Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Outcome-Based Regulations


A few respondents stated that the regulations are too rigid and need to be more person-centered and outcome based.

  • The regulations are too prescriptive. They look at pieces of paper rather than outcomes. It is easier to check off a chart than visit the residents. The surveyors ask, did they have a bath? They don't have a person-centered process. We need to look at outcomes. For example, with regard to diet, we should ask is the person gaining or losing weight, are they happy with the meals? We can serve them a nutritious meal, but if they don't like the food they won't eat much and they will lose weight. Same thing with hypertension. We can't have salt and pepper on the table because one resident may have hypertension, so everyone walks around with their own salt shakers. We need to spend more time taking care of residents and less time taking care of paper.

  • The rules are not flexible, which is especially important when caring for people with dementia. There is a regulation that says there must be a minimum of ten hours between breakfast and dinner. But this doesn't account for people who like to sleep late. If someone wants to eat at 9, then technically we can't give them dinner until 7 PM. But a lot of people want to eat between 5:30 and 6:30. A building was cited last week for this--a dementia unit. One of the residents sleeps late, eats a late breakfast and nibbles all day and wants dinner at 5:30 PM because that's the time they have always eaten dinner. They were cited for not meeting the 10 hour rule.

One noted that when looking at regulations, consumer advocates need to distinguish between the majority of providers who are doing a good job, and the few providers who are not.

  • Consumer advocates would like to see regulators walking around with a stick. They paint all providers with the same brush. It doesn't help when they come to the rules review committee and say we need a new rule to address one issue at one home.

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