I answer this question and reveal my personal bias. I admit it freely.

“Residential Care Home” is an up-to-date name for what some people used to refer to as “board and care” homes. The term “board and care” is a misnomer and does not exist as defined by California law. It evolved out of “room and board” where those living in the old boarding houses of yesteryear grew to be old enough and infirm enough that they eventually required more than meals and a bed. Those old boarding houses evolved into the first “old folks homes”. People received meals and a bed and, in theory, help getting from one to the other. Of course, other assistance with the activities of daily living was also required in varying degrees.

One can easily see how, as time marched on, these same places became known as “nursing homes” and today, as “skilled nursing facilities”. But I digress.

“Residential Care Home” is also a technically incorrect term. The California Code of Regulations, Title 22, Division 6, Chapter 8, puts forth the regulations for “Residential Care Facilities for the Elderly” (hereafter referred to as RCFE). Here lies my bias. There is a clear distinction between RCFE and Residential Care Home.

They are not the same. While both are subject to the same regulations, even the regulations themselves make a distinction in identifying different needs for different sized “facilities”.

My home, the home my husband and I live in, is a Residential Care Home. It is not a RCFE. I live in my home. I do not live in a facility. Some RCFE in California are licensed for up to 50, 100, even 200+ residents. Those are “facilities”. I am licensed for six. This is a home. A facility is more institution-like than it is home-like.

In 1989 I added four bedrooms and four half-baths to my then three-bedroom home so that each of my six residents could have a private bedroom and a private bathroom. I’ve frequently been asked why I limited myself and didn’t add six bedrooms, or eight, or twelve. To me, six is a magic number. Six people fit nicely around a dining table. With six residents the ambiance and atmosphere of a real family, home environment is retained. Privacy is assured, yet people feel they are part of a small social group, a family. Simultaneously, their needs are addressed individually and personally on a daily basis.

One of the issues that larger facilities grapple with and will always grapple with is the regimentation of tasks in order to get all the work done. People do not want to be regimented. Even confused individuals demonstrate a desire for choice somewhere in their lives. Something they like to eat, something they don’t like to eat, eating at times they prefer, having their very own birthday party; the list goes on and on. Regimentation robs people of the freedom to express themselves and be acknowledged as individuals. Individuality is subjugated by the system.

There are times in our lives when being the same as our peers and conforming to the fads or rebellion of the time is all-important. As we age, especially as we become elderly, how different we are becomes increasingly important. I am committed to elderly people living fully self-expressed and acknowledged for their contributions to humanity. One of the ways I can accomplish this is to allow those who live with me the freedom of their individuality.

That is why I say there is a distinction between RCFE and Residential Care Home. Facility and Home. Facility. Home. Given the option, wouldn’t you rather be home?