Moving From a Skilled Nursing Facility to Assisted Living in California

The two places do different jobs. A skilled nursing facility is a health care facility that provides nursing and therapy. An assisted living community or board and care home is licensed by the Department of Social Services as a residential care facility for the elderly (RCFE). It provides care and supervision, not medical treatment.

California Advocates for Nursing Home Reform (CANHR) puts the limit plainly: because an RCFE is not licensed as a medical facility, people who need 24-hour nursing care are not permitted to live in one. So the move tends to work when therapy has done what it can, the medical picture is steady, and what remains is help with bathing, dressing, meals, medications and supervision.

It tends not to work, or not yet, when your parent still needs a nurse every day. The doctor and the facility's team are the ones to say which side of the line your parent is on. Our comparison of assisted living and nursing homes goes deeper into the difference.

Families often hear "Medicare gives you 100 days" and plan around it. That is the ceiling, not a promise. Medicare Part A covers skilled nursing facility care on a short-term basis and only while its conditions are met, including a need for daily skilled care. These are the 2026 figures for Original Medicare, from Medicare's own coverage page.

Before covered services end, the facility should give your parent a Notice of Medicare Non-Coverage at least 2 days ahead. If you think care is ending too soon, Medicare says a fast appeal must be requested no later than noon the day before the end date on the notice. If the reviewer decides services should end, Medicare says your parent is not responsible for services provided before that end date, but may have to pay for services after it.

• Coverage needs a qualifying inpatient hospital stay of at least 3 days in a row first. Time under observation or in the emergency room before admission does not count.
• Medicare Advantage plans may charge copayments in the first 20 days and may waive the 3-day rule. Ask the plan.
• A benefit period ends when a person has had no inpatient hospital care or skilled care in a facility for 60 days in a row.
• After leaving, a person who goes back into the same or another skilled nursing facility within 30 days does not need a new 3-day hospital stay.
• Refusing daily skilled care or therapy can cost a person their coverage.
• Medicare does not pay for long-term care, which is the kind of help assisted living provides.

• The facility's social worker or discharge planner, who coordinates the discharge and is your main contact.
• The therapists and nurses, who can tell you what help your parent needs with each daily task today.
• A physician, physician assistant or nurse practitioner, who signs the medical assessment the care home must have.
• The care home's administrator or admissions staff, who do the home's own pre-admission appraisal and decide whether to accept.
• You and your parent. Medicare's discharge checklist calls the patient and caregiver important members of the planning team.
• The Long-Term Care Ombudsman, if there is a dispute. California's Department of Aging says ombudsman representatives help residents with problems that include improper transfer or discharge, at no cost. The statewide line is 1-800-231-4024.

1. 1

   Ask for the expected discharge date and the reason

   Ask the social worker what the team expects and whether the limit is progress in therapy, Medicare coverage or both.

2. 2

   Get a clear picture of daily needs

   Ask therapy and nursing staff what your parent can do alone and what needs one person's help or two. A care home will ask the same questions.

3. 3

   Work out the monthly budget

   CANHR notes that most people pay privately for assisted living. Our guide on how to pay for assisted living lists the options.

4. 4

   Start the medical assessment

   California requires a medical assessment made within the last year and signed by a licensed medical professional before a home accepts a resident. Ask who at the facility can complete the form the home uses.

5. 5

   Tour homes and let one assess your parent

   The home does its own appraisal. Ask whether its staff will visit your parent at the facility.

6. 6

   Plan the handover

   Ask for written discharge instructions, a summary of current health and an updated drug list, as Medicare's checklist advises, and confirm who orders equipment.

Some people stay in a nursing facility because Medi-Cal pays for it there and they cannot afford a care home. California's Assisted Living Waiver is aimed at that situation. According to CANHR's 2026 summary, it operates in 15 counties, including Los Angeles, requires full-scope Medi-Cal with no share of cost and a nursing facility level of care, and includes care coordination to help participants move from a nursing home to the community.

CANHR also reports that the program has had a waitlist since 2017 and that the list of participating homes changes from month to month, so treat it as something to ask about early. Our guides to the Assisted Living Waiver and to CalAIM and assisted living transitions explain who to contact. The county and the facility's social worker can tell you what applies to your parent.

Hamssa Benrekia is a senior living placement specialist in Torrance who serves the South Bay and Harbor area of Los Angeles County. She helps families find licensed assisted living, board and care and memory care homes. She does not place people in skilled nursing facilities and does not enroll anyone in Medi-Cal programs, though she can share information about them.

She has worked with families whose relative was in a skilled nursing facility at the time, alongside the facility's social workers: see hospital discharge placement. Contact Hamssa when a discharge date is first mentioned. The full California Assisted Living Placement Guide covers the stages before and after this one.