Adult Residential Facilities (ARFs) and Residential Care Facilities for the Elderly (RCFEs) represent an essential part of the continuum of housing support. Commonly referred to as ‘board and care’ facilities, these sites provide housing and enhanced support for a broad range of individuals with diverse care needs. They also provide customized assistance and community-based housing to individuals dealing with mental illness, seniors requiring supportive services, and individuals from these groups who have experienced homelessness – representing a crucial and distinct housing opportunity for some of our most vulnerable community members.

Yet due to rising costs and insufficient reimbursement rates, these sites have seen mounting closures in recent years as operators retire or property maintenance becomes overwhelming for mom-and-pop operators. Since 2016, over 100 facilities have closed in LA County alone, resulting in the loss of 1,700 beds. In response to these challenges, and in an effort to stem the loss of these vital housing resources, LA County and local stakeholders have been working to preserve and expand the supply of Adult Residential Facilities and Residential Care Facilities for the Elderly.

To gain an understanding of the challenges faced by owners of Adult Residential Facilities and Residential Care Facilities for the Elderly, and to best understand the role that ARF/RCFEs serve in the housing continuum for people experiencing homelessness and mental health challenges, as well as older adults with higher acuity needs, Brilliant Corners engaged The Future Organization, a specialized, research-based consultancy with a focus on serving the needs of nonprofits and government, to conduct a year-long research study to pinpoint the availability of ARF/RCFEs in LA County, examine the challenges to ongoing operation for these sites, uplift opportunities for increasing placement rates for people who have experienced homelessness, and provide recommendations to stabilize and increase access to these vital housing resources.

The study report, Serving Our Vulnerable Populations: Los Angeles County Adult Residential Facilities and Residential Care Facilities for the Elderly, is a first-of-its kind analysis of the landscape of ARFs and RCFEs and the most comprehensive study to date on the range of existing facilities in LA County, current vacancy rates, the percentage of residents who have experienced homelessness, and a deep dive into the unique needs of residents, as well as the needs of facility owners and operators. The report provides comprehensive solutions to strengthen these valuable community resources, and offers recommendations for system improvements.

Key findings include:

A comprehensive scan of 3,065 Los Angeles County-based, licensed Adult Residential Facilities and licensed Residential Care Facilities for the Elderly identified 750 facilities currently serving or willing to serve people reliant on public benefits for their room, board, and care, people living with mental illness, and people with experience of homelessness, with an estimated, total licensed bed capacity of 25,000 beds. During the study period (July 2022 – November 2022), owners and operators of Market ARFs and RCFEs identified that 25.9% of their resident bed capacity was vacant or underutilized (approximately 6,400 beds), with the majority of underutilized beds located at RCFEs which serve individuals 60 and over, often with chronic health conditions.

47.8% of all residents of Market ARFs and RCFEs interviewed indicated experiences of homelessness at some point during their adult lives, with 10.6% of the residents interviewed reported moving into their ARF or RCFE directly from experiencing homelessness. Despite the significant proportion of residents who have experienced homelessness, 58.7% of ARFs and RCFEs surveyed reported having no contact at all with any homelessness services providers in the Los Angeles County Continuum of Care.

The study revealed that residents of ARFs/RCFEs have very high mean levels of overall satisfaction (8.55 out of 10.00), with the majority indicating that their housing felt like a home and community. Market ARFs and RCFEs owners and operators expressed very high levels of mean satisfaction with their roles and work in the industry, providing a mean satisfaction score of 8.87 out of 10.00.

Despite Adult Residential Facilities (ARFs) delivering the greatest amount of direct service and public benefit to identified, vulnerable populations, the future outlook for sustaining the Market’s ARFs can be regarded as critically-challenged. Owners and operators, along with Market Users, have identified low levels of growth and expansion in this license class of facilities, disproportionately low levels of public funding in comparison to other housing and channels of care serving other vulnerable populations, and few, easy-to-access incentives from government to support the construction or expansion of ARFs to serve vulnerable populations.

Funding for Market ARFs and RCFEs to address the issue of homelessness is not seen by Market Users or owners and operators to have been prioritized in public policy discussions or in media coverage, nor has it been consistently viewed by decision makers as either permanent housing or as a critical tool to address the issue of homelessness. Market Users, Market facility owners and operators, and community stakeholders all conceded that Market ARFs and RCFEs have been persistently under-resourced with regard to all varieties of public funding for many years, and that decisive action is required to address the inequities to fully support the costs of equitable service, housing, and quality of care to vulnerable individuals across all categories of lived experiences.The difference between provision of on-location (on the street, in a vehicle, in temporary/crisis/bridge accommodation) homelessness services and provision of Market ARF and RCFE services, housing, and care equates to a 39.4% reduction in costs to taxpayers, per individual, over the 2022 calendar year. At an estimated mean savings of $13,481 per individual served, per year, there is significant prospective cost savings to Los Angeles County taxpayers in serving vulnerable individuals through significant enhancement of public funding to congregate Market ARFs and RCFEs.

Given local and national trends indicating substantive growth in the numbers of people over the age of 62 who currently experience (or who may yet experience) homelessness, Residential Care Facilities for the Elderly (RCFEs) will play an increasingly important role in serving the specialized needs of seniors with experience of homelessness. Greater utilization of RCFEs within homelessness services policy, planning, and funding to house seniors experiencing homelessness with significant care needs is an essential component to successfully addressing this segment of the homelessness crisis, especially for those with complex, co-occurring care needs or with a lack of capability to live alone. Funding to bridge the gap between relatively-low public benefit funding levels and low- to mid-level market rates at RCFEs is needed to maximize capacity for the identified, vulnerable population with a significant supply of existing, vacant beds at Los Angeles County RCFEs.

This study is part of a multi-pronged initiative funded by California Community Foundation and Cedars-Sinai to stabilize Adult Residential Facilities and Residential Care Facilities for the Elderly. In partnership with the LA County Department of Mental Health and Department of Health Services, Brilliant Corners, and Genesis LA, the initiative also includes an ongoing effort to deploy funding to owners and operators of ARF and RCFEs for capital improvements to stem the loss of at-risk facilities, in alignment with the State of California’s Community Care Expansion (CCE) program. The CCE Preservation Program is being administered locally by DMH in collaboration with Los Angeles County Development Authority.