Hole torn in a dollar bill with Medicaid text
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Older adults in Pennsylvania who no longer can afford their assisted living community but who don’t require skilled nursing care may get a lifeline to age in place under a new proposal.

State Sen. Michele Brooks (R-Crawford, Erie, Mercer, Warren) has released a memo announcing her intent to reintroduce a bill allowing Medicaid reimbursements in the Keystone State’s assisted living communities.

According to Paying for Senior Care, Medicaid programs in 47 states and Washington, DC, offer some level of assistance for individuals in assisted living or other forms of non-nursing home residential care. 

The Pennsylvania Health Care Association, the state affiliate of the American Health Care Association / National Center for Assisted Living, said that it has been advocating for this change as a way to allow residents to remain in their assisted living communities when they can no longer afford them. The bill would prevent a resident’s transfer to a nursing home when the resident does not require a nursing home level of care, saving tax dollars and limiting unnecessary transfers that can overwhelm nursing homes.

“PHCA recognized years ago a need to better accommodate seniors seeking a specific level of care that was affordable,” PHCA President and CEO Zach Shamberg told McKnight’s Senior Living. “This commonsense solution will not only save taxpayer money; it will also afford more seniors the opportunity to receive care at or remain in the care of an assisted living community, which may be the best setting for them.”

The proposal, he added, also supports nursing homes, which are overwhelmed with requests to admit new residents who may have “graduated” from private-pay to Medicaid, forcing them to relocate to nursing homes that accept Medicaid payments. 

“We shouldn’t be forcing seniors to a higher level of care simply because they can no longer afford to privately pay for a stay in assisted living,” Shamberg said. 

The Pennsylvania General Assembly in 2007 approved assisted living residences as a licensed model of care, providing a balance of availability between institutional and home- and community-based long-term care. According to PHCA, assisted living communities in the state can provide a higher level of care than can personal care homes. If a personal care home resident’s needs change to the point where the resident needs a nursing home level of care, then he or she must transfer somewhere else. If that older adult is an assisted living resident, however, then he or she can age in place.

The state Department of Human Services’ Office of Long-Term Living had projected that more than 300 licensed assisted living communities would be operating by FY 2014-2015, between new construction and the conversion of existing personal care homes to assisted living communities. Today, however, only 67 licensed assisted living communities are operating in Pennsylvania.

Brooks said the physical site requirements in state assisted living regulations, as well as the lack of intended medical assistance coverage, have prohibited or dissuaded personal care home providers from making the transition to assisted living. 

Her proposal, she said, would ensure that assisted living is funded by the state’s Medicaid program. Further, Brooks said, by allowing pre-licensure waivers of physical site requirements, the proposal would remove “unnecessary and unintended impediments” to personal care home operators who are interested in converting those homes into assisted living residences. 

“My hope is to promote and improve the availability of and access to assisted living residences as an age-in-place, residential care and supportive option for those seniors who may need more care than can be provided in a person care home, but do not yet require the around-the-clock care of a skilled nursing facility,” Brooks said in a memorandum. “With my legislation, Pennsylvania will finally offer the full array of facility-based options to our state’s seniors.”