With its sandy beaches, towering mountains and ancient redwood forests, sunny California offers a perfect mix of natural beauty and modern living. The state has a population of nearly 40 million people and some of the largest cities in the country, as well as charming small towns and lively villages. California has an array of high-quality health care providers and is home to some of the nation’s top-rated hospitals and nursing homes.
Nursing homes are best for seniors who need a high level of care, including those with chronic or progressive health conditions. As well as offering a secure environment, nursing homes provide residents with access to 24/7 nursing care on-site, as well as medical, rehabilitative therapy and pharmaceutical services. Highly trained staff provides around-the-clock supervision and can offer assistance with eating, personal care and medication administration. By providing information on the cost and availability of nursing homes in California, this guide is designed to help seniors and their loved ones find the ideal location for long-term care.
SeniorAdvice’s Guide to Nursing Home Care in California
The SeniorScore in California is 70, which indicates that the state is an overall pleasant place for seniors to live. California’s highest score is in the General Quality of Life section, at 72, partially due to its sunny, warm weather that persists all year. California’s low score of 51 in the Finances category is influenced by its high overall cost of living.
In the Health & Safety category, the state earned a relatively high score of 67. Residents of California have access to high numbers of hospitals and Medicare-registered health care providers. The state has a very high number of senior living communities, making it easy for seniors to get the care they need. The average life expectancy here is longer than in the rest of the nation, at 80.8 years compared to 78.6.
California has a slightly lower senior population than the national average, which contributes to its Recreation & Leisure score of 59. Despite this, it has a wide range of elder-friendly amenities and entertainment options. These include 6,451 churches, 942 golf courses and an average number of municipal parks in communities across the state.
Nursing Home Care Costs in California
In California, seniors in nursing homes typically pay $9,794 per month for semiprivate accommodations. This is nearly $2,000 higher than the national median of $7,908, indicating that California is among the costlier states in the nation for institutionalized care. In Oregon, rates are even higher at $10,342, and in Nevada, facilities charge slightly more competitive rates of $9,216. Rates in Utah are below the national median at $7,178, and in Arizona, care costs are relatively affordable at $6,540.
- California: $9,794
- United States: $7,908
- Oregon: $10,342
- Nevada: $9,216
- Utah: $7,178
- Arizona: $6,540
The Cost of Nursing Home Care in California’s Top Cities
Nursing home costs throughout California vary considerably, ranging from $7,559 in Madera to $11,566 in San Francisco. In Visalia, rates are well below the state median at $8,517, and in Los Angeles, California’s most populous city, seniors pay $9,125. Nursing home residents in Chico pay $9,201 per month, and in San Diego, facilities charge $9,384. Care costs in Sacramento exceed the state median at $10,646, and in Santa Rosa, nursing home residents pay $11,300.
- Santa Rosa Area: $11,300
- Madera: $7,559
- Los Angeles: $9,125
- San Diego: $9,384
- Sacramento: $10,646
- Chico: $9,201
- San Francisco: $11,566
- Visalia: $8,517
Senior Care Cost Comparison in California
Nursing home care is the most expensive long-term care option for California seniors, with residents paying $9,794 per month for semiprivate accommodations. Those who need short-term or intermittent skilled nursing services may save thousands of dollars by living in assisted living, which costs $5,250, or by receiving skilled nursing services at home via home health care, which costs $6,101. Those seeking basic homemaker services in their own homes pay $6,101 for in-home care, and those who attend daytime adult day care facilities pay the lowest monthly rates of $1,842.
- Assisted Living: $5,250
- In-Home Care: $6,101
- Home Health Care: $6,101
- Adult Day Care: $1,842
- Nursing Home Care: $9,794
Medicaid’s Coverage of Nursing Home Care in California
Qualifying seniors in California may pay for nursing home services via Medi-Cal, the state’s Medicaid program. Currently, over 13 million people are enrolled in this health insurance program, about 2 million of whom are aged 65 and over or who have disabilities. Across the state’s nearly 1,200 nursing homes, about five in eight residents rely on Medi-Cal to cover their care costs.
Medi-Cal pays for services that are deemed medically necessary. These services include:
- Some prescription medications
- Doctors’ office visits
- Adult day health services
- Some dental services
- Emergency medical transportation
- Home health care
- X-ray and laboratory costs
- Orthopedic devices
- Hearing aids
- Durable medical equipment
- Nursing home costs not covered by Medicare
Older adults at risk of nursing home placement may qualify for the Home and Community-Based Alternatives Waiver. This waiver provides care management services to help older adults delay or avoid nursing home placement by obtaining services they need in their own homes. A multidisciplinary team comprised of a nurse and social worker administers services and coordinates long-term care services in the community. Unlike Medi-Cal, which is an entitlement that guarantees coverage to everyone who qualifies, the HCBA Waiver has limited enrollment slots, and some qualified applicants are placed on a wait list until a slot opens up.
