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


No respondents mentioned lack of enforcement as an issue. A few said the state was doing alright and most facilities were in compliance.

  • Since Spring 2000, there has been statewide training for ALF surveyors to educate them on the different philosophy for assisted living as compared to nursing homes. They reorganized the survey offices so that there was a designated supervisor and primary surveyors for ALFs in each office.

  • The state just implemented Assistive Care Services a year ago, and did its first preliminary monitoring in August. Compliance was pretty good.

Several respondents described a government quality assurance initiative called Operation Spot Check, which found that 98 percent of facilities were in compliance with regulations. However, some providers had problems with how the initiative was carried out.

  • In my facility 22 people came in unannounced.

  • Operation Spot Check was not cost effective and it was frightening for the residents. They didn't find anything wrong in most ALFS; there were more problems with the nursing homes.

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