Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. General Comments About the State's Residential Care System


Because residential care facilities serve both private pay and Medicaid residents, a few respondents expressed views about the industry as a whole.

  • There is confusion among the public about long term care options.

  • One study showed that the most satisfied folks were those in assisted living, whereas people at home were not doing so well, primarily because there is a tremendous amount of unmet need at home.

  • Adults receiving HCBS services at home are like latch-key adults, they should be in an ALF, where we provide emotional security.

A number felt that the state was achieving its goals and being responsive to stakeholders.

  • I have been writing regulations since 1990 and supervising statewide training, and implementing the ACS program. It takes a long time but you do get to see some goals accomplished.

  • I am pleased with the willingness of the state to look at ideas and experiment and come up with different concepts, to listen to providers, and to be flexible; there is a good dialogue.

Comments about privacy in residential care settings indicated disagreement among providers and other respondents.

  • It is very clear that people want private rooms; it is so important in terms of their dignity. But sometimes, there are more than four in a room in an ALF, it looks like a ward.

  • The ECC regulations define "privacy" as encompassing dual-occupancy with a choice of roommate where possible. This is the stated philosophy of "privacy."

  • Sometimes when we're conducting surveys we see more than four individuals sharing a room in ALFs. In our work, we have found that the issue of privacy is very important to consumers, and single rooms are definitely preferred.

  • Some elderly people prefer to have a roommate as it gives them a sense of security.

There was disagreement about the need for additional adult foster care homes.

  • We should expand the use of adult foster care homes. They have slightly less stringent regulations, and are very successful in Oregon. In Florida the AFCH program has been shown to have good outcomes.

  • I disagree 100 percent that adult foster care homes should be expanded because they do not have enough oversight.

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