Expanding Flexibility for Long-Term Care Facilities

Proposal Presented for the Master Plan for Aging (#8)

Disclaimer

Throughout the MPA process, more than 100 proposals were developed thanks in particular to thousands of hours of work by external stakeholders and members of the public. These proposals and the MPA Council commentary are being submitted to the Governor and shared with policymakers and the public to inform policymaking. These proposals represent a starting point for discussion. Further discussion is necessary between relevant state agencies and stakeholders to both refine these proposals and assess which may be appropriate to adopt and implement.

 

Summary

Reduce regulatory and programmatic barriers through creating a sustainable, person and quality centric Assisted Living Model for the future, developing one uniform licensure category for assisted living, and increasing financial support for transitioning nursing homes to other care models. Allow ACFs to add Assisted Living Program (ALP) beds.

 

Justification

Regulatory and programmatic barriers, compounded with financial hindrances, generate gaps in the availability of facility-based LTSS for those who desperately need it. Additionally, individuals who need facility-based LTSS face scarce resources and limited accessibility to other options. Expanding flexibility for facilities will aid in optimizing health at the appropriate level of care and reducing accelerated access of costlier higher care levels.

 

Full Proposal

Reduce regulatory and programmatic barriers, that, in addition to financial barriers, are creating gaps in the availability of facility based LTSS and are limiting options for individuals in need of LTSS, impeding their ability to optimize their quality of life, as they age and their needs change.

  • Create a sustainable, person and quality centric Assisted Living Model for the future. Engage internal and external stakeholders, subject matter experts and advocates to create and codify in NYS Public Health Law, one uniform assisted living model that recognizes the deterioration of the old “hospitality model” characterized by an outdated, non-quality driven set of social service laws.
  • Create one uniform licensure category for Assisted Living. This should align with the development of:
    • A uniform assisted living facility need methodology and should consider the Medicaid funding for existing programs. (Codify language in Article VII submission with the SFY 2026 Budget).
    • Support innovation by offering Assisted Living Owners/operators local, state, and federal tax incentives and consider directing public subsidies if they increase access for middle- and low-income residents. (Include in SFY 2026 Budget)
  • Allow ACFs to add ALP beds.
  • Review capacity and barriers for adult day health care programs.
  • Study Skilled Nursing Facilities and lower levels of care available for individuals with Severe Mental Illness/Substance Use Disorder/Intellectual/Developmental Disability.
  • Study adequacy of capacity for behavioral intervention units.
  • Increase financial and regulatory support for transitioning nursing homes to other care models: adult day care, assisted living, outpatient services and home care services.

 

 

MPA Council Commentary

Components 1, 2 ,4, 5, 6, and 7 are categorized as long-term. These components would require additional reforms to the business model of Adult Care Facilities as the landscape continues to shift post pandemic. They may also require an assessment of the workforce capacity and availability of specialized services. Policymakers may reference this proposal during the legislative session, as statute and regulations may also be necessary to create a sustainable, person, and quality-centric model of care. Following the completion of assessment and development of statute and regulations, DOH would continue its pursuit of developing person-centered and sustainable levels of care. Component 3 of this proposal can be categorized as near-term. Proposed first steps for implementation could include an assessment of costs and savings to the State. Funding allocations would be subject to the annual budget process and the availability of resources.