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Levels of facility based care

When the decision has been made to place a loved one into long-term care there are options available depending on care needs.  Below are the different types of licensed care facilities.  This doesn’t include independent living facilities, as they are not licensed by the Department of Senior Services (which doesn’t mean they aren’t great places- just not what we are covering today!)

Residential Care I & II
The first and least restrictive level is a Residential Care Option I (RCF 1). In the
RCF 1 the resident is provided a bed, three meals a day, 24 hour protective oversight, help with medications and activities. In the RCF level 1 or 2 the resident must be able to transfer themselves without any assistance. Some of the RCF’s will not accept any resident who is in a wheelchair. The facility has an LPN who monitors medications and the general health of the residents. The LPN is not on-site all day, and the number of residents determine how often the LPN is at the facility.

Residential Care Facility II includes all the services in the RCF I plus supervision with diets, personal care and supervision of health care under the care of a physician.
The monthly rate for the residential care facilities is typically between $2,000 to $4,000.  RCF II’s are almost always more than a comparable RCF I

Assisted Living Facilities (ALF) also has two levels ALF Option I and ALF Option II. ALF’s  provide much of the same services provided in the RCF I. They also include help with Activities of Daily Living (ADL) such as bathing, dressing, toileting, eating, transferring or walking.
The monthly rate for assisted living is typically between $3000. to $6,000 per month.   Many of the newer memory care facilities that have opened in the last few years are actually licensed as assisted living, even though they may be providing a level of care that looks closer to a skilled facility.

In the RCF I & II and the ALF Option 1 the residents must be able to make a “pathway to safety”. This means if there were an emergency the resident must be able to get out of the facility in five minutes or less with minimal assistance. The ALF Option II has an option to take residents who can not make the pathway to safety. In order to do this the staff would have to make an individualized plan for that resident to make sure they would be safe during an emergency.

Intermediate Care
The intermediate Care Facility (ICF) has the same license as a skilled nursing home (SNF). The difference between intermediate and skilled is that the intermediate only requires supervision from an LPN and Medicare services are not available in the intermediate care facilities.  Intermediate care are eligible to participate in the Medicaid Program (vendor).   There are generally not a lot of ICF’s in the St. Louis area- but there are a few.

Skilled Nursing Facilities (SNF)
Skilled nursing facilities include all services listed above in the previous long-term care facilities. Typically, this is what most people refer to as a nursing home.  Also included is a Licensed Nursing Home Administrator and a  Director of Nurses. Skilled facilities may chose to provide medicare/medicaid services. The monthly rate for a skilled nursing home can range from $5,500 to over  $10,000 per month.


When deciding on where to put a loved one, you will generally look towards a place that matches up with your loved one’s needs at that time.  However, if you have someone that is barely able to pass the tests for a lower level, then it is likely to start out at the higher level so as to avoid another move in a few weeks or a month.