Long-Term Care Providers

Nursing Facilities
Sometimes called “skilled nursing facilities” (SNFs), “nursing homes” 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 1,300 licensed long-term care nursing facilities in California.
• As many as 300,000 Californians are cared for annually in licensed long-term care facilities.
• In 2007, the reported average cost per patient day for a skilled nursing facility was approximately $210 ($76,600 annually). Medicare and private pay costs are usually higher.
• Nursing facility occupancy rates in California are approximately 85%.
• The average length of stay in today’s long-term care facility in California is less than three months for over 78% of the resident population; with fewer than 9% of all residents remaining in the facility for one year or more.
• 87% of facilities are proprietary and 13% are nonprofit, according to the Office of Statewide Health Planning and Development (OSHPD).
• Two out of three nursing facility residents are women.
• Approximately 77% of nursing facility residents in California are age 65 or older.

 (Revised 9/09)

CAHF Facility Fact Sheet

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 2009, 109 nursing facilities provided subacute care. 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 $750 per day or less, depending on the patient’s needs.

Intermediate Care Facilities for the Mentally Retarded (ICF/MR)
Known in California as intermediate care facilities for the developmentally disabled (ICF/DD), intermediate care facilities for the developmentally disabled - habilitative (ICF/DD-H) and intermediate care facilities for the developmentally disabled - nursing (ICF/DD-N) are known at the federal level as intermediate care facilities for the mentally retarded (ICF/MR).

• ICF/DDs have 16 or more beds; ICF/DD-Hs and -Ns have 15 or fewer beds and average six beds.
• Currently, there are less than 20 large ICF/DDs, approximately 780 ICF/DD-Hs, and 400 ICF/DD-Ns in California.
• Medi-Cal is the payor of over 95 percent of the ICF/MR services provided to the 9,000 disabled individuals served in this program.
• ICF/MRs 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, 9% percent of ICF/MR clients were under 22 years of age, 42% percent were age 22- 45, while  43% percent were age 46 - 65, and 6 percent were over 65. (Source: AHCA)
• In California,46% percent of ICF/MR clients are considered profoundly mentally retarded, 23% percent are considered severely mentally retarded, 7% percent are considered moderately mentally retarded, and 14% percent are considered mildly mentally retarded. (Source: AHCA)
• In California, approximately 69% percent of ICF/MR 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 approximately 30 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).
• 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% went to nursing facilities and 33% to hospitals. (Source: AHCA, Survey of Assisted Living Facilities, 1995)
• The majority of assisted living services are paid for with private funds. Nearly 30 percent of RCFE residents rely on SSI/SSP.
• Medicare does not pay for assisted living services under any circumstances.
  
  

Payment Sources

Medicare

• California has 4.2 million Medicare beneficiaries, but Medicare covers less than 12% 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 http://www.medicare.gov/Choices/Overview.asp

Medi-Cal (Medicaid)

• 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 $162 per day.
• Ninety-five percent of services provided to Intermediate Care Facilities for the Mentally Retarded (ICF/MR) residents is paid for by Medi-Cal.