As a result, there are no national databases containing information on deficiencies. Thus, it is even more difficult than with nursing homes to generate anything approaching estimates of the prevalence or nature of abuse of neglect. This section of the paper briefly reviews what is known about these types of facilities and issues related to abuse and neglect.

What Are Residential Care Facilities?

Other than nursing homes, the most common form of residential settings with services for people with disabilities are generically known as board and care homes, or residential care facilities (RCFs). These terms describe a variety of settings; however, in general they refer to nonmedical community-based residential settings that house two or more unrelated adults and provide some services such as meals, medication supervision or reminders, organized activities, transportation, and help with bathing, dressing, and other activities of daily living (ADL). RCFs are known by more than 30 different names, including adult congregate care, personal care homes, homes for the aged, adult care homes, and group homes. In addition, many states have expanded the category of RCFs to include a specific classification known as assisted living (Mollica, 1998).

There are three basic types of RCFs: (1) group homes serving a clientele with mental retardation or developmental disabilities (MR/DD); (2) homes serving persons with mental illness; and (3) homes serving a mixed population of physically frail elderly, cognitively impaired elderly, and persons with mental health problems. All but 7,000 facilities are in the last category and are the focus of our initiative. They serve a mainly elderly population, although many house a mixed population of frail elderly and residents who have some type of psychiatric condition. In the early 1990s, there were an estimated 46,000 licensed and unlicensed RCFs with more than 700,000 beds (Clark et al., 1994; Hawes et al., 1993; Hawes et al., 1995a). The rapid growth since then of assisted living facilities has probably increased the total number of all types of residential care facilities to more than 50,000 facilities with more than 1 million beds (Hawes, et al., 1999; Assisted Living Federation of America, 1998; American Seniors Housing Association, 1998). As a point of comparison, there are an estimated 16,700 licensed nursing homes with approximately 1.8 million beds serving more than 1.5 million residents (Strahan, 1997). Thus, RCFs are a significant care setting for persons with chronic illness and disability.

Risk Factors: Vulnerability of Consumers

Consumers in RCFs face a number of daunting challenges to protecting their interests and securing adequate health care. Indeed, many RCF resi-

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