Public subsidies for elders in residential settings take different courses in different states. Older persons qualifying for low-income subsidies may apply their federal SSI benefits, as well as any state supplemental SSI benefits, toward assisted living charges for room and board. Medicaid generally pays for nursing or medical services provided to qualified individuals. In most states, this is done through Home and Community Based Services (HCBS) (Section 1915(c)) waivers. Waiver programs acknowledge that many individuals at high risk for being institutionalized can be cared for in their own homes or communities, thus preserving their independence and ties to family and community, at no more cost than that of institutional care. Thus, a person eligible for institutional care may “waive” that right and apply the funds toward home care or assisted living arrangements. Waivers are generally granted for three years and may be renewed for five years.

Finally, many states are developing policies that combine SSI with Medicaid benefits to provide one level of care appropriate for the resident. This encourages “aging in place” rather than the stressful alternative of finding another facility should the resident’s health decline and he or she needs more than what assisted living can offer.