The Biggest Challenges to Growing Old in California

By Dane Reeves

Last January Napa County had two weeks where no Skilled Nursing Home Beds were available. All the nursing homes were full. People needing rehabilitation services or nursing home care after a hospital stay, had to go to Solano, Sonoma, or Contra Costa Counties.

It was rough on families, especially on elderly spouses, who had to drive up to an hour each way to visit a loved one during their rehab stay.

Only four nursing homes remain in Napa County. It is not enough for the number of people who need both short and long term care. And as the population of older people continues to increase, we are all going to feel a real crisis of care. This problem needs to be addressed. If something does not change today, local nursing homes will NOT be able to meet the needs of seniors in our community.

I moved to Napa from Oregon two years ago to be an Administrator of an innovative, patient centered Skilled Nursing and Assisted Living Facility. Here, I was shocked to find out that Medi-Cal only pays for Skilled Nursing Facilities to provide Long Term “Custodial” Care. The difference is Oregon Medicaid (the Federal version of Medi-Cal) pays for multiple levels of care. The results are pretty shocking. In Oregon, I was constantly fighting to keep my “census” (the number of patients) up. In California, I am working on a rather lengthy waiting list for long term care. Poor people who are old and need to go someplace to be taken care of due to frailty, memory impairment, or illness have no place to go.

As the population of older people continues to increase, we are all going to feel a real crisis of care.

In Oregon, Medicaid pays for Dementia Care Units, Assisted Living Facilities, and Adult Foster Homes (called Board and Care – 6 Bed RCFEs in California). The result is that the Long Term Care population in Oregon Nursing Homes are either medically complex or are extremely disabled and mostly need two staff members to help them with their activities of daily living. Their system allows for people to live in the most appropriate level of care. The quality of life for the patient is better, the quality of life for the other residents in that facility is better, the State is not spending unnecessary money on the most expensive type of long term care (Skilled Nursing Facilities) and, the most important related to this discussion, Skilled Nursing Beds are available to those patients who need them, when they need them.

There is no shortage of studies and data out there that highlight the demographic change we will have in the next 10 to 20 years. The bottom line is that the demand will increase for both short term rehab services and long term care that Skilled Nursing Facilities currently provide. Only seven new Skilled Nursing Facilities have been built in the entire State of California since 2005!*  In Napa County, four Skilled Nursing Facilities have closed in the last 15 years. The only new facilities being built in California are licensed as a Residential Care Facility for the Elderly (RCFE, commonly known as Assisted Living) and, Medi-Cal does not pay for this care. Only seven Counties in California (Napa is not one of them) can use an Assisted Living Waiver (which allows for Assisted Living Facilities to care for Medi-Cal recipients) but it is ineffective and insufficient to address the larger need of system reform. California needs to follow Oregon’s lead and adopt a Medicaid system that allows people needing long term care to live in assisted living homes instead of forcing them all to stay in Skilled Nursing Facilities. We need to make changes now. The most effective thing would be to contact your State Representative (not local or county, as Medi-Cal is a State program) and tell them Medi-Cal reform needs to a high priority. Specifically, the Medi-Cal benefit must be expanded to include assisted living facilities. Secondly, you can join a local Senior Advocacy Group in your Area. I am a member of the Napa County Alliance on Aging. We meet on the Second Tuesday of every month at the Queen of the Valley at 8am. If you would like to make a difference in the lives of Seniors in Napa County, please join us.
I’d like to hear your thoughts on this subject.

Dane Reeves is an Administrator at Piner’s Nursing and Guest Homes. He can be reached at or 707.224.7925.
Data from the Office of Statewide Health Planning and Development (OSHPD)