Care Worker Helping Woman To Get Up Out Of Chair

When choosing a care facility for a loved one, the choices can be overwhelming.

To gain a better understanding of the different types of facilities and levels of care, we turned to the Oregon Long Term Care Ombudsman Office’s consumer guide to choosing an assisted living or residential care facility.

Assisted Living Facility (ALF) and Residential Care Facility (RCF) — These provide services to six or more adults and people with disabilities living in home-like settings. They offer and coordinate services available on a 24-hour basis to meet the daily living, health and social needs of the people who live there.

They provide person-centered care, which values personal choice, dignity, privacy, individuality and independence. Residents can direct their care and participate in daily decisions.

Each has different types of licenses even though they offer very similar services. These settings offer personal care services, 24-hour care staff, medication management, health services and social activities. They are not nursing facilities as they do not offer continuous nursing care or complex therapy services provided by nursing and post-acute care rehabilitation facilities.

However, they are required to have a registered nurse on staff or on contract who oversees and coordinates your health service needs but does not give hands-on nursing care.

The main difference between ALF and RCF settings is whether they offer shared or private apartment spaces and rooms. All ALF residents have their own apartments with a small kitchen area and a private bathroom. Some RCFs may have residents share rooms, while others offer private rooms or apartments. Individuals move into ALF/RCF settings for more social interaction, to reduce their responsibilities, for safety and security, and for activities, health services and wellness offerings.

All ALFs and RCFs must offer basic services. The rules require all ALFs and RCFs to provide you with the assistance of a caregiver, if needed, to help you with all activities of daily living, such as bathing, using the toilet, and getting in and out of bed, 24 hours a day.

These services include:

24-hour supervision

Three meals a day in a group dining room

Modified special diets (such as low salt and reduced or no added sugar, simple texture changes, pureed food)

Personal care services (help with bathing, dressing, toileting, eating)

Medication management

Health care coordination by a nurse

Recreational and spiritual activities

Laundry and linen services, and/or washers and dryers

Housekeeping and upkeep for your room or apartment

Transportation coordination services

Intermittent behavioral supports

Independent Living — You live in an ALF or RCF, but you take care of yourself completely. If you fall, for example, you call the local fire department to help you. You eat in your own kitchen or pay extra to eat in the dining room. Living situations might be apartments, or cottages with up to three bedrooms. If you need personal assistance, you hire outside help from a private caregiver.

Assisted Living — You choose the level of care you need, and often pay according to the services provided to you. You eat all meals in the dining room. Most utilities are paid for in your monthly fee. Rooms may be one or two bedrooms.

Skilled nursing — More like a hospital setting, as you may be recovering from surgery and need someone to help you. You can receive antibiotics and wound care.

Continuing care retirement communities — These settings offer living options grouped on a campus and often include independent, assisted living, residential care and nursing facilities.

Independent or non-licensed senior housing communities — These offer independent living options such as scheduled activities, housekeeping, meals and transportation services. Unlike ALFs and RCFs, these communities do not provide help with the activities of daily living, medication management or health care coordination. You can hire private caregivers to assist you in one of these settings.

Adult foster/care homes — These are licensed single-family homes where staff provide care for up to five people and serve a range of needs in a home setting.

Nursing facilities — These facilities provide licensed 24-hour supervised nursing care. Caregivers must be certified nursing assistants. Nurses and certified nurse aids provide nutritional, therapeutic and personal care.

Memory care communities (MCC) — These are specialized communities for persons with dementia and must be licensed and follow other rules specific to the care and services for people with dementia. MCC caregivers are provided with special training to better serve their residents. MCCs may be part of another building, or they may be free-standing communities.

These settings provide space for people to walk either indoors or within the confines of a secured outdoor courtyard. Residents are encouraged to bring personal items such as bedding and pictures to make their rooms feel more like home. They also must have programs which include individualized nutritional plans, activities, support for behavioral symptoms and family support.

ALFs and RCFs are licensed by the Department of Human Services. Licensing is a way to monitor the quality of care residents receive in ALFs and RCFs.

Licensed communities must meet and maintain certain standards and are inspected every two years. Licensing survey reports should be publicly posted.

To learn more about a specific facility, visit

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