I Consumer Choice/No Institutional Bias

• Consumer choice
• Remove limits for CAP and in-home assistance; consumers should not be forced into an institution because no CAP slots are available
• Maximize non-institutional options
• Funding Streams
• Expand HCCBG to encompass those who are close to Medicaid eligible, but not currently eligible
• Expand CAP/DA
• Expand in-home care/SA
• Expand regular Medicaid to include adult day health as a regularly covered service without having to be eligible for CAP/DA outside of waiver program
• Expand eligibility for Medicaid-funded personal care to individuals in adult day care
• Pre-Admission Screening
• Mandate pre-admission screening for both full-pay and Medicaid before they enter a long term care facility
• Conduct financial screening first by a qualified independent reviewer – if it costs more to maintain resident at home, do not need to proceed
• Develop an adequate core set of services in each county
• Implement core services plan developed by the Division of Aging in the Department of Health and Human Services
• Ensure counties are funded adequately to provide monitoring and oversight to assure that consumer choice elders receive the services funded and are not exploited or abused
• Provide complete information about facilities, facility ownership, performance audits and violations/penalties should be made readily available to the public online within 30 days

II Enforcement/Monitoring

• Keep monitoring for adult care homes local
• Develop minimum staffing, training and workload standards for adult home specialists
• Develop and implement a system for rated licenses for nursing homes and adult care homes
• Develop and implement performance-based reimbursement reform for adult care homes
• Enforce laws related to accountability/transparency in use of Medicaid funds
• Conduct biannual audits of adult care homes by the State Auditor, to include the financial implications of related enterprises operated by the same corporation that operates the facility
• Develop an objective cost model for adult care homes that determines actual cost of adult care home care and develop reimbursement models based on cost models
• Require that each county’s emergency services unit develop an emergency/disaster plan for special populations residing in their counties, whether located in long-term care facilities or at home
• Fund and develop process for implementing the temporary management law currently in the state statutes

III Staffing

• Require adequate staff training, based on individual resident needs
• Provide adequate pay and health insurance for direct care staff to increase retention and improve quality of care
• Improve staff-to-resident ratio
• Base staff-to-resident ratio on resident assessment
• Increase minimum staffing requirement
• Mandate drug testing for all long term care employees

IV Mixed Populations

• Meet adequately the needs of medically diverse populations in appropriate settings and appropriate groupings through appropriate reimbursement structures, resulting in adequate assessment, diversion and specialized services for these populations.

• Mental Health Units
• When a person’s mental health needs override physical care needs, the person should be served in settings licensed by G.S. 122-C, administered through the State Mental Health Commission
• When a person’s physical care needs override mental health needs, that person should be served by an adult care home/nursing home
• When determining how the needs of aggressive persons or sexual offenders will be met, a Pre-Admission Screening and Resident Review (PASARR)-type evaluation should be conducted to determine whether the overriding patient need is physical care or mental health care, aimed at identifying an appropriate long-term care setting that meets residents’ needs
• Special Care Units
• DFS should adhere to the regulations as written related to locked units or groupings of patients with Alzheimer’s or related dementias, not as the regulations have been interpreted in the past.
• Therefore, state law requires that a locked unit should be deemed to be a special care unit.
• Designation as a special care unit should also require enhanced staffing, training and activities to meet the needs of the residents.
• Use Medicaid and Special Assistance funding to improve the reimbursement structure for those units that meet the higher standards, thus enhancing the safety and health of residents, increasing staffing and improving bed availability.