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


Respondents raised a number of issues that they believed constituted existing or potential problems with the residential care systems generally.

  • The system is confusing for the typical consumer. There is a perception by residents and families that the assisted living services constitute 'nursing home lite'--or getting all the services of nursing homes, but a la carte. However, that is not the case. Twenty four-hour supervision cannot be assumed, although family members and residents are surprised to learn that it is not available when they are receiving assisted living services and not the assisted living plus package. Many families are surprised to hear that although a residence is licensed it is not regulated. They don't understand the system. Some refer to a residence as an "assisted living nursing home" and are surprised to learn that the assisted living model is licensed as a home care provider. We need education, education, and more education for consumers, their families and physicians.

  • We have more folks taking advantage of these services and avoiding a nursing home--and that's good--but we have some egregious situations and they will increase if we don't respond in a responsible manner. The Department of Health has been upfront about the fact that many of these places have not had onsite inspections and they are frustrated about the lack of staff to conduct these inspections. The tools in place to address poor providers are not adequate. There are discussions within the long term care task force to assure quality--there is recognition that a problem exists. But the state lacks adequate oversight of residential settings.

  • We don't have assisted living that focuses on dementia, but do have some foster homes that provide a high level of care.

Some respondents expressed concerns about lack of funds to build housing, and the impact of converting senior housing to assisted living.

  • On the housing side--we are flat broke. We cannot afford to build assisted living for low income seniors. We already have a large stock of housing that serves seniors--so there is no point in putting money into purpose built assisted living. We need to look at what we have and enhance it when needed; provide services in the existing housing stock and remain solvent.

  • I'm concerned about the impact of providing the assisted living service package on the character of low income public housing and congregate housing. This is an issue that is likely to be somewhat unique to Minnesota, however, it is worth noting. People are struggling with how far the state should go with the level of support before adversely affecting the living climate or environment for the other residents. Or, how far can services go in providing coverage for increasing levels of acuity and support, and where should the line be drawn? When should people move to other settings that can better meet their needs? This is a work in progress--we are implementing a philosophy.

  • It is complex when trying to turn subsidized senior housing into assisted living; it has not panned out. Many seniors in these settings are doing fine and not signing up for services. When there are vacancies and you bring in people who need services and supervision it changes the mix and character of the setting, although in some small towns it works out fine. You then change your stock of low and moderate income housing and turn it into assisted living. So for those who are poor and need housing you've limited their choice--an unintended consequence.

  • We have buildings where people who are being served don't need a lot of the services but they get the entire package.

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