TB Test and Health Requirements to Move Into Assisted Living in California

If your parent is moving into a board and care home or assisted living community, one of the first things the home will ask for is a TB test. For assisted living in California, tuberculosis screening is part of the required medical assessment, along with a physical exam and other health information. Families are often surprised by the request, and a missing or outdated result is one of the most common reasons a move gets delayed.

This guide explains the TB test assisted living California homes require, which tests are accepted, how recent the results need to be, what happens if a test is positive, and the other health paperwork your parent will need before move-in to a senior care home in San Diego County.

Why Do California Care Homes Require a TB Test?

California care homes require TB screening because residents live closely together and many are frail, so one case of active tuberculosis could spread to others. State regulations require every new resident’s medical assessment to address communicable tuberculosis before admission, so the home knows the person is not contagious.

Tuberculosis is a bacterial infection that usually affects the lungs. Many people, especially those who grew up in countries where TB is more common, carry a latent (inactive) infection that is not contagious. A smaller number develop active TB, which can spread through the air. Older adults are at higher risk of latent TB becoming active as their immune systems weaken.

For a Residential Care Facility for the Elderly (RCFE), the rule is found in California Code of Regulations, Title 22, section 87458, which lists communicable tuberculosis among the conditions the medical assessment must examine. Assisted living communities and board and care homes are both licensed as RCFEs, so the same rule applies to both.

What California Rules Say About the TB Test for Assisted Living

Under Title 22 section 87458, before accepting a resident, an RCFE must obtain and keep a medical assessment signed by a licensed medical professional and made within the last year. It must include a physical exam with findings on communicable tuberculosis and other contagious or infectious diseases. The regulation does not name a specific type of TB test.

What that means in practice:

• Timing. The medical assessment must have been made within the past 12 months. Many homes prefer TB results that are more recent, especially after a hospital stay. Ask each home what it accepts.
• Licensed professional. A physician, nurse practitioner or physician assistant acting within their scope can sign.
• On file before move-in. The home must have the assessment before admission, not after.
• Updated when required. The home must obtain an updated medical assessment when the state licensing department requires it.

Most homes collect this on the state’s LIC 602A form, now titled Medical Assessment for Residential Care Facilities for the Elderly. Our guide to the LIC 602A physician’s report walks through every section.

Which TB Tests Are Accepted?

Most California care homes accept either a TB skin test or a TB blood test, as long as a licensed medical professional documents the result on the medical assessment. If either test is positive, a chest X-ray and doctor’s evaluation are used to show the person does not have active, contagious TB.

The common options:

• TB skin test (TST or PPD). A small injection under the skin of the forearm. It must be read by a nurse or doctor 48 to 72 hours later, so it takes two visits. Hard to arrange quickly for a parent in the hospital or with limited mobility.
• TB blood test (IGRA). A single blood draw, such as QuantiFERON or T-SPOT. Results usually come back within a few days. It is often the better choice for people who received the BCG vaccine as children, which can cause a false positive skin test.
• Chest X-ray. Used after a positive skin or blood test, or for someone with a history of a positive test, to look for signs of active TB in the lungs.
• Symptom screening. The doctor asks about cough, fever, night sweats and weight loss, which can point to active TB.

Some homes have their own preferences, such as accepting only a blood test or a recent chest X-ray for residents with a past positive result. Confirm before ordering a test.

What If My Parent’s TB Test Is Positive?

A positive TB test does not automatically prevent a move into assisted living. Many older adults have latent TB, which is not contagious. If a chest X-ray and doctor’s evaluation show no active disease, the doctor can document that your parent is free of communicable tuberculosis and the home can usually admit them.

Typical steps after a positive result:

• Chest X-ray. Ordered to look for active disease.
• Doctor’s evaluation. Review of symptoms, history and the X-ray.
• Documentation. The doctor notes on the medical assessment that your parent is free of communicable TB.
• Possible treatment. The doctor may recommend treatment for latent TB to reduce the chance of it becoming active. Ask whether this is advised and how it affects medication management in the home.

If a doctor suspects active TB, your parent will need treatment and public health clearance before moving into a group setting. That can take weeks, so start early. For people with a known history of positive tests, bring prior X-ray reports to every new doctor and care home.

Other Health Requirements for Assisted Living in California

The TB screening is one part of a broader medical assessment. California requires the assessment to cover medical history, current conditions, medications, physical limitations, diet, ambulatory status, cognition and behaviors. These details help the senior care home decide whether it can safely meet your parent’s needs before admission.

The required medical assessment includes:

• A physical exam with diagnoses and findings on communicable TB and other infectious or contagious diseases
• Medical history and current status, including height, weight and blood pressure
• A list of current prescriptions, and whether each should be centrally stored by the home
• Physical limitations, including medically necessary diet restrictions
• Whether your parent is ambulatory, non-ambulatory or bedridden, and whether that is due to physical or mental condition
• Cognitive conditions, such as mild cognitive impairment or a major neurocognitive disorder
• Any known behavioral expressions

The ambulatory status line matters more than families expect, because it determines which homes have the fire clearance to accept your parent. See ambulatory vs. non-ambulatory in California care homes. Certain conditions, such as some types of wounds, catheters or insulin needs, also have special rules; read our guide to restricted health conditions in California RCFEs.

