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


Most felt that people in Oregon who need long term care have a wide choice of community residential options, depending on their preferences.

  • If you like bed and breakfasts, you'll probably prefer an adult foster home. If you like hotels, you'll prefer assisted living.

Several noted that because ALFs offered private apartments and were newer relative to many residential care facilities (RCFs) and adult foster homes (AFHs), not surprisingly they were the preferred option for many private pay and Medicaid eligible individuals.

  • Some of the older adult foster homes and residential care facilities (RCFs) are not as desirable to consumers who have a choice. Very few RCF's offer private rooms and if they have them, they are generally kept for private pay residents.

A few mentioned variation in the physical setting of RCFs and AFHs, some being "very nice" and others less so. The most important feature, most agreed, was that there is a sufficient supply of all types of facilities to guarantee a choice of residence for consumers, with two caveats. First, there is some geographic maldistribution of ALFs, with some areas of the stated being overbuilt and others' not having an optimal supply. Second, most felt that with the budget cuts in 2003, many facilities would go bankrupt.

One noted that the state had a certificate of need program only for new nursing facilities, and did not have the methodology to determine appropriate capacity for ALFs. However, data on the current population receiving services--their level of impairment and needs--and projections of population growth would give some idea of future need.

Respondents agreed that the state was right in limiting the use of the term assisted living to facilities that offered private apartments. Compared to the other five states, no one mentioned public confusion about the different types of residential care as an issue.

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