Medicaid rule could be an obstacle for dementia care in AL, Stateline reports

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David Kyllo
David Kyllo

As states begin to implement a new Medicaid rule for home- and community-based care, there is a danger that assisted living facilities might face difficult requirements that could limit access to care, according to an article published Wednesday by Stateline, a news service of the Pew Charitable Trusts.

Issued by the Centers for Medicare & Medicaid Services in January, the final rule is meant to ensure that home- and community-based care is person-centered and the settings are not too institutional. Now, the well-intentioned rule actually is causing problems, some prominent stakeholders told Stateline.

National Center for Assisted Living Executive Director David Kyllo spoke to Stateline about secure units in assisted living facilities. Under the rule, AL residents should not be locked in or otherwise have their movement constrained unless they are at risk for wandering. Providers now could face a challenge because resident populations often are mixed, with some who wander and others who don't. Having secured exits may not be viable in these situations under the final rule, but eliminating them would endanger many of the residents or force them to relocate.

“It's an issue that wasn't clearly spelled out in the final rule, and so, NCAL continues to communicate with CMS the importance of these care units for individuals living with dementia who are prone to wandering or seeking exits,” Kyllo elaborated in an email to McKnight's.

Another issue raised in the Stateline article: Facilities located near hospitals or nursing homes face “heightened scrutiny” because they are deemed likely to have an institutional feel and not be integrated into the community. However, many assisted living facilities and other senior living options purposefully are located in these areas, for easy access to acute care or so that residents can visit loved ones.

The issue stems in part from the fact that the final rule largely was driven by younger long-term care recipients, and some of the provisions do not neatly fit the needs of older people, according to Kyllo and others who spoke with Stateline. They praised the intent and much of the language in the final rule despite the complexities that are arising.

“The devil is the details,” Kyllo told McKnight's. “We want to make sure states don't overstep or misinterpret CMS guidance with this rule in a way that would threaten seniors' access to assisted living services.”