2011 Assisted Living State Regulatory Review

247 Pages·2011·1.28 MB·English

Assisted Living
State Regulatory
Review
2011

March 2011

1201 L Street, NW
Washington, DC 20005
www.ncal.org
Assisted Living
State Regulatory Review
2011

March 2011

Prepared by Karl Polzer, Senior Policy Director
National Center for Assisted Living
[phone]
Assisted Living
State Regulatory Review 2011

About one million Americans make their home in assisted living/residential
care communities, including about 131,000 receiving assistance under the
Medicaid program. A long term care option preferred by many individuals
and their families because of its emphasis on resident choice, dignity, and
privacy, assisted living continues to grow while adapting to changes in
consumer wants and needs. Assisted living communities provide housing
with services, including assistance with activities of daily living (e.g.,
bathing and dressing) and medication administration. Some communities
provide specialized services for people with Alzheimer’s diseases or other
dementias.

Although many federal laws impact assisted living, oversight of assisted
living occurs primarily at the state level. More than two-thirds of the states
use the licensure term “assisted living” and some states use a similar term
(e.g., Tennessee uses “Assisted Care Living Facilities”). While the second
most used term is “residential care,” other state licensure terms include
“boarding home, basic care facility, community residence, enriched housing
program, home for the aged, personal care home, and shared housing
establishment.”

Recent Developments

Even though most states were preoccupied with budget issues in 2010, state
policymakers continued developing and refining assisted living/residential
care regulations. At least 18 states reported making statutory, regulatory, or
policy changes in 2010 or January 2011 impacting assisted living/residential
care communities. At least six states made major changes including Idaho,
Kentucky, Oregon, Pennsylvania, South Carolina, and Texas.
Focal points of state assisted living policy development in 2010 include life
safety, disclosure of information, Alzheimer’s/dementia standards,
medication management, background checks, and regulatory enforcement.
Other areas of change include move-in/move-out requirements, resident
assessment, protection from exploitation, staff training, and tuberculosis
testing standards.

© 2011 National Center for Assisted Living
Pennsylvania implemented new assisted living regulations on January 18,
2011, thereby creating a second level of licensure alongside personal care
homes. Oregon developed new rules for the endorsement of Memory Care
Communities in 2010. Endorsement rules focus on person-centered care,
consumer protection, staff training specific to caring for people with
dementia, and enhanced physical plant and environmental requirements.
Rhode Island passed legislation that, once implemented, will expand the
types of assisted living residents that may receive skilled nursing care or
therapy and the length of time they may receive such services.
Washington state clarified that boarding homes must fully disclose to
residents a facility’s policy on accepting Medicaid as a payment source.
New Jersey passed legislation requiring an assisted living residence or
comprehensive personal care home that surrenders its license and promised
not to discharge Medicaid residents to escrow funds to pay for care in an
alternate facility.

NCAL publishes this report as a service to its members, consumers, policy
makers, researchers, the media, and others. As always, we would like to
thank the many people from state agencies and NCAL state affiliates who
provided information for this report and reviewed its contents.

Karl Polzer, NCAL Senior Policy Director
March 2011

© 2011 National Center for Assisted Living
This report summarizes regulation of assisted living in each state and the
District of Columbia. Information in the report is obtained from state
regulatory agencies, state provider associations affiliated with NCAL, and
through review of state regulations. Because many states are developing and
refining their assisted living rules and guidelines, readers are encouraged to
contact the identified state agencies and to obtain copies of the regulations in
their entirety if they desire more detailed information.

This review is based on the applicable statutes and regulations in each state
and specifically summarizes the following information:

• Agency/Phone Number is the name and general phone number of the
state assisted living regulatory agency.
• Contact Name/Phone Number/Email is the name, direct phone number,
and e-mail address of the state agency representative who is
knowledgeable about state regulatory classifications and new initiatives
regarding assisted living.
• Web Site is the Web site for the agency that regulates assisted living.
• Licensure Term is the term (or terms) used by the state that most closely
fits the general definition of “assisted living.”
• Opening Statement includes comments about new or recent assisted
living legislation or regulations.
• Definition summarizes the state’s definition of the licensure term.
• Disclosure Items includes specific information that must be provided to
a prospective resident prior to signing a residence or services contract.
• Facility Scope of Care summarizes the nursing and personal care
services that may be provided by the facility.
• Third Party Scope of Care indicates whether third parties, such as home
health agencies or hospice providers, may provide services.
• Move-in/Move-out Requirements summarizes the types of resident
conditions that would prevent move-in or mandate move-out.
• Resident Assessment indicates if the state requires a particular form or
process to be used when a prospective or current resident is assessed to
determine if the individual’s needs can be met by the provider and to
indicate the services that the resident will need.

© 2011 National Center for Assisted Living
• Medication Management indicates whether administration of
medication is permitted and the extent to which assistance with
administration is permissible.
• Physical Plant Requirements summarizes the square footage
requirements for resident units and any other special physical plant
requirements.
• Residents Allowed per Room summarizes the maximum number of
residents allowed per resident unit.
• Bathroom Requirements indicates whether bathrooms may be shared
and how many toilets, lavatories, and/or bathing facilities are required per
resident.
• Life Safety summarizes fire safety requirements and other standards
ensuring residents’ physical safety.
• Alzheimer’s Unit Requirements indicates whether facilities are
permitted to care for residents with Alzheimer’s disease and/or
summarizes special requirements for facilities that care for such
residents.
• Staff Training for Alzheimer’s Care indicates any additional training
that may be required for staff that provide care for individuals with
Alzheimer’s disease or other forms of dementia.
• Staffing Requirements lists required staff and may indicate if a certain
number of staff are required at particular times or based on the number of
residents, or if background checks are required.
• Administrator Education/Training summarizes qualifications for
administrators.
• Staff Education/Training summarizes qualifications for various staff
positions.
• Continuing Education (CE) Requirements summarizes the number of
hours of continuing education required annually of administrators and
staff.
• Entity Approving CE Program identifies the state entity that gives
prior approval for continuing education courses, if applicable.
• Medicaid Policy and Reimbursement summarizes whether the state
offers Medicaid coverage to pay for services in assisted living.

© 2011 National Center for Assisted Living
© 2011 National Center for Assisted Living
Alabama
Agency Department of Public Health, Bureau of Health Phone [phone]
Provider Standards
Contact Kelley Mitchell Phone [phone]
E-mail