Residential Alternate Care Site (R-ACS) Option to Increase Bed Capacity Due to Anticipated Surge in Coronavirus Disease 2019 (COVID-19)

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AFL 21-02 From the California Department of Public Health

TO: General Acute Care Hospitals
SUBJECT: Residential Alternate Care Site (R-ACS) Option to Increase Bed Capacity Due to Anticipated Surge in Coronavirus Disease 2019 (COVID-19)

All Facilities Letter (AFL) Summary

This AFL notifies General Acute Care Hospitals (GACHs) of the availability of R-ACSs as a potential discharge option for COVID-19 positive patients needing residential level of care.

California continues to experience increasing numbers of COVID-19 cases and hospitalizations. With COVID-19 positive cases surging, the California Department of Social Services (CDSS) has developed R-ACSs to accommodate individuals requiring residential level of care with intermittent incidental medical support. These sites are intended to care for COVID positive individuals from residential care facilities for the elderly (RCFEs) and adult residential facilities (ARFs) that can no longer care for them due to staffing shortages or level of care needs beyond what the existing facility can accommodate and to support the decompression of hospitals.

Definition of Residential Alternate Care Site
R-ACSs offer another discharge option for hospitals in addition to the alternate care cites referenced in AFL-20-48 for patients that only require intermittent incidental medical support. R-ACSs are low-acuity sites that receive residents RCFEs or ARFs or post-discharge from GACHs and, if needed, from emergency departments for ongoing monitoring. These sites also assist in providing additional beds to temporarily house individuals and support the decompression of hospitals. They are not set up to provide substantial nursing services, however, they do provide some level of nursing and medical services. Please see CDSS’ Provider Information Notice 21-01-ASC (PDF) for the level of care matrix delineating appropriate levels of care.

Process for Discharge Placement to a Residential Alternate Care Site

GACHs can refer eligible individuals to an R-ACSs by contacting the CDSS Regional Office (PDF). Prior to an individual being placed in the care of R-ACS, the needs of the individual will be assessed by the individual’s originating facility and coordinated by the individual and/or the individual’s representative, Ombudsman, and the local health department. Although CDSS has the final approval of individual placement into a R-ACS, the individual’s primary care physician, and if indicated, the individual’s responsible party must be apprised of the plan. The decision-making process may vary depending on the prevalence of COVID-19 in the surrounding community as well as local hospital capacity. 

R-ACSs will coordinate appropriate transportation for the individual once placement is approved.

Transfers from Alternate Care Site to the Hospital

R-ACSs cannot offer the same breadth of services as a skilled nursing facility (SNF) or GACH and will not be able to perform the close monitoring needed if an individual’s condition deteriorates. If this occurs, individuals may need to be transferred from the R-ASC to a SNF or GACH through a direct admit or via the 911 emergency system. An individual may also be transferred to a SNF or GACH if the R-ACS determines the person requires medical care beyond the level available at the R-ACSs (e.g., new onset abdominal pain, worsening respiratory status).

For additional information on R-ACSs please contact please contact the Adult and Senior Care Program Office at (916) 657-2592 or e-mail


Original signed by Heidi W. Steinecker

Heidi W. Steinecker
Deputy Director