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This has been coming for sometime

I started out years ago working home health under what was known as the CAP program. Medicaid funds to pay for in home care for individuals needing ADL assistance which was CAPPED at 37.5hrs a week. Now unlike some other states (such as VA) Medicaid funds pay for assisted living care besides Long term nursing care which is inappropriate for many people. Now most people assume assisted living is only for retired people however thats not true in NC. Ive seen and worked in a few facilities (back before I became a nurse) where you had younger adults living in such facilites including some with sexual predator histories unfortunately (the state was getting away with using such facilites as half way houses) My suspicion is that this is the root of part of the problem NC has created for itself. Its also likely that this is the Feds putting the 1st squeeze on the states over Obamacare because a person who is in Assisted Living facility is likely more needy then a person who lives at home with CAP assistance. Those on CAP have family usually who works in the daytime and cares for their family member at night while those in AL do not have that luxury. The catch 22 is as the article mentions treating them different is a violation according to the Feds when in fact common sense dictates those who can be at home USUALLY are and those in AL facilities obviously need assistance 24/7 but dont rise to the need of Nursing home care. I cant tell if this is a move to force more people into Long Term Care in NC by the Feds or not. I hope not because all it will do is increase costs and believe me there arent enough LTC beds in this local area to cover those who would have to be upgraded in care levels if this isnt resolved. Not to mention most LTC facilities prefer not to have a majority of medicaid beds because it just kills budgeting as the margin to even break even is damaged as cost to care and staffing requirements are higher for LTC vs Assisted Living in NC (Med Tech CNAs are allowed to be primary care and medication assistance in Assisted Living while the laws are very specific that in LTC you must have one LPN and that its very limited the ability to use Med Tech CNAs as CNAs are primarily relegated back to Personal care. Not to mention charting requirements for LTC for Medicaid/Medicare is much more extensive then is required for Asst Living.. Asst Living requires paperwork that legally can be completed by a supervising Nurse (usually the Health Care Director etc..) while LTC requires MDS documentation by RN staff constantly. Sure its good to have higher qualified staff available but again it increases care costs needlessly because the avg Asst Living client/resident doesnt require the same care as say a 90yr old female who requires tube feedings and turning and positioning every 2 hrs and extreme care to be monitored for skin breakdown due to severe dementia. I hope they get this situation resolved otherwise the state will see a crisis that nobody can handle and was totally avoidable


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