Those we interviewed had numerous suggestions for improving the Medicaid funded residential care system. The most frequent suggestion was increased funding for both the service component of residential care and the housing component. Several suggested that states allow long term care funding to "follow the person." Texas is using this approach by allowing money from its nursing home budget to pay for waiver services for people transitioned to home and residential care settings.
There was consensus among those we interviewed that states need to pay more attention to quality of care issues generally, and staffing issues specifically. To increase the recruitment and retention of direct care staff, many respondents noted a need for better pay and benefits, more training, career ladders, improved management, and better work environments.
In light of the older ages, higher levels of impairment, and chronic health conditions characteristic of residential care residents, several noted the need to increase both the quantity and quality of health and nursing services provided in residential care settings.
There was agreement among state staff, providers, and consumer advocates that service rates must reflect actual costs and that reimbursement systems need to better match payment rates to residents' needs.
Finally, at least one person in each state felt that the state needed to help consumers better understand the long term care system generally and the differences between different services options. Several said that consumers and their families needed some method to help them compare residential care options and choose those that were best suited to their needs and preferences.