Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Initial Development


  • The only distinction between assisted living facilities (ALFs) and other models of residential care in Oregon is that ALFs have private apartments. Other settings have both private and shared rooms and private and shared baths.

  • Oregon began developing a nursing home replacement model of assisted living facilities in 1987. The basic concept of assisted living is to combine apartment living with all of the non-skilled nursing services available in nursing homes plus assistance with activities of daily living (ADLs). Twenty HCBS waiver slots were designated for a facility in Portland as a test of this concept and the state developed administrative rules guaranteeing residents the rights of privacy, choice, independence, individuality and dignity.

  • In 1990, the state adopted assisted living regulations and policies to substitute for nursing home care and offer home-like environments which enhance dignity, independence, individuality, privacy, choice, and decision making. Facilities are required to have written policies and procedures which describe how they will operationalize these principles.

  • In some respects, the regulations are specific, e.g., ALFs must provide private apartments. In other ways, however, the rules are vague, e.g., there are no mandatory staff-to-resident ratios. and few service requirements. Residents negotiate service packages that cover everything from hours of personal care to the type of housekeeping services that will be provided.

  • ALFs serve a predominantly elderly clientele. As of December 2002, the state had 184 licensed ALFs, with a capacity of 12,200 units. About 37 percent of ALF residents are Medicaid clients.

  • Level II RCFs and ALFs can serve the same population but they operate under different regulations. When Oregon decided to regulate assisted living, it chose not to replace existing RCF rules, instead adding a new licensing category for assisted living with requirements that differ somewhat from its RCF rules, most notably with regard to physical plant requirements.

  • The state initiated a moratorium on assisted living facilities from August 2001 through June 2005.

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