Assisted Living State Regulatory Review 2013

258 Pages·2013·1.07 MB·English

Assisted Living
State Regulatory
Review
2013

March 2013

1201 L Street, NW
Washington, DC 20005
www.ncal.org
Assisted Living
State Regulatory Review
2013

March 2013

Prepared by Karl Polzer, Senior Policy Director
National Center for Assisted Living
[phone]
Assisted Living
State Regulatory Review 2013

Assisted living is a major long term care option preferred by many
individuals and their families because of its emphasis on resident choice,
dignity, and privacy. Assisted living communities provide housing, 24-hour
staffing, and a growing variety of services including assistance with
activities of daily living (ADLs), such as bathing and dressing, and
medication administration. Many assisted living communities provide
specialized services for people with Alzheimer’s disease and 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” or a similar term. The second most
used term is “residential care.” Other licensure terms include basic care
facility, community residence, enriched housing program, home for the
aged, personal care home, and shared housing establishment.

In 2012, the federal government continued releasing data from the first
1
nationally representative survey of assisted living/residential care facilities.
The study found that in 2010 there were 31,100 facilities with 971,900
licensed beds serving 733,400 residents. The findings reflect how assisted
living has evolved over the years to accommodate residents with greater
needs. Thirty-seven percent of residents were receiving assistance with
three or more ADLs and 42 percent had Alzheimer’s disease or other
dementias. Thirty-nine percent of communities provided skilled nursing
services by registered nurses or licensed practical nurses and 13 percent of
residents received these services. The study also found that 19 percent of
residents received Medicaid funding.

State Policy Developments in 2012
Eighteen states reported making regulatory, statutory, or policy changes
impacting assisted living/residential care communities from January 2012
through January 2013. At least nine of these states made major changes,
including Colorado, Georgia, Michigan, Missouri, New Jersey, New York,

1
See: Park-Lee E, Caffrey C, Sengupta M, Moss AJ, Rosenoff E, Harris-Kojetin LD. Residential care
facilities: A key sector in the spectrum of long-term care providers in the United States. NCHS data brief
no. 78. Hyattsville, MD: National Center for Health Statistics, 2011.

© 2013 National Center for Assisted Living
Ohio, Oregon, and Washington. In 2012, states continued developing new
models for surveys, expanding disclosure and reporting requirements,
addressing life safety and infection control issues, and allowing increased
delegation of medication admistration to non-nurse staff.
In 2012, New Jersey and Colorado joined the small but growing number of
states with innovative survey approaches, developed in part to help better
target resources. New Jersey’s Department of Health (DOH) collaborated
with The Health Care Association of New Jersey Foundation to create a
voluntary program called Advanced Standing. To receive this distinction, a
facility must comply with all applicable regulations as well as submit quality
data reaching benchmarks established by a peer review panel. Participating
facilities do not receive a routine survey, but any time a facility falls below
DOH standards, it can be removed for cause from the program. The state
also performs follow-up surveys based on a random sample. In January
2013, Colorado began conducting risk-based re-licensure inspections for
assisted living residences (ALRs), initially on a pilot basis. Under the new
system, ALRs meeting criteria specified in the law will be eligible for an
extended survey cycle. In 2012, Michigan also began using a new renewal
inspection system.

After creating an additional level of licensure for assisted living
communities a year earlier, Georgia updated rules for personal care homes in
January 2013, including new requirements for additional staff training,
staffing above minimal standards, and a resident needs assessment upon
move-in. Also effective in January 2013, New York adopted rules stating
that no adult home with a capacity of 80 residents or greater may admit or
retain more than 25 percent census of residents with serious mental illness.
Several states made changes to policies and rules for care provided to
residents receiving Medicaid services, some to accommodate managed care
contracting. In 2012, the state of Washington changed its licensure term to
“assisted living facility” from the outdated “boarding home.” Oregon began
requiring facilities to adopt policies for the treatment or referral of acute
sexual assault victims.

A state-by-state summary of 2012 legislative and regulatory changes and
copies of NCAL Assisted Living State Regulatory Review are available on
NCAL’s web site at: www.ncal.org.

NCAL publishes this report as a service to its members, consumers, policy
makers, researchers, the media, and others. As always, we would like to

© 2013 National Center for Assisted Living
thank the many people from state agencies and NCAL state affiliates who
provided information for the report and reviewed its contents.

Karl Polzer, NCAL Senior Policy Director
March 2013

© 2013 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 personal care and nursing
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.

© 2013 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 providing 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, and 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.

© 2013 National Center for Assisted Living
© 2013 National Center for Assisted Living