Eligibility for Medicaid in California
To qualify for nursing home coverage through Medicaid, California seniors must meet asset limits. Single applicants can have up to $2,000 in countable assets, and married applicants can have up to $3,000. If only one spouse is applying for coverage, they may have $2,000 in countable assets and the non-applying spouse can hold up to $137,400.
While California doesn’t impose income limits for those applying for Institutional Medicaid, applicants aren’t permitted to keep all of their monthly income. Instead, most of their income must go toward covering nursing home costs. Seniors can keep $35 per month as a personal needs allowance and whatever they need to cover Medicare premiums. If they’re married, their spouse may be entitled to a Minimum Monthly Maintenance Needs Allowance of up to $3,435 per month to prevent spousal impoverishment. Any income the individual receives in addition to this must go toward their care costs.
|Monthly Income Limits||Asset Limits|
|Single Applicant||No Income Limit||$2,000|
|Two-Person Household (Single Applicant)||No Income Limit||$2,000 for applicant $137,400 for non-applicant|
|Two-Person Household (Dual applicants)||No Income Limit||$3,000|
In addition to meeting financial requirements, those applying for Medi-Cal must be:
- Legal U.S. citizens or residents
- Permanent residents of California
- At least 65 years old, blind or disabled
- Require nursing home level care
Applying for Medicaid in California
California seniors have several options for applying for Medicaid. They may submit an online Medi-Cal application via CoveredCA.com. Those who prefer to fill out a paper application can send the completed application to Covered California at P.O. Box 989725, West Sacramento, CA 95798 or to their local county office. Once they submit the application, the approval process typically takes 3 – 6 months.
Information You Will Need
To apply for Medicaid, seniors must be able to produce documents that support their eligibility for the program. These include:
- Social Security Number
- Proof of age, such as a birth certificate
- Proof of permanent residency in California
- Proof of all annual income, including pensions, retirement savings and government benefits
- Policy numbers for existing health insurance coverage, including Medicare
Medicaid Application Assistance and Resources in California
Several programs help older adults navigate the Medi-Cal application process, helping them understand available coverage, necessary documentation and where to obtain care. Through the following resources, seniors can get help with applying for coverage, getting the most from their benefits and appealing denied claims.
|Health Consumer Alliance||(888) 804-3536||The Health Consumer Alliance provides free in-person and over-the-phone help for those who are having a hard time obtaining health insurance coverage. Its representatives can help older adults understand their health insurance rights and dispute denied claims.|
|Medi-Cal Managed Care Ombudsman||(888) 452-8609||California has a dedicated Medi-Cal Managed Care Ombudsman that advocates for beneficiaries. Seniors can contact the ombudsman if they feel a claim has been handled unfairly or if they need help resolving medical billing errors. The ombudsman can also help older adults connect with the right department to address issues regarding their coverage.|
|Medi-Cal Managed Care Health Care Options||(800) 430-4263||Medi-Cal Managed Care Health Care Options provides up-to-date information on policy changes that impact beneficiaries, such as the upcoming elimination of asset limits. The office can also help older adults choose the right plan for their needs or make changes to their existing coverage.|
|Medi-Cal State Fair Hearing||(800) 952-5253||Medi-Cal State Fair Hearing has a toll-free helpline that connects seniors with their local County Welfare Department, which can help them address problems such as canceled policies or denied coverage.|
Medicare’s Coverage of Nursing Home Care in California
For seniors who meet certain requirements, Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay. This benefit is only available to those who have been hospitalized for at least three days (not counting the date of discharge) so it’s typically used by those who are recovering from an injury, illness or surgery.
