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Nursing Homes in California
With around 39.5 million residents, California has the largest population in the United States. Almost 15% of that population is aged 65 and above, and seniors in California have access to resources and programs that can help them age in comfort. There are a large number of world-class hospitals in the state, including some that are ranked among the top in the nation for geriatric care, and healthcare costs are lower than the national average.
Seniors can also access excellent nursing care, with more than 1,200 nursing home facilities in the state caring for more than 400,000 Californians annually. These facilities provide extensive long-term care that includes personal care, skilled nursing care, medical monitoring and treatments. In California, nursing home care costs an average of $9,247 per month for a semi-private room and $11,437 for a private room.
This guide includes detailed information about the cost of nursing home care in California, the financial assistance and other resources available to seniors in the state and the rules and regulations that cover nursing homes in California.
The Cost of Nursing Home Care in California
The average monthly cost of nursing home care in California is $9,247, according to the Genworth Cost of Care Survey 2020. This is $1,491 higher than the national average of $7,756. Despite this, California’s costs are more affordable than most of its neighbors. Nevada’s costs are slightly higher at $9,262 per month. In Washington state the cost is $9,581 per month and seniors in Oregon pay $10,114 monthly, $867 more than those in California. Arizona is the only nearby state with more affordable nursing home care. The average cost there is $6,844 per month, $2,403 lower than California.
California’s diverse range of cities means that the cost of nursing home care can vary widely depending on a senior’s location. Large coastal cities tend to have higher prices, with San Jose offering the least affordable care at $12,547 per month. San Francisco is slightly lower at $12,471 and San Diego’s seniors pay $10,722. Sacramento’s costs are also higher than average, at $9,946 per month. Los Angeles is the exception, with costs in the state’s biggest city averaging $8,060, $1,187 lower than the state average. Seniors in Bakersfield have the same costs. Those looking for lower costs can look to inland cities such as Fresno and Riverside, where the seniors pay $7,787 and $7,756 respectively.
Sacramento
$9946
Los Angeles
$8060
San Diego
$10722
San Francisco
$12471
San Jose
$12547
Fresno
$7787
Bakersfield
$8060
Riverside
$7756
Due to the extensive skilled care available, skilled nursing is the most expensive type of care offered in California, at $9,247 per month. However, seniors do have other options for long-term care. Adult day care, which provides services in a group setting to seniors who live at home, is the most affordable option at $1,733 per month. Assisted living in the state averages $5,000 monthly and provides room, board and personal care, though doesn’t provide skilled nursing. Home care can provide either non-medical or skilled nursing care and may be an option for seniors that require a nursing home level of care. Both types in California cost an average of $5,529 per month.
In-Home Care
$5529
Home Health Care
$5529
Adult Day Care
$1733
Assisted Living Facility
$5000
Nursing Home Care
$9247
Does Medicaid Cover Nursing Home Care in California?
Medi-Cal, California’s Medicaid system, covers nursing home care for seniors who have limited financial means. There are 13 million people in California who rely on Medi-Cal, including 2 million seniors. Medi-Cal pays for around 55% of all patient days in long-term care facilities. There are approximately 1,230 licensed nursing homes in the state.
Nursing homes provide 24-hour skilled nursing care for seniors who require more supervision and medical attention than an assisted living facility would be able to provide. They help seniors maintain a high quality of life whether they’re recovering from an operation or living with the effects of a long-term condition.
Seniors who would prefer to receive care in their own homes rather than moving into a nursing home may be eligible for a Home and Community Based Services Waiver that allows them to receive skilled nursing care in the community. Institutional nursing home care is covered under the means-tested Medi-Cal program.
Medicaid Eligibility in California
To qualify for Medi-Cal, seniors must either reside in a skilled nursing facility or meet income limits. For these people, there are no income limits to be eligible.Once accepted, though, most of the beneficiary’s income must be paid toward the cost of the nursing home.
