Facts & Statistics
Long-Term Care Providers
Nursing Facilities
Sometimes called “skilled nursing facilities” (SNFs), “nursing homes” or “convalescent hospitals”, these facilities provider 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 Health Services, Licensing and Certification Section, 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 1,440 licensed long-term care nursing facilities in California.
- As many as 250,000 Californians are cared for annually in licensed long-term care facilities.
- The average Medi-Cal nursing facility costs range between $82 - $95 per patient per day ($30,000 - $35,000 per year). Medicare and private pay costs are usually higher.
- Nursing facility occupancy rates in California are approximately 86%.
- The average length of stay in today’s long-term care facility in California is less than two months for over 70% of the resident population; with fewer than 13% of all residents remaining in the facility for one year or more.
- In 1996, 82% of facilities were proprietary and 14% were nonprofit, according to the Office of Statewide Health Planning and Development (OSHPD). Government-owned facilities accounted for less than 4% of the total.
- The U.S. Census Bureau estimates that the number of nursing facility residents in the United States will rise steadily until 2020 and then increase sharply for the next 20 years, growing to more than four times the 1990 level. By 2080, the Bureau estimates that the nursing facility population nationwide will rise to 5.6 million elderly (age 65+).
- Three out of four nursing facility residents are women.
- Approximately 85% of nursing facility residents in California are age 65 or older.
- On average, residents require some level of assistance with 3.7 activities of daily living (ADLs), which include bathing, dressing, transferring, toileting, and eating.
- In California, approximately 37% of residents require psychoactive drugs – 6% below the national average. (Source: HCFA-OSCAR data.)
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.
- Fewer than 200, or approximately 15 percent, of California’s 1,440 licensed nursing facilities currently provide subacute care. The subacute units in these facilities range from 10 to 50 beds, with an average size of 24 beds.
- Compared to $700 to $1,000 per day for a hospital stay and $850 per day for a rehabilitation hospital, a nursing facility subacute unit generally runs $300 to $550 per day or less, depending on the patient’s needs.
Intermediate Care Facilities for the Mentally Retarded (ICF/MR)
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 700 ICF/DD-Hs, and 300 ICF/DD-Ns in California.
- Medi-Cal is the payor of over 95 percent of the ICF/MR services provided to the 12,300 disabled individuals served in this program.
- ICF/MRs in the community are licensed by the Department of Health Services, and are annually reviewed by state inspectors to assure strict compliance with the same comprehensive state and federal mandates required of nursing facilities.
- Nationally, 84 percent of ICF/MRs are privately-owned, 9% are operated by the state, and 7% are classified as “other”. (Source: AHCA)
- In California, 14 percent of ICF/MR clients were under 22 years of age, 62 percent were age 22- 45, 22 percent were age 46 - 65, and 3 percent were over 65. (Source: HCFA 1996 Historical Survey Data.)
- In California, 53 percent of ICF/MR clients are considered profoundly mentally retarded, 20 percent are considered severely mentally retarded, 13 percent are considered moderately mentally retarded, and 12 percent are considered mildly mentally retarded. (Source: HCFA 1996 Historical Survey Data.)
- In California, approximately 56 percent of ICF/MR clients participate in off-campus day programs. (Source: HCFA 1996 Historical Survey Data.)
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 47 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).
- 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 45 percent require some assistance with dressing. The vast majority of residents, 85 percent, require no assistance with eating, transferring, or toileting.
- Approximately 58 percent of assisted living residents moved to the residence from home and nine percent from other assisted living residences. Of those leaving assisted living, 57% went on to settings with more acute care: 44 percent to nursing facilities and 13% to hospitals. (Source: AHCA, Survey of Assisted Living Facilities, 1995)
- Approximately 28 percent of residences that responded to the 1995 AHCA Assisted Living Survey share a building with a nursing facility, with about a third of the beds for assisted living residents and two-thirds for nursing facility residents. A little over half of the residences are freestanding.
- 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 3.4 million Medicare beneficiaries, but Medicare covers less than eight percent of all skilled nursing care in California.
- One-third of the nation’s Medicare-risk enrollees reside in California and more than one million Californians are enrolled in a Medicare-risk managed health plan.
- One in three Medicare beneficiaries is enrolled in a managed care health plan. The state’s Medi-Cal program is following suit with three counties now offering managed care plans to the elderly, disabled and others requiring long-term care and services.
Medi-Cal (Medicaid)
- Sixty-four 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 $82 per day ($29,900 per year).
- Ninety-five percent of services provided to Intermediate Care Facilities for the Mentally Retarded (ICF/MR) residents is paid for by Medi-Cal.
Private Insurance
- Less than 2 percent of Californians currently pay for long-term care through private insurance.
- The California Partnership for Long-Term Care is an innovative alliance among consumers, the State of California and private insurers who offer policies meeting stringent, state-approved standards.
General Demographics
- One in 10 Californians is age 65 or older.
- Between 1980 and 1990, the 85 and older population in California increased by 37%
- Researchers estimate that the probability at age 85 of needing nursing facility services is 70 percent.
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