Preparing to Age in Place: The Role of Medicaid Waivers in Elder Abuse Prevention

32 Pages Posted: 14 Nov 2018 Last revised: 21 Apr 2021

See all articles by Tara Sklar

Tara Sklar

University of Arizona - James E. Rogers College of Law

Rachel Zuraw

University of California, Berkeley

Date Written: July 1, 2019


Over the last three decades, there has been a steady movement to increase access to aging in place as the preferred long-term care option across the country. Medicaid has largely led this effort through expansion of state waivers that provide Home and Community-Based Services (HCBS) as an alternative to nursing home care. HCBS include the provision of basic health services, personal care, and assistance with household tasks. At the time of this writing, seven states have explicitly tailored their waivers to support aging in place by offering HCBS solely for older adults, individuals aged 65 and over. However, there is growing concern about aging in place contributing to greater risk for social isolation, and with that increased exposure to elder abuse. Abuse, neglect, and unmet need are highly visible in an institutional setting and can be largely invisible in the home without preventative measures to safeguard against maltreatment. This article examines the seven states with Medicaid HCBS waivers that target older adults, over a 36-year period, starting with the first state in 1982 to 2018. We conducted qualitative analysis with each waiver to explore the presence of safeguards that address risk factors associated with elder abuse. We found three broad categories in caregiver selection, quality assurance, and the complaints process where there are notable variations. Drawing on these findings, we outline features where Medicaid HCBS waivers have the potential to mitigate risk of elder abuse to further support successful aging in place.

Keywords: Medicaid, state waivers, Home and Community-based Services, HCBS, nursing home, elder abuse, long-term care, aging in place

Suggested Citation

Sklar, Tara and Zuraw, Rachel, Preparing to Age in Place: The Role of Medicaid Waivers in Elder Abuse Prevention (July 1, 2019). 28 Annals of Health Law 195 (2019), Arizona Legal Studies Discussion Paper No. 18-34, Available at SSRN:

Tara Sklar (Contact Author)

University of Arizona - James E. Rogers College of Law ( email )

P.O. Box 210176
Tucson, AZ 85721-0176
United States

Rachel Zuraw

University of California, Berkeley ( email )

310 Barrows Hall
Berkeley, CA 94720
United States

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