Reports & Publications

2021 Quality Report - An annual report detailing the activities and accomplishments from members of CAHF from the previous year and summarizing data related to skilled nursing homes in California. 

The Long Term Care Continuum - One page graphic explaining the types of long term care available in California.

Next Steps in your Care - A printable handout for potential residents to help them understand payment, frequency of physician visits and how skilled nursing differs from a hospital setting.   

Guides/Forms

List Serve Rules and Etiquette Guide - Code of conduct for members who wish to participate in CAHF's listserv/forum

Photo/Video Release - A Microsoft Word document template for facilities to use to obtain permission from residents for publishing/posting photos and videos

CAHF Photo Release Form - Document used to grant CAHF permission to use a photo/video for promotional materials

Nursing Facilities

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 1,220 licensed long-term care skilled nursing facilities in California, including skilled nursing facilities that are attached to a hospital known as distinct part (DP) skilled nursing facilities.

• As many as 400,000 Californians are cared for annually in licensed long-term care facilities. The profession employs more than 147,000 workers with payroll and benefits exceeding $6.2 billion annually.

• 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.

• More younger people are being admitted for short term rehab. Approximately 40 percent of skilled nursing residents are age 45-74. Fifty seven percent are 75 or older. (Source: OSHPD utilization file, 2020)

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 who are medically fragile and require special services such as inhalation therapy, tracheotomy care, intravenous tube feeding and complex wound management care. 

• In 2019,120 nursing facilities provided subacute care to adults, nine provided care to children and one served both populations.. 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 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 13 large ICF/IIDs, approximately 677 ICF/IID-Hs, and 405 ICF/IID-Ns in California.

• Medi-Cal is the payor of nearly 100 percent of the ICF/IID services provided to the 8,000 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, three percent of ICF/IID 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/IID 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/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 17 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.

Payment Sources

Medicare

• California has 6.2 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

Medi-Cal (Medicaid)

• Fifty-six percent of California’s nursing facility residents rely solely on Medi-Cal to pay for their care in a skilled nursing facility. Eighteen percent are covered by Medi-Cal or Medicare managed care.

• In California, Medi-Cal reimburses skilled nursing facilities an average of $246 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.

(Revised 5/21)

The California Association of Health Facilities is a respected, credible voice for long term care. The association promotes the interests of the long term care community before federal and state legislative, regulatory and executive agencies. Working with long term care leaders, CAHF is able to identify and analyze critical legislative and policy issues and take action to enhance and protect our members' ability to continue to provide high quality care.

Critical to our effort is keeping our members alerted and engaged on the most important policy challenges facing long term care providers to enable them to help shape and influence public policy.

CAHF also works to improve the public’s understanding of long term care through ongoing campaigns in print, broadcast, social media, advertising and partnerships with community groups and related organization.

To learn more on how you can become an effective advocate and help CAHF's efforts with lawmakers, visit the various sections in www.cahf.org/Programs/Legislation.

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