California plans to remove assets from its calculations from the first day of 2024. Currently, a single person can have countable assets not exceeding $130,000, while the two-person household threshold is $195,000.
2022 Basic Medicaid Income Limits for Seniors in California
| Household Size | Number of Applicants | Income Limits Per Year* | Asset Limits: Applicant(s) | Asset Limits: Non-Applicants |
|---|---|---|---|---|
| One Person | 1 | No Limit | $130,000 | |
| Two Person | 1 | No Limit** | $130,000 | $148,620 |
| Two Person | 2 | No Limit | $195,000 |
*All monthly income except for a $35/mo. personal needs allowance and Medicare premiums must be paid to the facility as a share of cost. There may also be a monthly needs allowance for a non-applicant spous.
**Income limit is for applicant only.
Some individuals may qualify for Medicaid based on other criteria, for example, if they are:
- Aged 65 or over
- Blind
- Have a qualifying disability
- Hold refugee status
- Reside in a skilled nursing home
- Are enrolled in CalFresh, SSI/SSP or Refugee Assistance
There are some other qualifying criteria. Seniors can contact their local county office to determine if they’re eligible for Medicaid and other government programs.
How to Apply for Medicaid in California
Seniors can apply for Medi-Cal online via Covered California or visit their local county office to submit an application.
A printable application form is available from the DHCS website. For more information about applying for Medi-Cal, call the California Department of Health Services at (916) 558-1784.
What Information You Will Need
When applying for Medicaid, seniors may be asked to provide:
- Proof of date of birth (e.g. a birth certificate)
- Proof of U.S. Citizenship or eligibility for residence (e.g. a passport, driver’s license or green card)
- Proof of income, including pay stubs, SSI income and retirement benefits
- Proof of other resources, such as bank statements, evidence of stock holdings and life insurance information
- Proof of residence based on rent payment receipts, landlord information or property deeds
- Medicare card or evidence of other insurance
Seniors who are unable to provide the specific documents listed above should contact their county office for advice and a list of acceptable alternatives.
Additional Medicaid Support and Resources in California
There are several organizations that offer support to help seniors navigate the Medi-Cal system in California. Seniors can contact one of these organizations for help with the application or to discuss concerns about eligibility for Medi-Cal.
| Resource | Contact | Service |
|---|---|---|
| myMedi-Cal | (916) 552-9200 | The myMedi-Cal program includes a variety of informational resources to help seniors understand and apply for the financial support that's available to them. Medi-Cal includes waivers to help seniors pay for long-term care as well as in-home care, day care and services that allow seniors to remain in the community for as long as possible. |
| California Association of Area Agencies on Aging | (916) 554-0111 | This association is a statewide organization providing a network of services for older adults living in California. It is a nonprofit organization representing the 33 Area Agencies on Aging covering the state. Seniors can contact the C4A to be connected with their local AAA to request information and support with home- and community-based services, Medicare, Medi-Cal and other programs. |
| California Department of Health Care Services | (800) 541-5555 | The Department of Health Care Services oversees the provision of Medicare and Medi-Cal in the state. It also offers a helpline for seniors who need information about Medi-Cal, would like to know more about the benefits available or have a concern or complaint about the program. |
Does Medicare Cover Nursing Home Care in California?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it’s most valuable for those who are recovering from an injury, illness, or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers a number of specific services, including:
- Meals
- A semiprivate room
- Medications
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn’t Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors’ day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support & Resources in California
Seniors can request advice and information about Medicare and their insurance options by contacting one of the following organizations. These providers offer options counseling, advice and support to those who need help navigating the Medicare system in California.
