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


Several expressed concerns about inadequate staffing.

  • Insufficient staff is the key quality issue. We were involved in the effort to change the requirements for staffing ratios for the 11-7 night shift, effective in 2000. Prior to the change, it was only one personal care aide per 50 residents. Now it's one to 30 on the night shift, and one to 20 on the other two shifts.

  • We need more staff in adult care homes but I don't know if putting more Medicaid money in is the answer. We are just starting to learn about the actual costs of these homes. We've had so many studies, but I'm not sure that we have a sense of what the actual costs are.

  • Staffing needs to be based on care needs, not a ratio of 1 to 20. If people are heavy care then 1:20 is totally insufficient. We need an assessment form and a point system to determine what people need.

One respondent noted that it is difficult to recruit and retain good staff.

  • Workers in adult care homes do not receive a living wage and less than 25 percent of workers get any kind of benefits. They spend a lot of time applying for government benefits: health insurance and food stamps. If the industry doesn't pay enough so that their staff are not eligible for food stamps, then the federal government is subsidizing these businesses.

Others expressed concern about inadequate enforcement of new training requirements.

  • New regulatory requirements for increased staff training have not been enforced. Adult care homes are not held accountable for the additional funding they received to provide this training.

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