For those who meet the above requirements, Medicare will pay for up to 100 days in a skilled nursing facility (per benefit period). It’s important to note that the first 20 days are covered in full, but starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
California Medicare Support & Resources
Older adults in California can connect with several programs, websites and agencies within the state for assistance understanding Medicare benefits. The following table outlines some resources for Medicare beneficiaries that can help them make informed decisions regarding paying for nursing home care.
|Medicare Counseling||(800) 434-0222||California’s Medicare Counseling program provides free one-on-one assistance for Medicare beneficiaries, helping seniors understand their coverage and make informed decisions regarding paying for nursing home care. Through this program, older adults get answers to questions about Original Medicare and Medicare Advantage Plans in their area, as well as Medigap, which can reduce out-of-pocket nursing home expenses. Counselors can also help seniors protect themselves from Medicare fraud and dispute denied coverage.|
|Medicare.gov||(800) 633-4227||The federal Medicare website provides comprehensive up-to-date information on Medicare, including benefits under each part of the program, coverage limits, out-of-pocket cost-sharing obligations and private Medicare options. It also lists the type of mail Medicare beneficiaries get, including their Medicare card, the Medicare Handbook and the Get Ready for Medicare packet.|
|BenefitsCheckUp||(800) 794-6559||BenefitsCheckUp is a federal website that allows visitors to search the benefits programs in their state. Seniors can enter their zip code and basic information and get information on medication benefits, health care services, health insurance options counseling and Medicare Savings Programs.|
|California Department of Insurance||(800) 927-4357||The California Department of Insurance regulates health insurance policies within the state and advocates on behalf of consumers with issues regarding denied claims for covered services. Through the department’s website, seniors find information on Medicare’s coverage for nursing home care, as well as an overview of prescription drug coverage, Medigap plans and Medicare Advantage. The department also fields and investigates complaints regarding unfair claims practices.|
Additional Financial Assistance Options for Nursing Home Care in California
- Medicare: For the first 20 days in a skilled nursing facility, Medicare will cover the entire cost of care, and a portion of the costs up until day 100. After 100 days, Medicare won’t cover any of the costs. Importantly, seniors must also have a “qualifying hospital stay” that lasts 3 days prior to their admission to a nursing home in order to qualify for Medicare coverage.
- Aid and Attendance: Aid and Attendance may be available to veterans who receive a VA pension. This benefit is a monthly cash allowance that veterans receive in addition to their standard pension amount. It is intended for veterans in need of long-term care services and may be used to pay for skilled nursing care.
- Reverse Mortgages: For those who own a home, reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home’s equity into cash. It’s often a good fit for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Keep in mind that reverse mortgage loans do need to be repaid (with interest), typically within 12 months of receiving the loan.
- Long-Term Care Insurance: For seniors who already have long-term care insurance, the cost of skilled nursing care may be covered. Most policies cover at least a portion of the costs, but it depends on the specific policy terms. It’s important to note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a long-term care insurance policy.
California Nursing Home Care Rules and Regulations
The California Department of Public Health is responsible for regulating and licensing the state’s nursing homes. This agency also performs periodic reviews of nursing homes to ensure a high quality of care is provided in these facilities. Below are some of California’s state-specific nursing home regulations.
|Scope of Care||In California, skilled nursing facilities provide high levels of care to those who need 24-hour medical supervision but don’t need hospital care. In addition to accommodations and assistance with daily living tasks, nursing homes provide assistance with personal hygiene, incontinence, mobility, hydration and nutrition needs. These facilities also offer a full range of medical care, including pharmaceutical and physician services and various rehabilitative therapies. Residents also have access to specialized medical services such as injections, feeding tubes, foot care and IV fluid administration.|
|Care Plan Requirements||Nursing homes are required to work with residents to create a personalized care plan that meets their medical, physical, social and nutritional needs. Initial assessments and periodic reviews help attending physicians, residents and facility staff develop individualized plans for the delivery of services.|
|Medication Management Requirements||In nursing homes, staff is responsible for storing, managing and administering medication. This helps increase resident safety by removing the risk of pharmaceutical mix-ups and overdoses. Medications, except for some laxatives and topical treatments, must be administered by licensed nurses or trained medical personnel. Nursing homes are also required to maintain relationships with nearby 24-hour pharmacies to ensure that residents have access to their medications on a timely basis.|
|Staff Screening Requirements||As part of the required infection control protocol, all staff members in nursing homes must be screened for tuberculosis. Staff members must also obtain criminal record clearance as part of the hiring process.|
|Staff Training Requirements||Skilled nurses, who are available around the clock in nursing homes, are required to complete a state-approved training program before obtaining a license. All nurse assistants must undergo rigorous training on patient safety, clinical care and abuse prevention. Through a combination of classroom and clinical training, nurse assistants learn how to properly care for patients with special needs related to common conditions such as physical disabilities and dementia.|
|Medicaid Coverage||Around 65% of seniors in California qualify for Medi-Cal long-term care coverage, which can be used to pay for care in a nursing home when it’s medically necessary.|
|Reporting Abuse||Residents or their family members are encouraged to take up any concerns about their welfare with their local Long-Term Care Ombudsman. These volunteer ombudsmen advocate for seniors with concerns about inadequate care, unsafe conditions or improper medication management. If complaints can’t be resolved through negotiation, these ombudsmen can help residents submit complaints to the California Department of Public Health’s Licensing and Certification Division.|
Free Nursing Home Resources for Seniors in California
Seniors in California have access to numerous programs and services that help them make informed decisions regarding their long-term care plans. Through the following resources, seniors can access services in their own homes that may help them delay or prevent nursing home care. The table also includes resources to help older adults find facilities in their communities and identify ways to pay for services.
