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 many of the same residential care facilities serve both private pay and Medicaid residents, most respondents expressed views about the industry as a whole.

  • When it created RCACs the state had an idea of a clientele that never materialized -- younger and healthier. If Wisconsin did it over again -- I doubt they would do RCACs.

  • The assisted living industry has been overbuilt because the industry thought they'd attract younger, healthier clientele. But people do not want to leave their homes unless they absolutely have to. When you go to a CBRF or RCAC, you give up your home, all or some of your furniture, your support system. People do this only when they feel they don't have another alternative.

  • People don't go to RCACs unless they really need to and they usually don't plan to go there. Typically the decision is precipitated by a health care crisis. The average age for new entrants is the mid-eighties.

  • There is considerable over bedding in nursing homes, CBRFs, and RCACs. It's not to the industry's advantage, yet they keep building them. They say they want to develop affordable assisted living but when we sit down to talk about it, their ideas and ours are worlds apart.

  • There are very few private rooms in CBRFs and most do not have a private bath. The Family Care Program is supposed to look for private rooms and move in that direction. But the industry didn't build that way. It's an outrage that the residential industry has been allowed to treat people as marginal and put two people in a room.

  • The residential care industry does not understand that most people do not want to move to assisted living. They never bothered to look at what older people actually want. They want to eat what they want, when they want, with whom they want. They want privacy. They want to be able to watch a movie on TV at 3 AM and sleep late and have breakfast whenever they wake up.

    The entire industry was developed around a medical model -- it was supposed to be an alternative to the nursing home, but it looks too much like a nursing home. They can't think outside the box. There are other ways to structure assisted living. All you have to ask is how would you like to live your life when you are old and figure out how to structure services around those preferences, even if a person needs protective oversight.

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