Hospital Discharge to Assisted Living in California and the Admission Checks That Matter

One of the fastest ways to lose a placement is to discover too late that the person has a condition California generally prohibits in assisted living.

22 CCR 87615 identifies conditions that ordinarily prevent admission or retention in an RCFE.

The list includes stage 3 and 4 pressure injuries, gastrostomy tubes, nasogastric tubes, serious infections such as staph, tracheostomies and residents who depend on others to perform all activities of daily living.

The regulation says the list is not exhaustive.

A feeding tube is not a minor footnote in the referral.

The regulation explicitly names gastrostomy tubes.

If that device is present, the admissions team needs to know before discussing a move-in date.

The discharge diagnosis alone is not enough to screen the patient.

Review the actual care being provided and who must perform each task.

The same disease can create very different admission questions depending on wounds, devices and dependence on others.

Restricted Conditions Need a Separate Review

Some health conditions are restricted rather than prohibited.

Under 22 CCR 87612, facilities may care for residents with specified restricted conditions if they comply with the rules governing those needs.

Examples include oxygen use, catheter care, diabetes, colostomy or ileostomy care, incontinence, injections, contractures, wound care and stage 1 or 2 pressure injuries.

Being on the restricted list does not mean every assisted living residence can provide the service.

Ask who will actually deliver the care, what licensed outside professionals are involved and whether the facility can meet the condition-specific requirements.

Written acceptance should reflect the patient’s real needs, not a broad assurance that the staff have experience with similar cases.

Understand the Exception Process

California also permits a facility to request a written exception for certain restricted or prohibited health conditions under 22 CCR 87616.

The facility must document the current condition and propose how it will meet the resident’s needs while protecting other residents.

An exception is not automatic, and the family cannot simply waive a regulatory prohibition.

If a placement depends on an exception, ask whether the facility has received approval and whether all conditions have been satisfied.

Do not schedule transport based only on an intention to apply.

Hospice adds another admission question that families may not expect.

Under 22 CCR 87632, a facility accepting or retaining a terminally ill resident who will receive care from a hospice agency must have obtained a facility hospice care waiver from the Department of Social Services.

That requirement applies to the residence, not simply the hospice provider.

A family may have selected an excellent hospice agency and still need to confirm that the proposed assisted living community is authorized to accommodate hospice care.

Ask the facility directly whether it holds the waiver and whether it has capacity for the particular resident.

A waiver does not by itself establish that every resident’s needs can be managed safely.

Match the Hospice Plan to the Facility

The assisted living facility and hospice agency must coordinate responsibilities under the hospice care plan, including a required agreement on the care to be provided.

Confirm which tasks hospice personnel perform and which remain the facility’s responsibility.

The distinction becomes especially important when a hospice patient has a condition listed as prohibited or restricted.

22 CCR 87616(c) provides an exception-request exemption for qualifying hospice residents when the facility satisfies hospice-waiver requirements and the hospice plan specifically addresses the condition.

This is a carefully defined regulatory pathway, not general permission to admit any medically complex resident.

Check the terminal illness determination, hospice services, care plan and facility waiver together.

If any piece is uncertain, ask the licensing agency or an appropriately qualified professional before confirming placement.

Confirm the Day-to-Day Care Arrangement

Families may hear that hospice is coming and assume hospice will provide all care around the clock.

Ask the hospice agency what services it will actually provide and when.

Then ask the assisted living team how routine assistance, medication coordination and emergencies will be managed between visits.

If the patient needs services outside the facility’s ability or authorization, another level of care may be more appropriate.

The goal is a safe discharge, not simply finding a residence willing to say yes.

Placement paperwork is only part of discharge planning.

California Health and Safety Code section 1262.5 gives hospitalized patients an opportunity to identify one family caregiver who may assist after discharge.

The hospital records that designation in the medical chart.

The law also requires policies for notifying the designated caregiver about discharge or transfer as soon as possible and, in any event, upon issuance of the attending physician’s discharge order.

If the caregiver cannot be reached, the hospital must document its attempt.

The lack of contact shall not delay the patient’s medical care or an appropriate discharge.

The designated caregiver should be offered a chance to participate in discharge planning and receive appropriate information or instruction about posthospital care.

The law doesn’t automatically turn that person into a legal decision-maker or authorize them to sign every admission document.

Bring Everyone Into the Same Conversation

The person touring assisted living homes may not be the person attending hospital rounds.

Ask the patient who should participate and make sure the discharge team, receiving facility and designated caregiver have consistent information about medications, mobility and follow-up care.

Confirm who has legal authority to sign the admission agreement when the resident cannot do so.

It may be the patient, an authorized agent or another legally appropriate representative, depending on the circumstances.

Do not assume caregiver designation alone grants that authority.

A Practical Discharge Checklist

• Obtain a signed medical assessment made within the last year and clarify any changes during hospitalization.
• Reconcile the assessment, discharge medication orders and the facility’s requested forms.
• Complete the receiving community’s pre-admission appraisal before confirming a move-in date.
• Screen for prohibited conditions, restricted conditions and any necessary approved exceptions.
• For hospice patients, verify the facility’s hospice waiver and a workable hospice care plan.
• Notify the designated family caregiver and include that person in planning as appropriate.
• Confirm the facility has accepted the patient’s current care needs and that transportation and follow-up arrangements are ready.

The list is a starting point, not a substitute for individualized clinical judgment.

If a new condition appears after acceptance, tell the facility and reopen the discussion.

A postponed discharge is frustrating, but sending someone to a residence unable to meet their needs can be far worse.

• California Code of Regulations (Cornell LII). “Cal. Code Regs. Tit. 22, § 87458 – Medical Assessment.” Legal Information Institute.
• California Department of Social Services. “On-line Forms and Publications I – L.” California Department of Social Services.
• California Code of Regulations (Cornell LII). “Cal. Code Regs. Tit. 22, § 87457 – Pre-Admission Appraisal.” Legal Information Institute.
• California Code of Regulations (Cornell LII). “Cal. Code Regs. Tit. 22, § 87615 – Prohibited Health Conditions.” Legal Information Institute.
• California Code of Regulations (Cornell LII). “Cal. Code Regs. Tit. 22, § 87612 – Restricted Health Conditions.” Legal Information Institute.
• California Code of Regulations (Cornell LII). “Cal. Code Regs. Tit. 22, § 87616 – Exceptions for Health Conditions.” Legal Information Institute.
• California Code of Regulations (Cornell LII). “Cal. Code Regs. Tit. 22, § 87632 – Hospice Care Waiver.” Legal Information Institute.
• Justia. “California Health and Safety Code § 1262.5 (2025).” 2025 California Code.

Disclaimer: This article provides general educational information about hospital discharge planning and admission requirements for California Residential Care Facilities for the Elderly (RCFEs). It is not a substitute for medical advice, professional discharge planning or individualized assessments. Admission eligibility depends on the patient’s current health conditions, functional abilities, facility licensing requirements and available care services. California regulations and facility capabilities may change. Confirm all admission requirements, applicable exceptions and hospice waiver conditions with the receiving facility, treating healthcare team or California Department of Social Services before arranging a transfer. Raya’s Paradise provides residential assisted living and related supportive services, not skilled nursing facility care.