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. 

$9247

California

$7756

The United States

$10114

Oregon

$9262

Nevada

$6844

Arizona

$9581

Washington

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. 

$9946

Sacramento

$8060

Los Angeles

$10722

San Diego

$12471

San Francisco

$12547

San Jose

$7787

Fresno

$8060

Bakersfield

$7756

Riverside

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.

$5529

In-Home Care

$5529

Home Health Care

$1733

Adult Day Care

$5000

Assisted Living Facility

$9247

Nursing Home Care

Financial Assistance for Nursing Home Care in California

Most people do not pay for skilled nursing care entirely out of pocket. Rather, they utilize financial assistance programs to help cover the cost of nursing care. Of public financial assistance programs, Medicaid provides the most comprehensive coverage of nursing home care. But, not all seniors are eligible for Medicaid. And because each state operates its own Medicaid program within federal guidelines, eligibility and benefits vary from state to state. Below, we provide more information on Medicaid in California.

California’s Medicaid Program

As of July 2020, 11,899,370 Californians were enrolled in Medicaid and CHIP in California. This is a growth of more than 53% since 2013, in part due to targeted enrollment programs and expanded eligibility in the state through the ACA. Medicaid, known as Medi-Cal in California, covers the cost of medically necessary health care services for low-income residents. This includes the cost of nursing home care for people that meet the eligibility requirements. As Medi-Cal for nursing home residents is an entitlement, all eligible seniors receive assistance. 

There are around 1,230 nursing home facilities in California, which includes free-standing nursing homes and facilities attached to hospitals. These facilities care for more than 400,000 people annually, with 58% of residents aged 75 or older. Only 6% of residents remain in nursing homes for 12 months or more, and 84% of residents are discharged after a stay of three months or less.

Medicaid Eligibility in California

There are no income limits for seniors applying for nursing home Medicaid in California. Instead, residents keep $35 of their income for personal needs, and remaining income goes towards their care, called a share of cost. However, there is an asset limit for nursing home Medicaid, which starts at $2,000 for singles. Care must also be deemed medically necessary by a doctor. Medi-Cal is available to all California residents no matter their citizenship or immigration status, although those without a satisfactory immigration status may not be able to access all benefits.

Residents can apply for Medi-Cal in person, by phone or mail through their local county social services office. An online application is also available at Covered CA.

Alternative Financial Assistance Options

  • Medicare: Medicare will cover the cost of one’s care in a skilled nursing facility for the first 20 days of their stay, and a portion of the costs up until day 100. After 100 days, the individual is responsible for all costs. Seniors must also have a “qualifying hospital stay” of at least 3 days prior to their admission to a nursing home in order to qualify for Medicare coverage.
  • Aid and Attendance: 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: 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. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.
  • Long-Term Care Insurance: Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy.

Free and Low-Cost Resources for Seniors in California

Seniors in California have access to a wide range of resources that can assist them as they age. Some are available to people in long-term care while others can help seniors stay living in the community as they age. Remaining in the home is a more affordable option than nursing home care, so resources that help seniors age in place can give people the opportunity to save money for a future nursing home placement. 

ResourceContact Service
Medi-Cal(916) 552-9200Medi-Cal has a range of programs available to help people who aren’t in nursing home care. Seniors can access financial assistance to pay for adult day care, in-home care and assisted living. In most cases, these waiver programs are designed to help people who need a nursing home level care who wish to remain living at home. Although medical care may not be covered in these programs, personal care, home modifications, transportation and other services are offered that help seniors age in place. 
Area Agencies on Aging(916) 443-2800California’s Area Agencies on Aging offer a range of services that help seniors as they age. A primary function is to provide information and referrals, and the 33 agencies across the state connect seniors with local resources. AAAs can also help seniors plan their care, identify and access government benefits and make decisions about health insurance.  
California Department of Aging1-800-510-2020The California Department of Aging administers programs that help older adults, adults with disabilities and family caregivers. These include programs that provide nutrition support, health and exercise, Medicare counseling and legal advice. Family caregiver services can help seniors who live with family by connecting caregivers to training, counseling and respite care.
Long-Term Care Ombudsman1-800-231-4024The Long-Term Care Ombudsman advocates for and assists residents of long-term care facilities. Residents can contact their local Ombudsman office to talk about issues regarding day-to-day care, health and safety and other concerns. This can include issues relating to abuse and violation of residents’ rights, as well as concerns about diet, quality of care and benefit issues. Ombudsman representatives review and investigate reports of abuse and neglect in long-term care facilities and will follow the wishes of residents or their representatives. 
California Department of Veterans Affairs1-800-952-5626Seniors who served in the military can access assistance through the California Department of Veterans Affairs (CalVet). CalVet representatives can help veterans access benefits, including the Aid and Attendance Benefit, which can help people pay for nursing home care. In addition, California has eight Veterans Homes throughout the state that offer long-term care to veterans and, in some cases, the spouses and domestic partners of veterans. The homes have different levels of care available, including skilled nursing, so they may be an option for veterans looking for a senior living provider.

Nursing Home Laws and Regulations in California

Licensing RequirementsSkilled 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 RequirementsSNFs 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 RequirementsStaff 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 RestrictionsCalifornia SNFs can only admit patients on a physician’s orders and cannot accept a resident if they can’t provide adequate care.
Care Planning RequirementsResidents 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 RequirementsCalifornia 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 ServicesSNFs 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 ServicesSNFs 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 CoverageIn 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. 

Nursing Homes Facilities in California (202)