Long Term Care in California: Ready for Tomorrow's Seniors?

Charlene Harrington, Edwina Newsom, and Leslie Ross, University of California, San Francisco

The number of elderly residents in California is expected to balloon in the next 30 years. Will the long term care system be able to care for the state's aging population?

August 2013

The leading edge of the baby-boom generation is beginning to flood California's long-term care system. And the population of residents 65 and older is projected to triple by 2060. This report describes the state's supply and use of long-term care services, including Medicare and Medicaid spending on services, and quality of care. The oversight and regulation of long-term care services varies by provider, resulting in limited information — especially quality data — about assisted living facilities, personal care providers, and other home- and community-based services.

Key findings include:

Use of all long-term care services has increased in California, with the largest growth occurring in home- and community-based services.

Use of Long Term Care Services, California, 2005 and 2009

Medicare and Medicaid beneficiaries in California used long-term care services at a lower rate than that of the nation, with the exception of Medicaid patients' use of personal care services, which was nearly four times higher in California than in the US.

Beneficiaries Receiving Nursing Facility Services, Medicare and Medicaid, California vs. United States, 2003 and 2009

California's per capita supply of residential care beds for the elderly was larger than the nation's. The state's supply, however, has not kept pace with population growth since 2004.

Assisted Living Facility Beds, California vs. United States, 2004 to 2010, Selected Years

California's performance on care quality in nursing facilities and for home health services was mixed, with top-of-the-nation performance on some measures (for example, nursing facility residents losing too much weight) and bottom-of-the-nation performance on others (for example, home health care patients able to feed themselves).

Nursing Facility Quality Measures with High Rankings, California vs. United States, 2011

Gross revenues for California's freestanding nursing facilities grew over 50% between 2003 and 2010. One-third of these facilities had profit margins of 9% or higher in 2010.

Freestanding Nursing Facilities, by Profit Margin, California, 2003 and 2010

The complete report and all the charts found in the report, as well as the 2009 edition, are available under Document Downloads.