How Board and Care Rates Change: Annual Increases and Care-Level Changes

Most families choose a board and care home based on today’s monthly rate, then discover a year later that the rate has gone up. A board and care rate increase can come from two places: a general annual increase, or a change in your parent’s level of care. California has specific rules for both, including a 90-day written notice requirement that took effect in 2025. This guide explains how rates change in small board and care homes in San Diego, what the law requires, and how to plan for increases before they arrive.

If you are comparing larger assisted living communities and their tiered care fees, our separate guide to assisted living levels of care pricing covers that model. This article focuses on 6-bed residential care homes, often called RCFEs.

How Do Board and Care Rates Change Over Time?

Board and care rates usually change in two ways. First, a general increase applies to residents across the home, often once a year, to cover rising wages, food, insurance and utilities. Second, an individual increase happens when a resident needs more care. California treats these differently, especially for notice.

The two types side by side:

• General rate increase. The home raises the basic monthly rate or its rate structure. Under California law, the home must give 90 days’ advance written notice with the amount and the reasons.
• Level-of-care increase. Your parent’s needs grow, such as new incontinence care, a two-person transfer or dementia behaviors, and the home charges more for the added care. The 90-day notice does not apply, but separate notice rules do.

In 2026, board and care homes in San Diego typically cost $5,500 to $9,500 per month, and small dementia homes $6,000 to $9,500. Where your parent starts in that range, and how quickly needs change, shapes how much rates rise over a stay.

What Is California’s 90-Day Notice Rule for Rate Increases?

Since January 1, 2025, California Health and Safety Code Section 1569.655 requires residential care facilities for the elderly, including board and care homes, to give residents or their representatives at least 90 days’ written notice before a rate increase. The notice must state the amount of the increase and the reasons, including a description of the added costs.

What the rule covers:

• Who it protects. Residents of licensed RCFEs, from 6-bed board and care homes to large assisted living communities.
• What changed. SB 1406, signed in 2024, extended the notice period from 60 to 90 days.
• What must be in the notice. The dollar amount of the increase, the reasons for it and a general description of the additional costs behind it.
• What it does not cover. Increases due to a change in your parent’s level of care.
• No lump-sum assessments. The same section bars facility-wide lump-sum charges, so increases must be spread out (amortized) over 12 months, except for specific goods or services provided to an individual resident.

California law does not cap how much a board and care home can raise its rate. The 90 days give families time to review, ask questions, negotiate or plan a move if needed. Keep every notice you receive in a folder with the admission agreement.

How Level-of-Care Increases Work in Small Homes

In a board and care home, a level-of-care increase happens when your parent needs noticeably more help than when they moved in. The home reassesses, updates the care plan and adjusts the rate. California requires written notice within two business days after the new level of care begins, with an itemized explanation of the added services.

Common triggers for a level-of-care increase:

• New incontinence, especially needing frequent changes overnight
• Moving from a one-person to a two-person transfer, or needing a mechanical lift (see two-person transfers and Hoyer lifts)
• New insulin injections or frequent blood sugar checks
• Dementia progression with wandering, agitation or night-time waking
• Hospice or end-of-life care needing more frequent repositioning

Small homes often handle this differently from large communities. Many board and care homes use a simple all-inclusive rate with two or three tiers, or set a custom rate for each resident at move-in. When care needs jump, the owner or administrator usually calls the family first, then sends the written notice. Ask for the itemization in writing and compare it to the care plan.

How Much Do Board and Care Rates Usually Go Up?

There is no standard annual increase, and California does not cap increases. The best way to estimate future increases at a specific board and care home is to ask for its rate increase history. California law requires homes to give residents and prospective residents information about average rate increases over the past three years.

What the disclosure law requires:

• Health and Safety Code Section 1569.658 requires RCFEs to prepare an annual disclosure of their average monthly rate increases for each of the previous three years, in dollars and percentages.
• New residents receive the history in writing when they sign the admission agreement.
• Prospective residents and their representatives can ask for the most recent information before deciding.

Ask every home you tour: “May I see your rate increase history for the past three years?” A home with steady, modest increases is easier to budget for than one with irregular large jumps. Newly licensed homes may have a shorter history, so ask how they expect rates to change.

Board and Care Rate Increase Notices: What to Do When One Arrives

When a board and care rate increase notice arrives, read it carefully, check that it meets the 90-day rule, and compare the stated reasons with what you see in the home. Then talk directly with the owner or administrator. Many small homes will explain costs openly and sometimes adjust timing or amount.

A step-by-step response:

• Check the date. For a general increase, the effective date should be at least 90 days after you received the notice.
• Check the content. The notice should include the amount, the reasons and a description of the added costs.
• Ask questions. Is this increase applying to all residents? What specifically changed, such as caregiver wages or insurance?
• Negotiate when reasonable. Long-term residents with stable needs sometimes negotiate a smaller or phased increase, especially in owner-operated homes.
• Review your budget. Recalculate how long savings will last at the new rate.
• Get help if needed. If a notice seems improper, contact the long-term care ombudsman or Community Care Licensing.