| Program | Contact | Service |
|---|---|---|
| California Health Insurance Counseling and Advice Program | (800) 434-0222 | The California Health Insurance Counseling and Advice Program provides information and support for seniors who need help understanding Medicare and Medi-Cal. The program is open to those aged 65 and over as well as those who are living with a disability that makes them eligible for Medicare. Trained counselors answer questions and provide help with the application process. |
| California Department on Aging | (800) 434-0222 | The California Department on Aging oversees a variety of services for older adults in the state, including a helpline for those who need advice about their current and future health insurance options. Seniors can call the helpline to get advice about planning for the future and ways to maximize their current insurance coverage. |
| California Health Advocates | (916) 465-8104 | California Health Advocates is a nonprofit offering Medicare advocacy and education for seniors living in the state. It works alongside other state and nationwide organizations to advocate for seniors about Medicare-related issues. It also runs outreach sessions and offers support to seniors who need help understanding their Medicare options. |
Other Financial Assistance Options for Nursing Home Care in California
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
| Name | How To Apply | How It Works |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov | If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. 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. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be able to use it to pay for skilled nursing care. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not typically be eligible to sign up for a LTC insurance policy. |
Free and Low-Cost Resources for Seniors in California
There are many resources in California that assist seniors in their retirement. Caring.com has compiled information on local organizations, programs and agencies and categorized them into care types for easy reference.
Area Agency on Aging
Retirees can find support and advice on various senior-related issues from their local Area Agency on Aging. The agency provides advice on topics such as financial assistance programs, in-home care and long-term care planning. It also connects seniors and caregivers with community-based resources.
| Program Name | Phone Number | Description |
|---|---|---|
| California Area Agencies on Aging | 916-374-7739 | California's network of Area Agencies on Aging work under the umbrella of the California Department of Aging. These agencies promote healthy living for older residents through a variety of federal and state-funded programs. Some of these programs include supportive services, senior nutrition programs, care management programs, caregiving services and Medicare and insurance counseling. Low-income seniors can become productive community members through volunteer programs, such as the Senior Companion Program and the Senior Community Service Employment Program. |
Cash Assistance Programs
Cash assistance programs in California provide financial support to help low-income retirees remain in their own homes for as long as possible. Seniors and caregivers can apply for tax rebates and reductions, discounts on vital services and help covering the cost of heating and cooling their home.
| Program Name | Phone Number | Description |
|---|---|---|
| California General Assistance | The California General Assistance program offers help to low-income adults who don't have sufficient income through other sources. Many seniors on fixed incomes qualify for aid through this program. Seniors apply for this cash assistance program through their county Department of Social Services office. Because this program is county-based, the amount of funding varies from county to county. | |
| California Lifeline Program | The California LifeLine Program offers a discount on landline or mobile telephone service, ensuring that participants can stay in contact with loved ones. |
Food Assistance Programs
Local organizations help ensure elderly citizens have a balanced diet and receive essential vitamins and minerals to remain healthy. Through nutrition programs, congregate meals, home-delivered meals and food pantries, these programs help California seniors afford the nutritious food they need.
| Program Name | Phone Number | Description |
|---|---|---|
| California CalFresh | 800-777-7575 | California CalFresh offers food assistance to low-income residents of the state and serves as the state's SNAP program. Seniors and other residents who meet federal income eligibility rules can apply online for assistance paying for healthy food to eat. To apply, seniors need a copy of their ID and income verification. Seniors can use their benefits at most food stores and farmers' markets anywhere in the state. |
| California Meals on Wheels | Meals on Wheels California delivers healthy meals to homebound seniors who can't get to the grocery store or cook independently. The program serves the entire state through local, county-based organizations. In addition to the meal delivery, Meals on Wheels offers a friendly visit from dedicated volunteers to protect seniors from loneliness. |
Free Used Medical Equipment
Due to the high cost of purchasing new medical equipment, several organizations in California collect lightly used medical devices such as wheelchairs, ramps and walkers and distribute them to local seniors and residents in need.
