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


  • ALFs may admit and retain residents with dementia. No special license is required for dementia care unless an individual with dementia does not meet standard residency criteria. Training requirements have been increased for ALFs that market themselves as providing special care for persons with Alzheimer's disease or other dementias.19

  • ALFs with ECC licenses can adopt their own requirements for continued residency within regulatory guidelines and must provide each resident with a written copy of facility policies governing admission and retention. However, they may never retain residents who require 24-hour nursing supervision, which is equivalent to a skilled nursing level of care.

  • As stated in the assisted living statute, aging in place means the process of adjusting or increasing services to a person to compensate for the physical or mental decline that may occur with the aging process, in order to maximize the person's dignity and independence and permit them to remain in a familiar, non-institutional, residential environment for as long as possible.

  • ECC ALFs are required to promote aging in place by determining the appropriateness of continued residency based on a comprehensive review of the resident's physical and functional status; the ability of the facility, volunteers, family members, friends, or any other pertinent individuals or agencies to provide the care and services required; and documentation that a written service plan consistent with facility policy has been developed and implemented to ensure that the resident's needs and preferences are addressed.

  • A facility is not required to retain residents who require more services or care than the facility is able to provide in accordance with its policies and criteria for admission and continued residency.

  • Terminally ill residents may continue to reside in any assisted living facility if a licensed hospice agency coordinates services, an interdisciplinary care plan is developed, all parties agree to the continued residency, and all documentation requirements are maintained in the resident's file.

  • If an ALF resident no longer meets the criteria for continued residency, or the facility is unable to meet the resident's needs, the resident may be discharged as long as the facility provides at least 45 days' notice of relocation or termination of residency. Special provisions apply in specific situations, e.g., emergency relocations for medical reasons and harmful behavior.

19. Staff must receive four hours of initial training covering understanding Alzheimer's disease; characteristics of the disease; communicating with residents; family issues; resident environment; and ethical issues. An additional four hours of training must be obtained within nine months of employment covering behavior management; assistance with ADLs; activities for residents; stress management for the caregiver; and medical information. Four hours of annual training must be obtained on topics specified by the Department of Elder Affairs (DOEA).

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