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Nursing Care Facilities - An Overview

Unless one can afford continual nursing care in the home, nursing and care facilities commonly referred to as nursing homes are the best option for seniors who need continuous nursing care.

There are over 50 nursing care facilities in the Sacramento area providing a wide variety of choice including living environments, care and therapy services, dining and cuisine options, room arrangements, onsite services and activities.

Nursing care facilities provide around the clock nursing care, are overseen by a medical director and with care being supervised by registered nurses. These facilities can operate as independent facilities, as part of a hospital complex or part of a Continuing Care Retirement Community (CCRC).

The facilities that are part of a hospital operation are typically geared toward intensive rehabilitative care following serious injuries, illnesses or operations.

Independent nursing care facilities and those that are part of CCRCs are most often utilized by seniors in need of long term nursing care.

Health and medically oriented services include services of registered and licensed vocational nurses, certified nursing assistants; physical, occupational and speech therapists; social workers and recreational assistants. The majority of the hands on care in nursing facilities is provided by certified nursing assistants,

Services provided by nursing care facilities are generally categorized into two groups: skilled nursing care facilities (which provide nursing care for a short period of time during rehabilitation following serious injuries, illnesses or surgery), and custodial care facilities (providing long term daily assistance to seniors who can no longer carry out basic day-to-day activities such as bathing, grooming, using the toilet, and others). Facilities that provide "custodial care" are most often referred to as nursing homes. Custodial care is an out date term used in the nursing care industry and will hopefully be replaced by a less institutional label.

Nursing homes were also referred to in the past as "rest homes" or "convalescent homes".

Nursing care facilities are also commonly referred to as "nursing homes", "rest homes" or "convalescent homes".

Property Type Overview:

Nursing care facilities are often the choice for seniors who need a level of medical care that is not available in an assisted living facility or through in home care.

Nursing homes are supervised by a medical director that oversees the care of the residents and registered nurses are on the premises around the clock to administer medications and to supervise licensed vocational nurses and certified nursing assistants. Other skilled medical personnel include speech therapists to aid those who need help in improving communication skills (for example, due to a stroke) and physical therapists to help residents gain physical strength.

Medicare reimbursements are only made for rehabilitation and various therapy services that are deemed eligible by Medicare.

Medi-Cal reimbursements are only made for residents that are determined to be eligible by the California Department of Health Care Services. The program is administered by the applicable county social services department.

Most nursing homes offer private or shared rooms. Some even allow senior couples to live together. Since nursing care facilities are often viewed as long-term solutions, there has been a change in its architectural design of late, where the focus is not just efficiency but also to create a homelike ambience so that seniors feel more relaxed in their surroundings.

Nursing homes are undergoing a change in their operations where the focus is on creating a resident-centered environment, where the buildings and care are more personal in nature.

In newer facilities you might find several pods which consist of a small set of rooms surrounding living room and common areas. Staff members are assigned to a specific area either permanently or on a long term basis where a team rotates from one area to another. Care givers become more familiar with each patient and are in a better position to focus each resident's specific needs

Residents decide what time they want to sleep, when to eat and select their own daily schedule. There is also an emphasis on companionship such as pets and integrating family members into activities. The industry describes this as being a "resident focused culture change".

Nursing homes in California are licensed, regulated, inspected, and/or certified by a number of public and private agencies at the state and federal levels, including the California Department of Public Health (CDPH) Licensing and Certification Division (L&C) and the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services (CMS). These agencies have separate -- yet sometimes overlapping -- jurisdictions.

CDPH is responsible for ensuring nursing homes comply with state laws and regulations. In addition, CDPH has a cooperative agreement with CMS to ensure that facilities accepting Medicare and Medi-Cal (in California, Medicaid is referred to as Medi-Cal) payments meet federal requirements. Of California's 126,800 nursing home beds, on any given day approximately 68 percent are occupied by a Medi-Cal beneficiary and most nursing care facilities are certified to accept both Medicare and Medi-Cal.

Inspection teams consist of registered nurses and life safety code surveyors and in some cases might include state pharmacists, nutritionists, physical and occupational therapists, infection control experts and physician consultants.

Health Care / Medical services provided to Residents:

The purpose of the nursing home is to provide continuous care with psychosocial and rehabilitative services on an in-house basis. Individualized care plans are prepared for each resident based on his or her medical, cognitive and social needs, taking into account the individual's level of independence and activity. Some nursing homes provide specialized care facilities for individuals suffering from varying levels of Alzheimer's disease.

The more recently constructed or remodeled facilities resemble independent or assisted living facilities with furnishings that are more reminiscent of home with attractive well-designed and appointed rooms.

Physical Description:

Living space in skilled nursing facilities generally includes private and semi-private rooms as well as multi resident rooms.

Nursing homes are designed to ensure the safety of the residents, most who are seriously disabled. For this reason, some nursing facilities may vary the services and level of care provided according to unit, floor, or wing, thus grouping residents by the level and type of care needed.

Some units may be highly secure with locked elevators and monitored doors to prevent residents from walking out of the facility.


Payment for nursing homes varies according to the facility and according to the services provided. Some individuals must pay out of their own funds until those funds are exhausted, at which time they may receive state assistance from MediCal. Others must completely cover the cost of their stay themselves.

Costs vary widely from $5,000 to over $9,000 per month.

According to a 2006 survey conducted by the MetLife Mature Market Institute, the average daily rate for a private room in nursing care facilities is $206 ($75,190 yearly), while the average daily rate for a semi-private room is $183 ($66,795 yearly).

The majority of the nursing home services are not paid for by Medicare.

Rehabilitative care is only paid for by Medicare guidelines using strict standards that include but are not limited to the following:

  • Patient must have been hospitalized for at least 3 days before entering the nursing home.

  • Patient must enter the nursing home within 30 days of hospitalization.

  • Only the first 20 days are 100 percent covered; then there is a daily copayment.

  • There is a 100-day maximum related to any one hospitalization and diagnosis.

  • Regular progress as documented by medical professionals is required. If progress toward independence is no longer occurring, Medicare coverage ends.

Supportive custodial care is generally provided while the individual is receiving rehabilitative care.

Medi-Cal will not pay for the cost of long-term nursing home care until the individual's own resources are exhausted. So for most individuals, entering a nursing home can result in the depletion of their life savings in addition to any investments that they've worked hard to accumulate.

Finally, there are rules to the type of nursing home that state insurance will cover. While for the most part, the state will not require an individual to move from the nursing home that he or she resided in during self-pay, be sure to check out the guidelines of nursing homes you are considering.