| Program Name | Phone Number | Description |
|---|---|---|
| California Ability Tools | This project is funded and managed by the California Department of Rehabilitation and Foundation for Independent Living. It helps people with disabilities live happier, healthier and more independent lives by providing access to information and demonstrations of assistive technology as well as offering an online marketplace to buy/sell/borrow or receive free equipment. Financial loans may also be available for eligible residents. | |
| California Dignity At Home Fall Prevention Program | Adults aged 60+ or those with a disability who have fallen, are at risk of falling or at risk of being institutionalized could qualify for the California Dignity at Home Fall Prevention Program. Eligible seniors must also have a household income of less than 80% of the area's median income. In addition to paying for home modifications and medical equipment to help prevent injury, the program provides information and education on fall prevention. |
Home Repair and Modifications
Seniors and those with disabilities can access a variety of local resources to help them pay for home repairs and modifications. Programs in California have different eligibility criteria and often assist retirees by providing grants or loans.
| Program Name | Phone Number | Description |
|---|---|---|
| California Low-Income Weatherization Program | California's Low-Income Weatherization Program provides energy efficiency upgrades at no cost to those who qualify, letting households lower their utility bills to free up limited disposable income for other necessary expenses. This program covers expenses such as installing energy efficient air conditioning and improving insulation. To qualify, seniors must meet income guidelines. | |
| California Section 504 Home Repair Program | The Section 504 Home Repair Program makes up to $10,000 in grant funds available to elderly residents living in rural areas. These funds can be used to eliminate health and safety hazards, allowing older adults to remain in their homes. To find out if your home is eligible, visit the United States Department of Agriculture Eligibility Site. |
Legal Resources
Many organizations offer free or low-cost legal services to California seniors. Older adults can access advice on issues such as estate planning, living wills and power of attorney. Some firms also act as long-term care ombudsmen, advocating for the rights of seniors in senior living communities.
| Program Name | Phone Number | Description |
|---|---|---|
| California Helping Elders Live Productively (H.E.L.P.) | This nonprofit organization aims to empower older adults and their families by offering information, counseling and advice on elder law, consumer protection, elder care and finances. It offers classes and events and also advises seniors on a one-to-one basis, providing resources and referrals. | |
| California Long-Term Care Ombudsman | The statewide Long-Term Care Ombudsman Program supports older adults in assisted living by helping them understand their rights, obtain the services in their care plans and resolve issues related to substandard care. The ombudsman can mediate family disagreements regarding their loved ones' care and represent seniors' interests regarding problems with insufficient or excessive services, billing mistakes and unfair intake or discharge procedures. The ombudsman can also investigate concerns about abuse, neglect or exploitation. | |
| The State Bar of California | The State Bar of California funds nonprofit legal agencies across the state and maintains a comprehensive database of local offices that provide free civil legal services to those aged 60 and over. Through these offices, older adults can get one-on-one assistance with determining whether they're eligible for public benefits including Supplemental Security Income, Social Security Disability Insurance and Medi-Cal. The State Bar also publishes legal guides with topics such as legal resources for veterans, how seniors can avoid legal fraud and what to know before hiring an attorney. |
Senior Centers
Senior centers in California bring together residents through recreational activities and events. Many also offer advice and support on senior issues, run wellness and nutrition programs, and connect older adults with other resources in the local area.
| Program Name | Phone Number | Description |
|---|---|---|
| Alzheimer's Association California Chapter | 866-675-6623 | The Alzheimer's Association is a large, nationwide group of experts and volunteers providing advocacy and assistance at the local level in various parts of California. The available resources are particularly useful for family members and people who have been recently diagnosed with Alzheimer's and are unsure of how to plan for their future care needs. Seminars, workshops and support groups are available, along with important links, news and updates on clinical trials. |
| California Assisted Living Association (CALA) | 800-952-5661 | CALA calls itself the voice of assisted living, and it provides advocacy, information and education to assisted living residents and providers. Consumer data includes details about residential facilities for the elderly (RCFEs), including a facility search, reviews from residents and a shopping guide for senior services and housing. Although CALA is an industry-oriented organization, it's a useful free resource to help seniors find out about pending legislation that affects seniors and laws related to RCFEs. The association also provides continuing education opportunities for senior living staff members and the opportunity to network and develop best practices for caring for the elderly. |
| California Registry | California Registry is a free public service licensed by the State of California Department of Health that provides assisted living resources to area seniors. Seniors can find links to information about assisted living waivers, Medicare, SSI benefits and veteran's pensions on the website, along with an explanation about different types of care. |
Senior Engagement
Senior engagement resources and programs in California help older adults remain active and ensure they contribute to the community. Resources include wellness programs, volunteer opportunities, support groups and organizations that help residents connect with the community to live fulfilling lives.