For example, a family in Santee whose father has lived in a 6-bed home for two years might receive notice of a $300 monthly increase tied to new minimum wage rates for caregivers. After asking, they learn the increase applies to all residents and the home has not raised rates in 18 months. They decide it is fair and adjust their budget.

Level-of-Care Disputes: When You Disagree With a Reassessment

If you believe a level-of-care increase is not justified, ask for a care conference, the updated appraisal and the itemized list of new services. Compare them with what you see during visits. Many disagreements come from changes families have not noticed, like night-time help, but some are genuine billing errors.

How to approach it:

• Ask what specific tasks are new, how often they happen and which shift handles them.
• Request a copy of the updated needs and services plan.
• Ask your parent’s doctor or home health nurse whether the change in needs matches their observations.
• Visit at different times, including early morning or evening, to see the care being provided.
• If needs have stabilized or improved, ask whether the rate can go back down.

Honest information at move-in prevents many disputes. Families who describe night-time needs, falls and behaviors fully during the pre-admission appraisal usually see fewer surprise increases later. Our guide to board and care admission agreements explains which clauses set the rules.

Questions to Ask About Rates Before Signing

The best protection against surprise increases is asking the right questions before your parent moves in. Board and care homes vary widely in how they price care, and the admission agreement sets the rules. Get answers in writing, and compare at least two or three homes.

Questions for every board and care home:

• What is included in the monthly rate, and what costs extra? (See what’s included in a board and care monthly rate.)
• How often do you raise rates, and what was your average increase over the past three years?
• How do you decide when a resident’s level of care has changed?
• What specific changes would move my parent to a higher rate, and by how much?
• If my parent’s needs decrease, does the rate go down?
• Do you charge extra for hospice residents, incontinence supplies or special diets?
• What happens if our funds run low? Do you accept residents on the Assisted Living Waiver or other programs?

Write down the answers and keep them with your copy of the admission agreement. If a home will not answer clearly, that is useful information too.

Budgeting for Rate Increases Over a Multi-Year Stay

Plan your budget assuming rates will rise each year and that care needs will likely increase too. Many residents stay in board and care for several years, so modest yearly changes add up. Building in a cushion helps families avoid an unwanted move when savings run lower than expected.

A planning approach:

• Start with the current monthly rate and your parent’s monthly income.
• Use the home’s own three-year rate history to estimate yearly increases.
• Add at least one level-of-care step up during the stay, especially with dementia or Parkinson’s.
• Keep a reserve for medical costs, supplies and personal expenses.
• Revisit the plan every year when you receive a rate notice.

If the numbers will not work long-term, look at options early, such as a shared room instead of private (often $1,000 to $2,000 less per month), VA benefits, long-term care insurance, or the Medi-Cal Assisted Living Waiver, which has a waitlist. Our post on how long residents stay in board and care helps with timeline planning.

How Elder Answers Helps

Elder Answers helps families compare board and care homes in San Diego on the details that affect long-term cost, including what is included, how care levels are set and how rates have changed. Our service is free because care homes pay us after a resident moves in, and your rate does not change.

Our advisors personally visit the homes we recommend and know how many of them handle pricing in practice. We share your information only with the homes you choose. Contact Elder Answers to compare residential senior care options, or browse board and care homes in San Diego and local pages like board and care in Santee.

Frequently Asked Questions

How much notice must a board and care home give before raising rates?

At least 90 days’ written notice for a general rate increase, under California Health and Safety Code Section 1569.655 as amended by SB 1406, effective January 1, 2025. The notice must include the amount and reasons for the increase.

Does the 90-day notice apply to level-of-care increases?

No. Increases due to a change in your parent’s level of care are exempt from the 90-day notice. California instead requires written notice within two business days after the new level of care begins, with an itemized explanation of the added services.

Is there a limit on how much a board and care home can raise rates?

California does not cap rate increases for board and care homes or assisted living. Homes must give proper notice and explain the reasons. Asking for a home’s three-year rate history before moving in is the best way to gauge future increases.

Can a board and care home charge a one-time lump-sum fee to all residents?

Under current California law, RCFEs may not impose facility-wide lump-sum assessments. Increases must be amortized over 12 months, except for charges for specific goods or services provided to an individual resident.

What is a rate increase history disclosure?

California requires RCFEs to disclose their average monthly rate increases for each of the previous three years, in dollars and percentages. New residents receive it at admission, and prospective residents can ask for the most recent information.

Can we negotiate a rate increase?

Often, yes, especially in owner-operated board and care homes. Ask what is driving the increase, whether it applies to all residents, and whether it can be phased in. A long, stable stay gives you a reasonable basis to ask.

Will the rate go down if my parent needs less care?

It depends on the home and the admission agreement. Some homes lower rates when a resident’s needs decrease after recovery. Ask about this before signing and request a reassessment if your parent improves.

Who can I contact if I think a rate increase is improper?

Start with the home’s administrator. If the issue is not resolved, you can contact the local long-term care ombudsman program or the California Department of Social Services Community Care Licensing Division.