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Assisted Living and Residential Care in Oregon: Two Decades of State Policy, Supply, and Medicaid Participation Trends

Correspondence: Address correspondence to Mauro Hernandez, PhD, Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California Street, Suite 455, San Francisco, CA 94118. E-mail: Mauro.Hernandez{at}ucsf.edu

Purpose: The study describes Oregon state policy and supply developments for licensed long-term-care settings, particularly apartment-style assisted living facilities and more traditional residential care facilities. Design and Methods: Data came from a variety of sources, including state agency administrative records, other secondary data sources, and key informant interviews. Descriptive statistics examined public financing, Medicaid reimbursement, and licensed bed supply trends from 1986 to 2004, as well as Medicaid resident use between 1990 and 2004. Results: Residential care expansion, combined with nursing facility contraction, has transformed Oregon's supply of licensed long-term-care settings in favor of less institutional options. State financing, reimbursement, and licensing policies varied across provider type, with greater public resources supporting growth of assisted living facilities. By 2004, such settings were more likely to be Medicaid providers than residential care facilities and had a higher proportion of Medicaid residents relative to available bed supply. Implications: State financing and reimbursement policies may play a role in stimulating the supply of apartment-style assisted living available to low-income and/or rural service users. Less favorable policy conditions may have unintended consequences for the supply and use of other residential care settings.

Key Words: Medicaid • Home- and community-based services • Waivers • Long-term care • Adult foster care • Nursing homes