| Program Name | Phone Number | Description |
|---|---|---|
| California Cyber Seniors | 800-510-2020 | Founded in 2015, Cyber-Seniors: Connecting Generations Inc. is a nonprofit organization that allows young people to volunteer their time providing free technology assistance to avid learners aged 60 or older. Daily webinars are accessible, such as Online Banking Safety, but seniors who miss them can watch available ones from the archives. Ample cybersecurity information is handy for learning how to avoid getting scammed. Seniors needing tech assistance can book a one-on-one tech call to speak with a qualified volunteer. |
| California Friendly Phoning Program | 866-442-2529 | The California Friendly Phoning Program is part of the homebound adults support program offered by H.E.L.P. (Helping Elders Live Productively). The goal of this program is to help seniors live independently with dignity by staying connected to the community. Volunteers make weekly phone calls to seniors' homes to check in, engage in conversation and provide emotional support, which can help minimize feelings of loneliness and isolation. To sign up, seniors can call H.E.L.P.'s main office at (310) 533-1996. |
| California Senior Employment Training | Low-income seniors aged 55 and over can brush up on their skills, learn new ones and access a variety of services designed to get them ready for the job market. They can receive on-the-job training while working at public agencies and local nonprofit organizations as well as get help crafting resumes and developing customized employment plans. |
Social Security Offices
Social Security offices in California help seniors and disabled people access the benefits they're entitled to. Older adults can contact their local office for information about receiving retirement benefits, disability allowance and Supplemental Security Income.
| Program Name | Phone Number | Description |
|---|---|---|
| California Social Security | Social Security is a source of income available to retirees and people who can no longer work because of a disability. The money for Social Security comes from a payroll tax levied on employers, employees and self-employed individuals. When you retire, you'll receive monthly payments based on how much you earned when you were working. |
Tax Assistance
Seniors can apply for tax assistance from several California resources. Elderly residents and those with disabilities could be eligible for tax exemptions on medical expenses, reductions on property tax and other tax assistance programs.
| Program Name | Phone Number | Description |
|---|---|---|
| California Property Tax Postponement (PTP) Program | The Property Tax Postponement Program allows an eligible homeowner to defer the current-year property taxes on their primary residence. |
Utility & Energy Bill Assistance
Low-income seniors who are struggling to meet the costs of maintaining their homes can find support from organizations that offer assistance with utility and energy bills. California retirees could also qualify for emergency funding programs if they're in danger of losing utility services due to unpaid invoices.
| Program Name | Phone Number | Description |
|---|---|---|
| California Low Income Home Energy Assistance Program (LIHEAP) | The Low Income Home Energy Assistance Program helps eligible households balance their utility bills, while the LIHEAP Energy Crisis Prevention Program provides financial assistance to low-income households facing energy-related crises. For example, the ECPP may offer assistance to a homeowner who's in danger of having their power shut off. |
Veteran's Services
California retirees who have served in the U.S. military can find support from local veteran services. These offices and organizations help vets access the benefits they're eligible for and provide advice and information on a variety of issues.
