Overview of the State System

Assisted Living facilities provide care to over one million people every year. However, many individuals and family members find it a real challenge to select a facility and to ensure that appropriate care will be provided. There are different agencies in each state that provide information or receive complaints regarding problems or concerns. State-specific contact information for each of the state agencies or organizations mentioned below can be found on the website of the National Citizens’ Coalition for Nursing Home Reform (NCCNHR) at http://nccnhr.org/static_pages/help.cfm. · The Long-Term Care Ombudsman Program. Ombudsmen advocate for the rights of residents of long-term care facilities and for high quality care. They investigate and work to resolve residents’ complaints, educate consumers and providers, and provide information to the public. Each state has a State Office of the Long-Term Care Ombudsman, and most states have local or regional programs located throughout the state. · The State Licensure Agency – which is often located in the state Department of Health, inspects and licenses long-term care facilities to determine whether they are meeting standards that are set in state law and regulation. Licensing requirements and standards vary widely from state to state. o Alternatively, the Department of Aging or the Department of Social Services is sometimes the state agency that inspects and licenses assisted living facilities to determine their compliance with state laws and regulations. The Ombudsman Program can provide information on the specific state agency that licenses assisted living facilities. · The state Medicaid Fraud Control Unit (MFCU) is authorized by the federal Social Security Act to investigate fraud and abuse by providers that receive payments from Medicare and Medicaid. Most units are located within the Office of the State Attorney General. They have broad investigative powers and can bring criminal and civil cases against providers. · The state Medicaid Agency establishes the state Medicaid benefit and eligibility requirements as well as the reimbursement rates the state pays facilities for their services. Most residents of assisted living pay privately with their personal funds for services; but a number of states have adopted Medicaid waivers that allow Medicaid to pay for some residents who meet eligibility requirements. Beginning in 2007, states also have authority to pay for assisted living under Medicaid state plan amendments. · The Protection and Advocacy System (P&A) provides federally-funding to state-designated organizations that provide representation for people with mental illness and disabilities. · The Adult Protective Service Agency (APS) provides protective and supportive services for aged, disabled, or incapacitated adults who are abused, neglected, or exploited. In some states, APS staff are responsible for investigating complaints from individuals about abuse, neglect or exploitation in licensed/unlicensed long-term care facilities, including assisted living facilities. · A Citizen Advocacy Group (CAG) is a local or statewide organization formed to work for long-term care reform in order to help assure that residents in long-term care facilities receive quality care according to publicly adopted state and federal standards (regulations). Many people who organize and join CAGs have had direct experience as family members of residents. · The Eldercare Locator is a nationwide, directory assistance service designed to help older persons and caregivers locate local support resources for aging Americans. Anyone can call the toll-free number, 1-800-677-1116, Monday through Friday, 9 a.m. to 11 p.m., Eastern Time.

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