As the California Association of Health Facilities celebrates a half century of service, it is important to remember that the Association and the industry it represents have gone through many changes since CAHF was organized in 1950 as the California Association of Nursing Homes, Sanitariums, Rest Homes and Homes for the Aged.

Gone are the days when CANH, as it originally was called, relied on rummage sales for funds, and no longer does the Association office consist of a corner on a nursing-facility administrator's basement desk.

In the past 50 years, both health care in America and the specific services and licensure categories of long-term care facilities have undergone a revolution.

In 2000, with a staff of 40, CAHF conducts its advocacy and educational efforts in the most populous and in many ways most complex state in the union and, as the largest organization of its kind in the nation, finds itself more than ever dealing with issues at the national level.

CAHF's history goes back even earlier than the date in 1950 when the Association was formed in Fresno by 88 delegates. As early as the 1930s or before, long-term care began with the setting aside of a few beds in private homes hence the now-obsolete term nursing "home."

In the San Francisco Bay area, small facilities dominated in the 1930s and 1940s and often were owned by a woman with a natural proclivity for nursing. In contrast, the welfare system in Los Angeles County led to the establishment of larger homes run more like businesses and attuned early on to getting by on county reimbursement allotments.

During the Depression of the 1930s, the Nursing Home Association of San Francisco was formed, and after World War II similar regional organizations sprang up in the east Bay area and Los Angeles.

Local government inspection and licensing gave way in 1948 to state surveys and regulations, leading to the formation of more regional groups on the peninsula and Sacramento. It was these regional groups with diverse agendas that began to coalesce in 1950 to create the California Association of Nursing Homes, Sanitariums, Rest Homes and Homes for the Aged.

At that time, one of the big questions was whether the term "rest homes" should go before or after "nursing homes" in the title.

CANH initially comprised only four chapters San Francisco, East Bay, Peninsula and Sacramento. In 1953, the Association grew to eight chapters with the addition of Placer County, the Redwood Empire, Napa Valley and Sierra.

It continued to grow in 1954 and 1956 with the addition of chapters in Fresno, San Luis Obispo, Santa Barbara and Ventura counties. Also in 1956, the large regional Los Angeles association joined, giving CANH a sense of truly statewide clout.

In 1955, CANH joined the American Nursing Home Association, which later became the American Health Care Association. In recognition of California's importance to the national scene, ANHA held its 1958 annual convention in San Francisco.

In 1972, CANH became CAHF, the California Association of Health Facilities. In the following decades, CAHF consolidated its role as the largest state organization of long- term care providers, with an increasingly important national voice. Now, in the year of its golden anniversary, CAHF speaks with integrity on such issues as Medicare and Medi-Cal regulations and reimbursement and the public-relations image of long-term care.

In 1995, CAHF established its own Internet Web site, now at http://www.cahf.org, with news, answers to frequently asked questions and a wealth of other information for providers and the public. In 1996, the Association bought and moved into its own office building in Sacramento, just a mile from the Capitol and close to other state offices.

In its 50 years of existence, CAHF has had 29 presidents and chairmen, including five women. Former CAHF President Blaine Hendrickson became chairman of the American Health Care Association in 1999.

Within the organization, CAHF reconciles the different needs and outlooks of Northern Californians and Southern Californians, urban and small-town providers, multi-facility corporations and independent owners and operators, 100-bed skilled-nursing facilities and six-bed group homes.

Facilities devoted to assisted living, behavioral health and services for people with developmental disabilities have joined the Association and have become increasingly important as the continuum of long-term care broadens to include services that were virtually unheard of a half century ago.

On the educational front, CAHF provides a wide range of timely seminars through its Quality Care Health Foundation. In a typical year, QCHF provides training for between 7,000 and 10,000 long-term care staff with courses that are aimed at directors of nursing, directors of staff development, qualified mental retardation professionals and other specialties.