Snapshot: The Changing Face of California's Nursing Home Industry

Charlene Harrington and Janis O'Meara, UCSF School of Nursing

As the California population ages, demand for nursing home services will increase while staffing, quality, regulatory, and financial issues persist. This snapshot highlights challenges facing the nursing home industry.

March 2007

California's nursing home industry is facing the "perfect storm": increasing projected demand for services by an aging population coupled with rising staff turnover and an apparent decrease in quality of care.

This snapshot examines California's freestanding and hospital-based nursing and intermediate care facilities as they continue to face significant challenges. The snapshot presents a range of data and trends including patient demographics, supply and demand, quality of care indicators, staffing, regulatory compliance, and financial information.

Findings include:

  • Nursing home staff turnover, which had been declining in recent years, is once again on the rise, reaching 62%. High turnover is associated with poor quality, including disruption to continuity of care.
  • The percentage of nursing homes meeting or exceeding the state-mandated minimum level of nursing care more than doubled from 2000 to 2005, yet some 22% still did not meet the requirement.
  • A third of California's nursing homes operate in the red.
  • Indications of poor quality include patient weight loss, time spent in bed, and use of physical restraints (more than twice the national average).
  • California's troubled oversight process underestimates serious care violations.

Increased Medicaid reimbursement and litigation judgments after 2005 may help moderate these troubling trends, along with continued oversight and review of publicly available information.

The complete snapshot is available under Document Downloads.