|Area Agencies on Aging||(800) 510-2020||There are 33 Area Agencies on Aging throughout California, each of which serves those aged 60 and over in designated regions. Through their local AAA, seniors can access services that may help them avoid nursing home placement, including home health care services, homemaker services, transportation and home-delivered meals.|
|Long-Term Care Ombudsman||(800) 231-4024||The Long-Term Care Ombudsman Program advocates for those in long-term care facilities throughout the state, including nursing homes. The ombudsman can help seniors understand their rights, find care solutions in the communities and identify options for paying for services. They can also investigate concerns regarding substandard care.|
|California Department of Veterans Affairs||(800) 952-5626||The Department of Veterans Affairs provides benefits, advocacy and support to the state’s 1.6 million veterans. It operates county offices where qualifying individuals access benefits counseling and apply for programs that can help cover nursing home costs. The department also operates eight veterans’ homes throughout the state, which may provide an affordable alternative to private-pay nursing home care.|
|State Bar of California||(415) 538-2000||The State Bar of California provides funding for nonprofit legal agencies throughout the state and offers an up-to-date database of law offices that offer free civil legal services to older adults. Through their local nonprofit law office, older adults can get help resolving issues related to nursing home care, including unfair intake and discharge procedures, excessive or insufficient services and billing errors.|
|Social Security Administration||(800) 772-1213||There are over 100 Social Security offices in California. At these offices, seniors can get income statements, replacement Social Security cards and proof of benefits. They can also apply for benefits that may help pay for nursing home care, including Supplemental Security Income, Social Security Disability Insurance and Medicare.|
|Meals on Wheels California||Meals on Wheels California oversees home-delivered meal programs in communities throughout the state. Through this organization, seniors can locate the Meals on Wheels program in their region and apply for services, which may help them avoid nursing home placement.|
|California Community Action Partnership Association||(916) 443-1721||CalCAPA supports local Community Action Agencies throughout the state and provides an up-to-date database of state programs and local agencies. Through their local CAP, seniors may obtain services such as home-delivered meals, chore services, friendly visits and phone calls, volunteer-based transportation and homemaker services, which may help them postpone, avoid or shorten the duration of nursing home care.|
California COVID-19 Rules & Regulations for Nursing Homes
All of the information below is based on research from a variety of sources, including those listed above. Among other types of senior living facilities, these rules apply to skilled nursing facilities. It’s important to note that since COVID-19 is a rapidly evolving crisis, you should contact your local nursing home or Area Agency on Aging for the latest information.
Visitation & Group Activities
|Are loved ones allowed to visit residents in-person?||Yes (Conditions Apply)|
|Are residents to quarantine after being visited by loved ones?||No (Conditions Apply)|
|Are visitors required to mask when visiting loved ones?||Yes|
|Are third-party contractors allowed in senior living facilities?||Yes (Conditions Apply)|
|Are temperature checks required for visitors coming into the senior living facility?||Yes|
|Can residents leave the facility for non-medical reasons?||Yes|
|If residents leave, are they required to quarantine when they return?||No (Conditions Apply)|
|Does the state require senior living facilities to cancel all group outings?||Not Available|
|Does the state allow senior living facilities to host group activities?||Yes (Conditions Apply)|
Safety Measures for Staff and Residents
|Does the state require senior living facilities to regularly check staff members for elevated temperatures?||Yes|
|Does the state require senior living facilities to regularly test staff members for COVID-19?||Yes|
|Does the state require senior living facilities to regularly screen residents for COVID-19 symptoms?||Yes|
|Does the state require senior living facilities to regularly check residents for elevated temperatures?||Yes|
|Does the state require senior living facilities to regularly test residents for COVID-19?||Yes (Conditions Apply)|