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 carefacilities must meet additional, more stringent state and federal requirements.
There are approximately 1,230 licensed long-term care nursing facilities in California. These include free-standing nursing homes and ‘distinct part’ nursing homes which are attached to hospitals.
More than 400,000 Californians are cared for annually in licensed long-term care facilities.
In 2020, the reported average cost per patient day for a skilled nursing facility was approximately $304 ($110,960 annually). Medicare and private pay costs are usually higher. 2020 Genworth Cost of Care Survey
Nursing facility occupancy rates in California are approximately 87 percent.
In 2020, 88 percent of nursing home residents were discharged after a stay of three months or less – only six 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 58 percent of nursing home residents. Forty two percent are male.
More younger people are being admitted for short term rehab. Approximately 43 percent of skilled nursing residents are age 45-74. Fifty seven percent are 75 or older.
(Source: OSHPD utilization file, 2020)
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 2018,118 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.
While known in California as intermediate care facilities for individuals with developmental disabilities (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), these facilities are known at the federal level as intermediate care facilities for the intellectually disabled (ICF/IID).
ICF/DDs have 16 or more beds; ICF/DD-Hs and -Ns have 15 or fewer beds and average six beds.
Currently, there are 13 large ICF/DDs, approximately 669 ICF/DD-Hs, and 402 ICF/DD-Ns in California.
Medi-Cal is the payor of nearly 100 percent of the ICF/DD services provided to the 8,000 disabled individuals served in this program.
ICF/DDs in the community are licensed by the Department of Public Health (CDPH), 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, three percent of ICF/DD clients were under 22 years of age, 32 percent were age 22- 45, while 48 percent were age 46 – 64, and 17 percent were 65 or older. (Source: CMS)
In California, 33 percent of ICF/DD clients are considered profoundly mentally retarded, 24 percent are considered severely mentally retarded, 21 percent are considered moderately mentally retarded, and 19 percent are considered mildly mentally retarded. (Source:CMS)
In California, approximately 76 percent of ICF/DD clients participate in off-campus day programs. (Source: AHCA)
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 17 skilled nursing/mental disorder facilities licensed in California, known as STPs.
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.
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.
A majority of residents require assistance with bathing and approximately 48 percent require some assistance with dressing. About 57 percent need help with walking.
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 6.3 million Medicare beneficiaries; Medicare covers about 15 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 visit Medicare
In California, Medi-Cal reimburses skilled nursing facilities an average of $246 per day (includes 10 percent temporary pandemic increase).
Ninety-five percent of services provided to Intermediate Care Facilities for the Developmentally Disabled (ICF’s/DD) is paid for by Medi-Cal.
