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


Most respondents were not in favor of adopting national standards or model standards for assisted living.

  • Every state has its own set of issues and conditions. For example, Florida has a higher percentage of elderly persons and the climate increases utility costs because we need air conditioning almost year round.

  • With assisted living there is no uniform type of resident, and unless we changed the entire program, there is no uniform type of provider.

  • Assisted living serves a very heterogeneous population: with and without families, demented, wards of the state. It wouldn't be fair to the people receiving the service to have standards that didn't take this into account. The states should be charged with setting the standards, using set guidelines under Medicaid, and incorporating relevant national standards. Each state has its own issues and problems.

  • There are different needs in different areas of the country. If you have a national standard, it has to be regionalized, to meet each state's unique needs.

However, a small number of respondents stated they would like to see federal standards.

  • We need regulations like the nursing home; we are deficient in ALF regulation; the state makes excuses saying the federal government does not say we have to do certain things.

  • I believe that there should be federal regulations for the type of staff because I am concerned about uncertified staff giving assistance with medication, particularly staff who don't know how to look for signs of adverse reactions.

  • I did a side-by-side comparison of draft national model standards and Florida's regulations, and Florida's were more stringent. I think model standards are good. If I had a facility I would want to use the national standards for guidance for running the facility.

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