For this purpose, competence is defined as someone who does not have an activated Durable Power of Attorney for Health Care or a Legal Guardian.  Note that exceptions can be made for couples under certain circumstances. 

The reason for this difference in the rule is very straightforward.  CBRFs are licensed Wisconsin entities designed to care for people, some of whom may be quite vulnerable.  Vulnerable people are protected by various State agencies that play a role in assuring the level of service provided in a CBRF.  People who live in RCACs are expected to manage their satisfaction through the legal system.  To clarify, if a person took issue with a CBRF, the State would manage the complaint.  In a RCAC, the person is expected to manage their own complaint up to and including the court system, if needed. 

Laureate Group difference: We operate both CBRFs and RCACs and comply with all applicable rules. We participate in many forums, which help direct industry best practices.

The Building Distinction

Across the State of Wisconsin, nearly 80% of the CBRFs have a capacity of 20 residents or less.  Often casually called “group homes”, many people think of CBRFs as small environments with individual bedrooms, shared bathrooms and living room and dining room areas that would be similar to those in a traditional house.  Although the rules allow for CBRFs to be quite large, large CBRFs are the minority.  All of the Laureate Group’s CBRFs are home to 70 or more residents which is quite uncommon.  In addition, they are known as “independent apartment CBRFs.”  In this case, every person has their own apartment complete with a kitchenette and their own bathroom and shower.  By contrast, all RCACs are required to provide individual apartments complete with locked entrances, kitchens and bathrooms – shared kitchens and bathrooms are not allowed.  

Laureate Group difference:  Whether CBRF or RCAC, all Laureate Group communities offer private studio, one or two bedroom apartments complete with kitchens and bathrooms.  

The Care Distinction

Both the RCAC and CBRF administrative rules give very broad direction on how care is to be delivered to the people who live in the facilities.  In very general terms, the assisted living operator is expected to identify the people they are going to care for and the amount and type of care they will provide up to the maximum allowed.  In addition, the expectation is that the amount of trained staff in the facility depends on the people they are going to care for and the amount of care to be provided. 

Therefore, you would expect that nearly every assisted living facility would have a different staffing pattern.  In addition, the staff would have differing skills sets based on their occupancy and the acuity of the people who live there.  With 40% resident turnover per year (the industry average), the occupancy and the acuity of facilities varies greatly over a period of months and years.  Sometimes people think that the amount of staffing and care provided is a function of its license type.  When in fact, the amount of staff and the amount of care that’s provided is the operator’s choice and should be determined by who is living in the facility today.  

Laureate Group difference:  Our staffing model, which can be adjusted daily, is managed by each community’s full time RN.  The staffing plan ebbs and flows with the occupancy and acuity care needs of the people who live in the building.  

Aging in place

All assisted living rules allow the people who live in the facilities to “age in place” meaning that they can stay in residence often for the rest of their life -- even someone who lives in a RCAC that becomes incompetent.  The rules differ in terms of how that is to be accomplished – sometimes through outside agencies like a hospice, sometimes a variance is required to exceed a maximum care level, sometimes in other ways.  Everyone recognizes that moving an older person as health declines can be problematic. 

Both RCACs and CBRFs can care for people with very complex needs as long as they have the trained staff needed to meet the needs of their residents. 

Laureate Group difference:  Don’t be fooled.  In addition to our CBRFs, Laureate Group RCACs manage very complex residents even those with cognitive limitations. 

As stated, the beauty of assisted living is that all facilities are not the same – even those in the same regulatory category.  Don’t assume that facilities are all the same.  Many RCACs are very successful in meeting the needs of high acuity clients while some CBRFs only meet the most basic activities of daily living (ADL) needs of clients.  When you  are looking for an assisted living facility, make certain you know the difference. 

Laureate Group difference:  Our staff would be happy to answer any questions you may have, or assess someone you know to determine how their needs are best met in assisted living.