2007 Assisted Living State Regulatory Review

218 Pages·2007·0.88 MB·English

Assisted Living
State Regulatory
Review
2007

March 2007

1201 L Street, NW
Washington, DC 20005
www.ncal.org
Assisted Living
State Regulatory Review
2007

March 2007

Prepared by Karl Polzer, Senior Policy Director
National Center for Assisted Living
[phone]
Assisted Living
State Regulatory Review 2007

Almost one million Americans now make their home in assisted living
facilities, including more than 120,000 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.

There are federal laws that impact assisted living but oversight of assisted
living occurs primarily at the state level. The varying laws and regulations
affecting assisted living settings have created a diverse and fluid operating
environment for providers and a mix of terminology, settings, and available
services for consumers. Overall, these variations reflect the development of
assisted living to meet the needs of the individuals in each particular state.

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.”

In 2006, about a third of the states made changes to their assisted living
regulations and three began covering assisted living under Medicaid
waivers. About seven states made major regulatory changes. Only a
handful of states now do not provide Medicaid coverage for assisted living.

Continuing a trend in recent years, many states made regulatory changes in
response to increasing levels of resident acuity and needs for health services.
At least two states – New Hampshire and Missouri – created new licensure
categories in part to accommodate higher resident acuity levels. Several
states added requirements relating to fire safety, incident reporting,
emergency preparedness, disease control, and other resident safety issues.

The trend toward creating enhanced standards for the care of residents with
Alzheimer’s disease and other dementias also continued. Many states added
staff training requirements, staffing requirements, and other standards to
ensure appropriate care for people with Alzheimer’s. Massachusetts created
a new “Special Care Residence” certification category that includes care for
© 2007 National Center For Assisted Living
people with dementia. Florida began requiring facilities to monitor and
manage residents that wander and are at risk for elopement.

Several states initiated or added to facility disclosure and information
requirements. Other areas of regulatory change in 2006 include medication
management, including delegation of authority to administer medications;
staff training requirements; and resident rights.

Massachusetts began requiring every facility to have a quality improvement
and assurance program. In addition, facilities in that state now must provide
specified aggregate data to the state describing residents and their needs in a
number of ways.

As state regulators, fire officials, and assisted living providers have
increased their attention to fire safety issues, we have added a new section to
Regulatory Review called Life Safety beginning with this year’s edition.
This section includes a summary of standards for sprinklers, smoke
detectors, and other life safety requirements as well as life safety codes and
standards that states follow. In most states, assisted living facilities must
meet statewide fire safety standards. In some, there is a combination of state
and local requirements. In a few states, life safety falls mainly under local
government jurisdiction.

Finally, we would like to thank the many people from state regulatory
agencies and NCAL state affiliates who provided information for this report
and reviewed the contents.

Karl Polzer, NCAL Senior Policy Director.
March 2007

© 2007 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 used by the state that most closely fits the
general definition of “assisted living”.
• Opening Statement includes comments about new assisted living
legislation or regulation that is being discussed, drafted, or proposed by
the state.
• 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 a third party, 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.
© 2007 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.
• 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
uses a Medicaid waiver to pay for services in assisted living.

© 2007 National Center For Assisted Living
Alabama
Agency Department of Public Health, Division of Licensure Phone [phone]
and Certification
Contact Eddie May Phone [phone]
E-mail
administration of oral medications, or skilled nursing care for no
longer than 90 days, or if a resident has been admitted to a
certified and licensed hospice program because of a condition
other than dementia, may remain in the facility by arrangement
of such care to be delivered by properly licensed individuals. In
these instances the facility is responsible for the delivery of the
appropriate care.
Resident Assessment Each resident must have a medical examination prior to
entering an assisted living facility and a plan of care developed
by the facility in cooperation with the resident and, if
appropriate, the sponsor. There is certain information that
must be included in the plan of care, but there is no required
standard form.
Two assessments on required forms must be completed for
individuals who move into a specialty care assisted living
facility: a Physical Self Maintenance Scale and a Behavior
Screening Form. Each resident must have a specified score to
be able to live in the specialty care assisted living facility.
Medication Management A resident may either manage, keep, and self-administer his or
her own medications or receive assistance with the self-
administration of medication by any staff member. Medications
managed and kept under the custody and control of the facility
shall be unit-dose packaged. In specialty care assisted living
facilities that care for residents with dementia, medication must
be administered by a registered nurse (RN), licensed practical
nurse, or an individual licensed to practice medicine or
osteopathy by the Medical Licensure Commission of Alabama.
Physical Plant Private resident units must be a minimum of 80 square feet,
Requirements and double occupancy resident units must be a minimum of 130
square feet.
Residents Allowed Per A maximum of two residents is allowed per resident unit.
Room
Bathroom Requirements Bathrooms may be shared and resident rooms may have
common toilets, lavatories, and bathing facilities. When shared,
there must be at least the following: one bathtub or shower for
eight residents; one lavatory for six residents; and one toilet for
six residents.
Life Safety The state of Alabama has two types of licensed assisted living
facilities for the elderly: standard assisted living facilities and
specialty care assisted living facilities for residents with
dementia or Alzheimer's symptoms. Each of these is divided
into the three categories of Family (three residents or less),
Group (4-16 residents), and Congregate (17 or more residents).
A Family facility is usually set up in an individual's home. The
home is reviewed and modified as necessary for compliance with
the National Fire Protection Association (NFPA) 101 chapter for
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One and Two Family Dwellings. By rules, both Group and
Congregate facilities are required to comply with the NFPA 101
chapter on Residential Board and Care with residents classified
as "impractical to evacuate." Under this evacuation
requirement, the Life Safety Code requires each facility to have
both a sprinkler system and a supervised fire alarm system. In
the Residential Board and Care chapter, a Group facility is
required to comply with Small Facility standards. A Congregate
facility is referred under Large Facility to the requirements of
Limited Care found in the NFPA 101 chapter for Health Care
Occupancies.
Alzheimer's Unit Facilities that are not licensed as specialty care facilities may
Requirements neither admit nor retain residents with severe cognitive
impairments and may not advertise themselves as a "Dementia
Care Facility," an "Alzheimer's Care Facility," or as specializing
in or being competent to care for individuals with dementia or
Alzheimer's disease.
Residents must be screened and approved to move into the
specialty care facility. The screening must include a clinical
history, a mental status examination including an aphasia
screening, a geriatric depression screen, a physical functioning
screen, and a behavior screen. Additionally, the Physical Self
Maintenance Scale and the Behavior Screening Form must be
completed and the state has required scores that must be
achieved in order for a resident to move in and continue to
reside in the facility.
Staff Training for All staff having contact with residents in specialty care
Alzheimer's Care dementia units must receive training on specific topics prior to
having any resident contact and must have at least six hours of
continuing education annually.
Staffing Requirements There must be an administrator, RN consultant, and personal
care staff as needed to provide adequate care and promote
orderly operation of the facility.
Specialty care assisted living must have an administrator, a
medical director, at least one RN, and a unit coordinator.
Specialty care assisted living must have at least two staff
members on duty 24 hours-a-day, seven days a week, and must,
at a minimum, meet the staffing ratios specified in regulation.
Administrator Administrators are required to be licensed by the Assisted
Education/Training Living Administrator Licensure Board.
Staff Education/Training In an assisted living facility, staff having contact with residents
including the administrator must have initial training and
refresher training as needed. In a specialty care assisted living
facility, each staff member must have at least six hours of
continuing education per year.
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