Auxiliary Grant Rate |
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The Alzheimers
Association supports an increase in the auxiliary grant rate -- the state/local funding
source for low income ACR (Adult Care Residence) residents -- and the ACR personal needs
allowance to reduce the number of residents who must be placed out of the area and away
from their families.
Background: Assisted living -- provided by ACRs in Virginia -- is "a promising option for providing care to an increasing number of frail elderly persons in a less costly and more homelike setting than nursing homes" (May 1997 GAO Report). Assisted living facilities offer housing, meals, protective oversight and personal assistance to people with physical or cognitive disabilities. Residents need help with activities of daily living, and 48% have dementia (GAO 1997). Most residents pay for assisted living privately, but Virginia and 21 other states make available Medicaid funds through waivers, and some states supplement costs for low income residents. ACRs offer maintenance and care for four or more adults with functional limitations. The "auxiliary grant program" administered by the Department of Social Services provides financial assistance to Supplemental Security Income eligible residents. Concerns often have been raised about ACR care (particularly for residents with mental disabilities), about licensure standards and enforcement, and about the auxiliary grant program. Recent actions include: three Joint Legislative Audit and Review Commission (JLARC) studies (1979, 1990, 1997); a 1993 Virginia Long Term Care Council study; 1993 legislation establishing two levels of care; revised and expanded regulations in 1996, and auxiliary grant increases (including an increase in July 1997). The Alzheimers Association supports an increase in the auxiliary grant rate. The auxiliary grant is the state/local funding source for low income ACR residents. There is no federal funding source for this level of care, although there are federal sources for assistance for individuals needing either a higher or lesser level of care. The monthly rate (comprised of both the resident's and the public share) currently paid to providers is $833 in Northern Virginia and $725 in the rest of Virginia. In return, residents receive shelter, meals, an activities program, supervision, and assistance with one activity of daily living. By contrast, the range of basic monthly costs for local private ACR residents in Fairfax County is $1,014 to $4,830 with additional fees, according to a current study group in the county, which references the low rate of auxiliary grant reimbursement compared to costs, resulting in frequent placement of Northern Virginia residents out of the area and away from their families. Finally, the ACR personal needs allowance of $40 per month should be increased, as recommended in the 1997 JLARC report. Virginia has 612 ACRs with 25,537 beds (JLARC 1997). The Alzheimers Association endorses JLARCs finding that to improve ACR care, especially for the 43% of residents with mental disabilities: 1) the General Assembly should provide statutory authority for an ACR staffing standard; 2) ACR licensure should clearly define required services in levels of care -- residential living, assisted living and intensive assisted living (Medicaid funded); 3) Licensure requirements for medication administration/monitoring should be strengthened; 4) Stronger enforcement processes should be established, with timelines and financial penalties to ensure compliance; 5) Links between CSBs (Community Services Boards) and ACRs should be strengthened; funding should provide for CSBs to focus on ACR services, training and technical assistance. For more information, please read the 1998 Legislative Updates page.
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