California Nursing Homes Are ‘Warehousing’ People With Serious Mental Illness, Experts Say

Back in 2021, as I was reporting on ReNew Health, a nursing home chain with a poor track record of care, I was struck by how many state-issued citations for nursing home violations involved people with serious mental illness.

Nursing homes are generally designed to help people rehabilitate after surgery or provide round-the-clock care for people who are older or physically disabled. Federal code says they’re “not primarily for the care and treatment of mental diseases.”

So I decided to see how many people with serious mental illness — defined as schizophrenia, bipolar disorder, and psychotic disorder — are living in California nursing homes, the kinds of places you’d place a parent who needs help with medication management or getting from bed to bathroom.

First, I filed federal records requests for a dataset that covered all California nursing homes — nearly 1,200 — that accepted Medicaid and Medicare. The response was so massive that I couldn’t open the files on my computer. My colleague Elisabeth Gawthrop at APM Research Lab could, and the two of us analyzed that data.

What we found was astonishing not just to us, but to lawyers and other experts who are steeped in nursing home and mental health policy. As Toby Ewing, executive director of the state’s Mental Health Services Oversight and Accountability Commission, told me about our data findings: "You've done more work on this probably than the state of California has done.”

Nursing homes, said Rachel Tate, L.A. County’s ombudsman for long-term care, have become “de facto mental health centers.”

Tony Chicotel, senior attorney at California Advocates for Nursing Home Reform, put the problem in even starker terms. “For most patients with a serious mental illness, the nursing homes just serve as a warehouse — keeping them alive, keeping them fed and sheltered and out of the streets and out of people's way.”

Here are 6 key data points from our reporting

We found that in 2022:

• Nearly 22,000 nursing home residents had a serious mental illness; that’s 25% of all nursing home residents in California. 

• Nearly 1 in 3 residents who’d been in a California nursing home for over a year had a serious mental illness.

• Almost 100 California nursing homes filled at least half their beds with people who had a serious mental illness; in several facilities, at least 8 in 10 residents had a serious mental illness. 

• In 2022, nursing home residents with serious mental illness had spent nine months longer in their facility than those without serious mental illness.

• Less than 1% of long-term nursing home residents with serious mental illness received any psychotherapy in the week leading up to their annual assessments. 

• Nearly one-third of residents in L.A. County nursing homes had a serious mental illness — the highest rate of any county in California.

More key findings from our reporting

• Legal experts and advocates told us that California might be violating the Americans with Disabilities Act, because the state has allowed so many residents with serious mental illness to end up in nursing homes, instead of community-based settings.  

• The state lacks a full accounting of nursing home residents with serious mental illness, making it difficult to know how many of these residents are in nursing facilities at any given time. 

• Gov. Newsom’s new mental health plan worries some experts that it could lead to more institutionalization. 

More on this investigation

• Investigation: California Nursing Homes Are Becoming ‘De Facto Mental Health Centers’
• Methodology: How We Reported This Story