Of the six states, only Oregon requires assisted living facilities to provide private apartments to Medicaid clients.20 In the other states, Medicaid contracting rules may encourage, but do not require, private bedrooms and bathrooms. Yet, in every state, nearly all respondents who commented on the issue of single vs. double occupancy rooms felt strongly that Medicaid clients should have private rooms and baths in residential care settings, noting that most older people highly value their privacy and want private rooms.
Many were highly critical that the term "assisted living" was used to describe facilities that had two and as many as four people in a room (in Florida). One respondent criticized Florida's Extended Congregate Care regulations for defining privacy as "encompassing dual-occupancy with a choice or roommate where possible." However, some noted that the low room and board rates mandated for Medicaid clients could make it difficult for some providers to offer private rooms.21
In North Carolina, dual occupancy is the standard for Medicaid-eligible residents. Several North Carolina respondents felt that many facilities that called themselves assisted living were similar to institutional care. In Wisconsin, whether a waiver client is served in a single room depends on the availability of these rooms in the area they live in, and whether the facility will accept the low amount that waiver clients typically have to pay for room and board.
Oregon respondents felt that success of the state's assisted living program lay in its offering Medicaid waiver clients the same residential care options available to the private pay market. As one said, "if the private pay market gets privacy and independence, then so should the Medicaid client." Another noted that while giving Medicaid clients private rooms in assisted living had been very successful, the downside was that the state has not invested in the physical upgrading of nursing homes, which are viewed as being "stuck in the 50s and 60s."
One Oregon respondent noted that the assisted living physical plant requirements had generated a greater degree of accessible housing for persons under age 65 with disabilities, noting that ALFs offer a housing option for the younger disabled who need some oversight and services but want privacy and independence.