Long-Term Care Providers Learn How Skilled Nursing is Different from Assisted Living
Sometimes called “skilled nursing facilities” (SNFs), “nursing homes,” rehabilitation centers" or “convalescent hospitals," these facilities provide nursing care for chronically ill or short term residents of all ages.
California’s nursing facilities are subject to comprehensive state and federal mandates governing all aspects of resident care and facility operations. The Department of Public Health Licensing and Certification Division, as an agent of the federal Health Care Financing Administration, performs annual inspections of all licensed long-term care facilities. The typical inspection lasts three days and involves three or more state surveyors. Medi-Cal and Medicare certified long-term care facilities must meet additional, more stringent state and federal requirements.
- There are approximately 1,250 licensed long-term care nursing facilities in California.
- As many as 350,000 Californians are cared for annually in licensed long-term care facilities.
- In 2014, the reported average cost per patient day for a skilled nursing facility was approximately $238 ($90,000 annually). Medicare and private pay costs are usually higher.
- Nursing facility occupancy rates in California are approximately 88 percent.
- In 2014, 83 percent of nursing home residents were discharged after a stay of three months or less - only 6 percent of all residents remain in the facility for one year or more.
- 88 percent of facilities are proprietary and 12 percent are nonprofit, according to the Office of Statewide Health Planning and Development (OSHPD).
- Women make up 60 percent of nursing home residents.
- More younger people are being admitted for short term rehab. Approximately 39 percent of skilled nursing residents are age 45-74. Sixty one percent are 75 or older.
(Source: OSHPD utilization file, 2015)
Subacute Care in Nursing Facilities
Subacute care is a goal-oriented level of care received immediately following or instead
of hospitalization to treat one or more specific complex medical conditions or to
provide extensive rehabilitation.
- Subacute care is provided under a nursing facility’s state operating license and federal and state Medicare/Medi-Cal certification requirements.
- Typical admissions to subacute facilities include patients with hip replacements, post surgical recovery and rehabilitation, head trauma, cancer, stroke, wound care and AIDS.
- In 2014,112 nursing facilities provided subacute care to adults and 10 provided care to children. The subacute units in these facilities range from 10 to 125 beds, with an average size of 36 beds.
- Compared to an average cost of $2,200 per day for a hospital stay, a nursing facility subacute unit generally runs $300 to $600 per day or less, depending on the patient’s needs.
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)
While known in California as intermediate care facilities for individuals with intellectual disabilities (ICF/IID), intermediate care facilities for the intellectually disabled - habilitative (ICF/IID-H) and intermediate care facilities for the intellectually disabled - nursing (ICF/IID-N), these facilities are known at the federal level as intermediate care facilities for the intellectually disabled (ICF/ID).
- ICF/IIDs have 16 or more beds; ICF/IID-Hs and -Ns have 15 or fewer beds and average six beds.
- Currently, there are 16 large ICF/IIDs, approximately 760 ICF/IID-Hs, and 420 ICF/IID-Ns in California.
- Medi-Cal is the payor of over 95 percent of the ICF/IID services provided to the 9,000 disabled individuals served in this program.
- ICF/IIDs in the community are licensed by the Department of Health Services (DHCS), and are annually reviewed by state inspectors to assure strict compliance with the same comprehensive state and federal mandates required of nursing facilities.
- In California, 6 percent of ICF/IID clients were under 22 years of age, 35 percent were age 22- 45, while 48 percent were age 46 - 64, and 10 percent were 65 or older. (Source: CMS)
- In California,38 percent of ICF/IID clients are considered profoundly mentally retarded, 24 percent are considered severely mentally retarded,19 percent are considered moderately mentally retarded, and 19 percent are considered mildly mentally retarded. (Source:CMS)
- In California, approximately 76 percent of ICF/IID clients participate in off-campus day programs. (Source: AHCA)
Institutes for Mental Health (Special Treatment Programs)
Institutes for mental health focus on extended treatment periods for people of all ages with chronic mental-health problems. These facilities offer specialized staff serving clients in a secured environment.
- Currently, there are 26 skilled nursing/mental disorder facilities licensed in California.
- Nearly 100 percent of mental-health clients rely on Medi-Cal.
- Twenty percent of all Americans will have a mental disorder at some time in their lives. Less than seven percent have symptoms for a full year or longer.
Assisted Living/Residential Care Facilities for the Elderly (RCFEs)
RCFE’s provide personal care and safe housing for people who require supervision for medication and assistance with daily living, but who do not require 24-hour nursing care.
- Assisted living providers in California are licensed by the Department of Social Services as Residential Care Facilities for the Elderly (RCFEs).
- They are inspected every five years
- The average length of stay is 28.3 months (Source: NCAL)
- Seventy-four percent of residents are female and the average age is 87 years old.
- Most residents of assisted living settings require limited assistance with the five major activities of daily living (bathing, dressing, transferring, toileting, and eating). More than half require assistance with more than one activity of daily living.
- Many residents require assistance with bathing and approximately 40 percent require some assistance with dressing. The vast majority of residents, 80 percent, require no assistance with eating, transferring, or toileting.
- Approximately 70 percent of assisted living residents moved to the residence from home and five percent from other assisted living residences. Of those leaving assisted living, 59 percent went to nursing facilities and seven percent to hospitals. (Source: NCAL, Survey of Assisted Living Facilities, 2009).
- The majority of assisted living services are paid for with private funds. Nearly five percent of RCFE residents rely on SSI/SSP.
- Medicare does not pay for assisted living services under any circumstances.
- California has 4.2 million Medicare beneficiaries; Medicare covers about 16 percent of all skilled nursing care in California.
- Medicare has a fee-for-service plan and Medicare Advantage Plans in some areas.
- Medicare also has Prescription Drug Plans. (Medicare Part D)
- For more information about Medicare, go to www.medicare.gov/Choices/Overview.asp.
- Sixty-six percent of California’s nursing facility residents rely solely on Medi-Cal to pay for their care in a skilled nursing facility (three out of five residents).
- In California, Medi-Cal reimburses skilled nursing facilities an average of $195 per day.
- Ninety-five percent of services provided to Intermediate Care Facilities for the Developmentally Disabled (ICF's/DD) is paid for by Medi-Cal.