This article was produced by Capital & Main. It is published here with permission.
A couple of years ago, the trickle became a flood. Christina Lockyer-White had long known that the skilled nursing facility where she worked in Bakersfield was receiving more mental health patients than it previously housed, but after the pandemic, those numbers appeared to skyrocket.
“We’re seeing more and more mental health (patients) coming in my building,” said Lockyer-White, a 20-year certified nursing assistant. “They are younger. Many of them are homeless. When I started as a CNA, we had more dementia patients or people who needed rehab after a stroke — some kind of skilled nursing need, for which we all have trained.”
These new patients require a different level of care, claims Lockyer-White, who adds that their mental health issues are often intertwined with drug addiction. They act out, sometimes violently: “We began to come to work every day knowing we were going to get verbally abused. I’ve seen nurses get hit.”
That dynamic is hardly new inside California’s skilled nursing facilities, nor is it confined to the Rehabilitation Center of Bakersfield, where Lockyer-White works. In 2023, the news site LAist wrote at length about the increasing warehousing of patients with severe mental health problems inside the state’s SNFs.
But despite an abundance of evidence that caring for the severely mentally ill has become a de facto part of every work shift at such facilities, employees who spoke with Capital & Main over the past year said they receive virtually no training in that specialized area. Further, California doesn’t require it — and it also doesn’t much limit nursing homes’ freedom to take on more patients with such issues.
“It’s bad for the residents with mental illness because they are getting poor care in an unsuitable setting, and bad for the rest of the residents because of the increased risk to their safety,” said Anthony Chicotel, senior staff attorney with the watchdog group California Advocates for Nursing Home Reform. “The one group that benefits is the nursing home providers, who pump up their profits by keeping their beds filled.”
Across the state, nurses and CNAs have come to expect that the beds in their skilled nursing facilities will be occupied by patients with varying degrees of mental illness. In its report, LAist noted that in 2022, hundreds of California nursing homes “admitted and housed thousands of people with serious mental illness,” including those with schizophrenia, bipolar disorder or other psychotic disorders.
That matches the experience of Dolores Solarzano, a CNA who has worked for 16 years at the East Terrace Rehabilitation Centre in the Western Heights neighborhood of Los Angeles. Like the Bakersfield facility, East Terrace, formerly known as Country Villa East, has a one-star overall rating (out of five) at the federal website medicare.gov.
“Things have just been ugly there,” Solarzano said. “We have not received any training for this level of mental illness. We were trained to take care of other types of patients.” Last fall, after she said she was threatened with violence by a mentally ill patient, Solarzano said, “We are in great danger. We walk in fear. It looks like a jail cell in there.”
Attempts to reach a spokesperson for Brius Healthcare, California’s largest owner of nursing homes and either the operator of or affiliated party to each facility mentioned here, were unsuccessful. The company’s website appears to be an unfinished template, save for a two-sentence biography of its owner. Brius and its affiliated companies have been cited repeatedly for providing deficient care and inadequate staffing at their facilities.
Skilled nursing facility companies are not violating state law by taking in mental health patients, for which they’re generally paid out of Medicare or Medicaid funds. Mark Smith, with the California Department of Public Health’s communication office, said the procedure for admitting them includes a federal “preadmission screening and resident review,” known as PASRR in industry jargon.
“A PASRR process is required for any individual seeking admission to a Medicaid-certified skilled nursing facility to determine if an individual has a diagnosed or suspected serious mental illness,” Smith said in an email. The PASRR, he noted, provides recommendations on “appropriate placement” and informs the nursing facility of the need for specialized care.
Further, the fact of a patient being seriously mentally ill “does not negate the potential need for skilled nursing facility-level care,” Smith said. “It is important that individuals who are experiencing (mental illness) can access SNF care when needed.”
Chicotel, with the watchdog group, said the PASRR process “is supposed to address this, but it’s often ignored in many facilities. … We’ve heard of facilities where there are hundreds of 911 calls each year, mostly to deal with resident altercations and violence.”
None of that addresses one of the most glaring problems: The nurses and CNAs on staff don’t have the training to deal with such severe cases of mental illness.
“Nobody gave us any of that kind of training,” said Keffer Isaac, a dietary aide at the Centinela Skilled Nursing & Wellness Centre West in Inglewood. “I’ve been here since 2000. Most of this stuff with severe mental health patients started recently.”
The California Department of Public Health’s Smith said that only Sacramento could make such training mandatory, by passing a law. Terry Carter, a spokesperson for Service Employees International Union Local 2015, the union that represents the workers mentioned in this story, said no state legislation is currently pending. (SEIU is a financial supporter of Capital & Main.)
The union works with a partner organization, the Center for Caregiver Advancement, a training program for certified nursing assistants. That work includes a CDPH-directed three hours of generalized mental health training covering patients with intellectual disability, cerebral palsy, epilepsy, Parkinson’s disease and mental illness.
What’s needed, facility workers say, is an extensive, state-mandated training program to meet the challenges of an era in which skilled nursing facilities are taking in ever greater numbers of patients with severe mental health problems. Absent that, the workers are left to bargain with their employers, facility by facility, to fund such training.
In the meantime, they must deal with the situations in front of them. Last October, Solarzano said, a mentally ill patient tried to lock her in a room “while basically threatening to kill me.” She hid near a patient bed until her shift supervisor could help her exit the room, and the patient was later arrested after threatening another worker at the facility, she said.
“I understand that these patients help the corporation make money,” Solarzano said. “But this isn’t right. It’s not what this facility was made for.”
Capital & Main is an award-winning nonprofit publication that reports from California on the most pressing economic, environmental and social issues of our time, including economic inequality, climate change, health care, threats to democracy, hate and extremism and immigration.
Copyright 2025 Capital & Main
Read More Details
Finally We wish PressBee provided you with enough information of ( Have skilled nursing facilities become dumping grounds for the mentally ill? )
Also on site :
- ‘SNL’s Ego Nwodim Accidentally Makes Audience Cuss During Weekend Update
- Myanmar Earthquake: Death Toll Reaches 3,471 as Rescue Efforts Continue
- David Lammy accuses Kemi Badenoch of ‘cheerleading’ for Israel over Labour MPs