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


Residential care settings may have specific service requirements and limitations based on their particular licensing category. Beyond those requirements, they may choose from an array of possible "supportive" and "health-related" services to develop their own service packages based on the needs of their community and their target market.

Services furnished or arranged for by a provider may include supervision, supportive services, individualized home care aide tasks, individualized home health aide-like tasks, and individualized home management tasks (see description below). Individualized means services are chosen and designed specifically for each resident's needs, rather than provided or offered to all residents regardless of their illnesses, disabilities, or physical conditions.

Supervision is defined as a service which includes an ongoing awareness of the residents' needs and activities. It is provided by an employee of the assisted living provider whose primary job responsibility is to supervise residents of the congregate living setting, and who is capable of communicating with residents, recognizing the need for assistance, providing the assistance required or summoning appropriate assistance, and following directions.26

The setting must provide the resident with a means to summon assistance, for example, with a pull cord near the toilet, and the employee must be able to respond, in person, to the request for assistance within a reasonable amount of time, not to exceed 10 minutes, depending upon the physical plant.

Supportive services includes assisting clients in setting up medical and social services, assisting clients with funds, arranging for or providing transportation, and socialization (when socialization is part of the plan of care, has specific goals and outcomes established and is not diversional or recreational in nature),

Home care aide services include:

  • preparing modified diets, such as diabetic or low sodium diets;
  • reminding residents to take regularly scheduled medications or perform exercises;
  • household chores in the presence of technically sophisticated medical equipment or episodes of acute illness or infectious disease;
  • household chores when the resident's care requires the prevention of exposure to infectious disease or containment of infectious disease; and
  • assisting with dressing, oral hygiene, hair care, grooming and bathing, if the resident is ambulatory, and if the resident has no serious acute illness or infectious disease.

Home health aide-like services include:

  • administration of medications under the supervision of a licensed nurse;
  • performing routine delegated medical or nursing or assigned therapy procedures;
  • assisting with body positioning or transfers of clients who are not ambulatory;
  • feeding of clients who, because of their condition, are at risk of choking;
  • assistance with bowel and bladder control, devices and training programs;
  • assistance with therapeutic or passive range of motion exercises;
  • providing skin care, including full or partial bathing and foot soaks; and
  • during episodes of serious disease or acute illness, providing services for a client or to assist a client to maintain hygiene, to satisfy nutritional needs, and to assist with the client's mobility, ADLs, grooming, basic housekeeping, and meal preparation.

Home management tasks include housekeeping, laundry, preparation of regular snacks and meals, and shopping.

  • Home care provider regulations cover the service agreement, which includes a description of the service to be provided and the frequency of each service, the persons or category of persons who will provide the service, the schedule or frequency of sessions of supervision or monitoring, fees for each service, and a plan for contingency action if scheduled services cannot be provided.

  • Providers may not accept anyone whose service needs they cannot meet. Orientation and training are required based on the tasks performed by the worker.

  • Providers of any service must hold all required license(s) and/or registration(s). The county is responsible to take all necessary steps to ensure that such license(s) and/or registration(s) are current, and that providers meet applicable provider standards as stated in state or federal statute or rule.

  • Counties must develop a contract for Elderly Waiver or Alternative Care services with providers before any services can be approved. Each setting must be licensed to provide a distinct set of services and each provider may choose to provide some or all of those services they are licensed to deliver, depending upon their mission and their targeted market.

26, Supervision may not be provided by a resident who is receiving services.

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