| Program Name | Phone Number | Description |
|---|---|---|
| California Department of Veterans Affairs | The California Department of Veterans Affairs serves the state's 1.6 million veterans by helping them access state health care benefits and the VA Aid and Attendance and veterans' and survivors' pension programs. It provides advocacy and assistance via County Veteran Service Offices throughout the state. It can also help veterans determine whether they qualify for placement in one of California's eight veterans' homes, which may be an affordable alternative to private long-term care services. | |
| California VA Benefits and Health Care | California VA Benefits and Health Care is a dependable source of support for senior veterans in California. The agency offers health care services, disability benefits, guidance on pension arrangements and housing options. It assists with record management as well as planning for burials and memorials. Eligibility for services is determined based on service record, residency and personal circumstances. Through its comprehensive services, the organization prioritizes veterans' well-being. |
Nursing Home Laws and Regulations in California
| Topic | Rule |
|---|---|
| Licensing Requirements | Skilled nursing facilities (SNFs) in California may be a health facility or distinct part of a hospital. All SNFs must be licensed by the California Department of Public Health. Separate licenses are required for SNFs that are maintained on different premises, even if they’re under the same management. California also has intermediate care facilities (ICFs), which offer a lower level of care, and must also be licensed. |
| Staffing Requirements | SNFs in California must employ sufficient nursing staff to provide a minimum daily average of 3.5 hours of nursing care per patient, per day. The staff-to-patient ratio is as follows:Day shift: one direct caregiver for every 5 patientsEvening shift: one direct caregiver for every 8 patientsNight shift: one direct caregiver for every 13 patientsIn addition, facilities must have a registered nurse or licensed vocational nurse awake and on duty at all times. Larger facilities must also have the director of nursing services available. |
| Staff Training Requirements | Staff provided skilled services, such as skilled nursing or physical therapy, must be trained and licensed to provide these services. Unlicensed caregivers, such as nurse assistants, must complete an approved training program prior to employment.All facilities must have an ongoing educational program that develops and improves the skills of staff. At least once every two years staff must also receive training in discrimination prevention. |
| Admission Restrictions | California SNFs can only admit patients on a physician’s orders and cannot accept a resident if they can’t provide adequate care. |
| Care Planning Requirements | Residents of SNFs must have an individual care plan developed by their physician, the resident or their representative and facility staff. It must be completed within 14 days of admission and reviewed at least every 90 days or when the resident’s medical status changes. |
| Dietary and Nutritional Services Requirements | California SNFs must employ a dietitian either full-time, part-time or on a consulting basis. If there’s no full-time dietitian, a dietetic services supervisor must be employed to manage food services. |
| Specialized Rehabilitative Services | SNFs can choose to provide optional services. The following types of optional services can be offered in a nursing home:Physical therapyOccupational therapySpeech therapySpeech pathologyAudiologySocial work servicesSpecial treatment program services. Each optional service unit in a SNF must be approved by the department. |
| Medication and Pharmaceutical Services | SNFs must arrange for pharmaceutical services to be available to provide residents with prescribed drugs and biologics. Dispensing, labeling, storage and administration of these substances must comply with state and federal laws. In addition, if a pharmacy is located on the premises, it must be licensed by the California State Board of Pharmacy and approved by the department. |
| Activities Requirements | California nursing homes must employ experienced activity program personnel to manage an activity program that meets the needs and interests of individual residents. It should be designed to support physical and mental health and help residents maintain social, physical and emotional functioning. The program should have individual, small and large group activities available daily. Each resident must also have an activity plan that is reviewed quarterly and approved by the attending physician. |
| Infection Control Requirements | All nursing homes must establish policies and procedures regarding infection control in the facility. This must be reviewed annually. The facility must report all incidents of communicable diseases and outbreaks of infectious or parasitic disease to their local health officer. In addition, all incoming residents and new staff must be screened for tuberculosis. |
| Medicaid Coverage | In California, Medi-Cal covers nursing home care for eligible individuals. To qualify for Medi-Cal, applicants must meet asset requirements and a physician must deem that nursing home care is medically necessary for the applicant. |
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