Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Admission, Retention, and Discharge Criteria, and Aging in Place


  • There are provisions to protect residents from premature involuntary discharge including a mandatory bed hold policy of sixty days per year.

  • A study of the state's system conducted in 1991 found that there was considerable concern about the inappropriate placement in adult care homes of persons who needed a nursing home level of care.11 The report cited a number of reasons for inappropriate placement, including,

    • Residents wanting to age in place,

    • Private pay residents wanting to avoid paying higher nursing home rates,

    • Lack of nursing home beds, and

    • Lack of nursing homes willing to admit "heavy care" residents, i.e., those needing tube feeding, oxygen, or decubiti care.

Several respondents believe that the same reasons for inappropriate placement apply in 2003.

11. Elise Bolda's report: Initial report on North Carolina domiciliary care policy. The Long Term Care Resources Program, Duke University Center for the Study of Aging and Human Development (1991).

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