Long-term care in the United States encompasses a broad spectrum of services designed to meet health or personal needs over an extended period. These services are delivered across various settings, from in-home assistance to residential facilities, each corresponding to a specific level of need and medical intensity. The Intermediate Care Facility (ICF) represents a distinct and specialized tier within this healthcare landscape, providing comprehensive residential services. Understanding the ICF level of care requires examining its regulatory framework, the specific population it serves, and the unique philosophy of the care provided. This framework is designed for individuals who require consistent support and training to maximize their personal independence.
Defining Intermediate Care Facilities
An Intermediate Care Facility is a federally designated residential setting that provides health and rehabilitative services for individuals requiring regular support but who do not need the continuous, intensive medical care found in a hospital or a skilled nursing facility. The regulatory foundation for these facilities is established by the Centers for Medicare & Medicaid Services (CMS) under federal law. Specifically, the standards for operation and services are detailed in 42 Code of Federal Regulations (CFR) Part 483, Subpart I. This federal oversight ensures that all certified ICFs meet baseline requirements for resident protections, staffing, health services, and the physical environment. The primary purpose of an ICF is to offer comprehensive care designed to improve an individual’s overall level of functioning, promoting the development of life skills and greater independence. While the term “ICF” broadly refers to this level of care, the vast majority of facilities operating under this designation today are Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). These facilities are structured to offer a supportive, residential environment with 24-hour supervision and services.
Target Population and Eligibility
The ICF level of care is almost exclusively focused on individuals with intellectual or developmental disabilities. The most common facility type is the ICF/IID, which serves a population requiring a structured, continuous program of specialized services. To qualify for admission to an ICF/IID, an individual must meet specific diagnostic and functional criteria defining a developmental disability or a related condition that manifested before the age of 22.
The eligibility determination involves an assessment confirming the individual has significant limitations in at least three major life activity areas:
- Self-care
- Language
- Learning
- Mobility
- Self-direction
Additionally, the individual must require and benefit from “active treatment.” This requirement ensures that the placement is therapeutic, focusing on skill acquisition and maintenance, rather than being merely custodial. The applicant must need 24-hour support that cannot be sufficiently provided through other community-based options. A multidisciplinary team evaluates the functional, developmental, behavioral, and health status to confirm the ICF/IID level of care is appropriate.
Scope of Services and Active Treatment
The core philosophy governing services within an ICF/IID is the concept of “Active Treatment,” a requirement that fundamentally distinguishes this setting from other forms of long-term care. Active Treatment is defined in federal regulation as the aggressive, continuous, and consistent implementation of a program of specialized and generic training, treatment, and health services. This means the care provided must be deliberately focused on helping the individual acquire the behaviors and skills necessary to function with the greatest possible self-determination. The continuous nature of this treatment means that all aspects of the individual’s day, including all activities and support, are coordinated toward specific, measurable goals.
Care begins with an individualized program plan (IPP) developed by an interdisciplinary team, which serves as the blueprint for all services. This plan outlines specific, personalized goals for skill development in areas like self-care, communication, and social interaction. The aggressive nature of the treatment involves providing continuous, structured support to prevent the loss of current functional status or to decelerate any potential regression.
Habilitation services form a large part of the program, focusing on developing daily living skills, such as dressing, eating, and hygiene (Activities of Daily Living or ADLs). Therapeutic services are integrated into the daily routine and can include physical, occupational, and speech therapy as determined by the IPP. The team also provides comprehensive behavioral support, which is often necessary for individuals with more profound intellectual or developmental challenges. Active Treatment extends to promoting community integration, where residents participate in structured activities outside the facility to practice social skills and engage with the broader community. The staff, which includes a Qualified Intellectual Disability Professional (QIDP), coordinates and monitors the individualized program to ensure consistency across all environments.
Funding and Regulatory Distinctions
Financial support for the ICF/IID level of care is primarily derived from Medicaid (Title XIX of the Social Security Act). Although the benefit is technically optional for states, all fifty states currently offer the ICF/IID program. This benefit covers the comprehensive array of services, including residential costs, specialized training, and all necessary health care services, for individuals who meet both the medical and financial eligibility criteria for Medicaid.
The ICF/IID level of care is distinct from that provided by a Skilled Nursing Facility (SNF), which represents the highest intensity of institutional long-term care. An SNF is required to provide 24-hour skilled nursing care, focusing on complex medical needs, wound care, or short-term post-acute rehabilitation. In contrast, the ICF/IID focuses on long-term habilitation and developmental training, with less intense medical oversight. While an ICF provides nursing supervision, it is not required to have a Registered Nurse on site 24 hours a day, a standard mandated for an SNF.