California isn’t ready to grow old — or to provide nursing care to its seniors

Published on
April 8, 2019

When families of patients at a San Francisco hospital learned in 2017 that the specialized long-term care unit they relied on was slated to be shut down, they were devastated. Some of the patients at this facility had been there for years — the unit was their home. But the real shock was figuring out where their loved ones could go, because the nearest facilities that could meet their needs were as far away as San Jose, Sacramento, or even Los Angeles.

I reported on these families’ efforts to place their loved ones somewhere within San Francisco, and got a glimpse of how difficult it can be to find care for family members who need long-term nursing care. The families organized a desperate but persistent campaign to keep their loved ones in the county, and succeeded. In doing so, they also drew attention to a more pervasive, more widespread, and more insidious problem: It can be very difficult to find long-term care in California, even if it isn’t specialized to medically fragile patients. And it’s even harder for families without a nest egg to pay for it.

That spells trouble, because California is getting older. As the Los Angeles Times illustrated in October, by 2060, seniors will represent 13.5 percent of the state’s population, up from 5.5 percent. A focus group in San Francisco indicates that the reimbursement structures of the health care programs most widely used to pay for nursing home stays make it hard for patients to access care, and are also pushing nursing facilities to favor short-term patients. 

What’s more, the quality of the care available is dismal. In fact, according to the advocacy group Californians for Nursing Home Care Reform, it’s never been worse: Complaints against nursing homes are exploding and the state is grappling with a backlog of cases numbering in the thousands. News investigations have uncovered sexual assault in nursing homes, residents being evicted and dumped, and failure to adhere to basic procedures to prevent infections. Understaffing is rampant, and caregivers and advocates alike are frustrated with attempts to force better staffing practices through new regulations — more than half of the state’s nursing homes have asked to be exempted from these rules.

But somehow, the nursing home industry still manages to be good business. In 2015, more than 80 percent of nursing homes in California were run by for-profit facilities. A report from the California State Auditor in 2017 found that three for-profit companies had swelled both in size and income over the preceding decade — increasing their profits by tens of millions of dollars.

In a three-part series for KALW public radio in San Francisco, my 2019 California Fellowship project will explore how California got to this point, and what solutions are at hand for those families already struggling to find adequate care for their elders. How did the state land in the precarious position of anticipating an aging population and facing crises on multiple fronts in the delivery of nursing care? How are nursing homes at once profitable and so profoundly troubled? I’ll also look into the alternatives — regulations and solutions that are being tested. Focus groups and legislators are working to find a fix, but so are individuals.

Families across the state are facing this crisis right now. Perhaps their stories, like the families of those San Francisco patients, will help us understand the shape of things to come.