California’s rules do not list vaccinations as part of the required medical assessment. Some homes set their own policies on vaccines such as flu or COVID-19, so ask during your tour.

The Rest of the Move-In Paperwork

Along with the medical assessment and TB results, a California RCFE will ask for identification and emergency contacts, consent and release forms, a medication list, insurance cards and legal documents. Having these ready before a tour can turn a weeks-long process into a few days, which matters when a bed is available now.

A typical packet for a board and care home in San Diego:

• LIC 602A medical assessment with TB results
• LIC 601 Identification and Emergency Information
• LIC 603 Preplacement Appraisal Information, used in the home’s RCFE pre-admission appraisal
• LIC 605A Release of Client/Resident Medical Information
• LIC 627C Consent for Emergency Medical Treatment
• LIC 621 Client/Resident Personal Property and Valuables
• Current medication list and pharmacy information, plus any new prescriptions from a hospital discharge
• Copies of Medicare, Medi-Cal, supplemental and long-term care insurance cards
• Powers of attorney, advance directive and POLST, if available
• The signed admission agreement; see board and care admission agreements in California

Getting a TB Test Quickly in San Diego

The fastest route is usually a TB blood test ordered by your parent’s primary care doctor or the hospital team before discharge. If your parent is in the hospital or a skilled nursing facility, ask the case manager to order the test and complete the LIC 602A before discharge, which can save days.

Practical tips:

• Ask early. As soon as a move is likely, ask the doctor or hospital team for a TB test, even before you pick a home.
• From the hospital or rehab. Hospitals and skilled nursing facilities can usually do TB screening and fill out the medical assessment. Our guides to discharge from Sharp hospitals and Scripps hospitals cover next steps.
• From home. Your parent’s doctor can order a blood test at a lab. A mobile doctor or house-call practice can help if getting out is hard.
• Keep copies. Save a PDF of results and the signed LIC 602A to send to several homes at once.
• Check dates. A form dated 11 months ago may technically meet the rule but be refused by a home that wants something current.

For example, a family in Escondido whose mother is leaving Palomar Medical Center might ask the case manager on day one for a TB blood test and a completed medical assessment, so a North County board and care home can accept her the day she is discharged.

TB Screening After Move-In and for Staff

TB screening does not end at admission. California care homes must also show their staff are free of active TB, and residents may need updated medical assessments when the licensing department requires them or when their condition changes. Good homes keep these records current and available.

What to know:

• Staff screening. Under Title 22 section 87411, every RCFE staff member, including the administrator, needs a physician’s health screening that includes a TB skin test or chest X-ray, done shortly before or after hire. You can ask the home how it keeps staff health records up to date.
• Updated assessments. The home must request an annual routine visit with a licensed medical professional for each resident, and reappraise needs at least every 12 months.
• Symptoms. If a resident develops a persistent cough, fever, night sweats or weight loss, the home should contact their doctor promptly.

You can check a home’s licensing record, including any citations for missing health records, in the CDSS Care Facility Search. See our guide to reading RCFE inspection reports in California.

How Elder Answers Helps

Elder Answers helps San Diego families get through the paperwork and find the right home quickly. We tell you exactly which documents each home needs, including TB results, and we match your parent to board and care homes in San Diego and assisted living communities that fit their needs and budget. Our advisors personally visit the homes we recommend.

Our service is free for families; care homes pay us after move-in, and the rate you pay does not change. We share information only with homes you choose. When it is urgent, moves can often happen within a few days. Contact Elder Answers to get started.

Frequently Asked Questions

Is a TB test required for assisted living in California?

Yes. California requires every assisted living community and board and care home licensed as an RCFE to obtain a medical assessment before admission that includes findings on communicable tuberculosis. This is Title 22 section 87458. Most homes ask for a TB skin test, TB blood test or chest X-ray result.

How recent does the TB test need to be?

The medical assessment, including TB findings, must have been made within the last year. Many care homes prefer more recent results, especially after a hospitalization. Ask each home what it will accept before ordering a new test.

Is a TB blood test or skin test better for moving into a care home?

Both are generally accepted. A blood test needs only one visit and is less affected by a past BCG vaccine, so it is often faster and more reliable for older adults. A skin test requires a second visit 48 to 72 hours later to read the result.

Can my parent move into assisted living with a positive TB test?

Usually yes, if a chest X-ray and doctor’s evaluation show no active, contagious TB. Many older adults have latent TB that cannot spread. The doctor documents this on the medical assessment, and the home can then admit your parent.

Who fills out the LIC 602A form?

A licensed medical professional, such as a physician, nurse practitioner or physician assistant, completes and signs it. Hospitals and skilled nursing facilities can often complete it before discharge, which speeds up a move to a board and care home.

Do board and care homes have the same TB rules as assisted living?

Yes. Board and care homes and assisted living communities in California hold the same RCFE license and follow the same Title 22 rules, including the medical assessment and TB screening requirement before admission.

Are vaccines required to move into assisted living in California?

The state’s required medical assessment does not list vaccinations. Some homes set their own policies on flu, COVID-19 or other vaccines, so ask during your tour and get the policy in writing.

What other health documents does a care home need?

Expect to provide the medical assessment, a medication list, insurance cards, emergency contacts, consent and release forms, and legal documents such as powers of attorney. The home will also complete a pre-admission appraisal of your parent’s needs.