The SCAN Foundation

There is a high turnover among certified nursing assistants working in nursing homes. This hurts the quality of care for people receiving long-term services and supports that have the people who care for them leave quickly and unexpectedly. The solution may be the appointment of a retention specialist, a person whose job is to stay in close contact with the workers, find out their goals and grievances, and figure ways to keep them on the job, according to an August 2008 study by the Robert Wood Johnson Foundation, “A Facility Specialist Model for Improving Retention of Nursing Home Staff,” published in the Journal Gerontologist.

Medicaid in many states will pay for the cost of assisted living facilities, which provide a welcome alternative for people who need long-term services and supports, and want to avoid going into a nursing home. Assisted living residences typically have meals provided, a nurse on duty, help with taking medications, and assistance with activities such as bathing. Medicaid reimbursement for assisted living “can be a tremendous benefit, but the design and implementation of these programs has too often led to discrimination against Medicaid-eligible residents, eviction, and other types of poor care,” according to the January 2010 report “Medicaid Payment for Assisted Living: Current State Practices and Recommendations for Improvement,” by the National Senior Citizens Law Center.

Assisted living communities are home to a million people who are receiving long-term services and supports, but usually at a much less intense level than the care available in nursing homes. Unlike nursing homes, which are under a relatively strict set of rules because the nursing homes receive large amounts of federal money, the assisted living industry is regulated by the states, and there is great variation in state handling of this industry. The continuum of care in assisted living facilities varies — some residents may just need to be reminded to take their medicines, others will need help with bathing — making the application of regulations uncertain, with each state having different policies and approaches. “A long term care option preferred by many individuals and their families because of its emphasis on resident choice, dignity, and privacy, assisted living continues to grow while adapting to changes in consumer wants and needs,” according to a March, 2010 report “Assisted Living State Regulatory Review 2010," by the National Center for Assisted Living.

More than a million people receiving long-term services and supports are “dual eligibles” enrolled in Medicare because they are over 65 and in Medicaid because they are poor. The “dual eligibles” have been found to have higher than average medical expenses, according to chapter five in the June 2010 report, “Report to the Congress: Aligning Incentives in Medicare," by the Medicare Payment Advisory Commission.