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A Comprehensive Guide to State Regulations for Assisted Living

Written by Noah Bandt
 about the author
13 minute readLast updated November 1, 2021

Making sure your loved one receives high-quality care can be one of the most stressful parts of finding assisted living. However, each state in the U.S. has organizations in place to audit communities and make sure they’re meeting the state’s requirements, ensuring your relative gets the care they need.

Key Takeaways

  1. Assisted living facilities must adhere to certain standards and state regulations. For example, facilities must be licensed by the local health department or social services.
  2. Each state has different regulations overseeing assisted living. Below you’ll find links to state regulation guides so you can explore your state’s standards.
  3. State regulations can be rated based on a number of criteria. We’ve developed a rating methodology that provides a picture of how transparent each state’s regulations are.
  4. It’s important to report assisted living violations. If you suspect neglect, elder abuse, or lack of compliance with state guidelines, contact Adult Protective Services.

To make an informed decision about your loved one’s care, check a community’s audit and licensing history. This will help you to determine if the facility has a track record of providing high-quality services.

Take a look at some common questions about assisted living regulations, including how to check licenses and inspection reports of senior living facilities in your state.

Which agency regulates assisted living facilities?

Individual states — not the federal government — regulate assisted living facilities. While there is a national website to view the audit and licensing history of Medicare-approved nursing homes, no such website exists for assisted living communities.

Assisted living communities provide senior housing, supportive services, personalized assistance with activities of daily living (ADLs), and health care, generally excluding hospital-level care. They’re sometimes more broadly referred to as “residential care settings.” In most cases, it’s up to the state health department or social services office to regulate assisted living communities.

Most states also regulate residential care homes, sometimes called “personal care homes” or “board and care homes.” These typically have a more homelike setting and fewer residents than assisted living communities.

The Centers for Medicare & Medicaid Services (CMS) is a federal agency that regulates and provides ratings for nursing homes and skilled nursing facilities — not assisted living communities. However, CMS does offer guidance to state Medicaid services regarding rules for facilities that are Medicaid certified. According to the National Center for Assisted Living, this includes about half of all assisted living facilities.

Who regulates memory care facilities?

Many states have specialized requirements for communities that provide memory care to seniors with Alzheimer’s disease and other types of dementia. These requirements concern basic living unit features, staff-to-resident ratios, staff training, and behavior management methods. When applying for licensure, memory care communities often must provide a “special care unit disclosure form” describing how they meet these requirements.

Do assisted living communities need a license?

Yes — before opening, assisted living communities must have a license from the proper state agency. The agency then proceeds to inspect or survey communities on a routine basis. Inspections usually occur both annually and when someone files a complaint.

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Deficiencies — sometimes called violations or citations — are noted during inspections. These deficiencies can provide insight into the quality of care provided at a community. For each deficiency found during a survey, a provider must submit a plan of correction that includes a timeline explaining how they will respond to the issue. States can suspend or revoke a license and impose penalties for failure to comply with state requirements.

In some states, a facility may operate without a license if it offers a lower level of care or different services than a licensed assisted living facility or equivalent provider. For example, if a residential care home only offers help with housekeeping or basic assistance with ADLs, it may not need a license.

Regulations vary from state to state. Some common state regulations include the type of training staff are required to receive, what must be covered in the initial service agreement, and which medical services staff members who aren’t registered nurses can provide.

A Place for Mom only refers families to appropriately licensed facilities. Twice a year, our regulatory licensing team confirms all communities in the company’s referral network are licensed and/or compliant with applicable regulations. Our dedicated local senior living experts are also here to help you and your family navigate the ins and outs of your state’s assisted living regulations.

A state-by-state guide to assisted living licensing and reports

Our state-by-state guide to assisted living licensing and reports is intended to help simplify the process of researching state assisted living licenses and inspections. Each state page includes a summary of how to obtain records and rates each state’s system based on the amount of information available to the public, the ease of access to the information, and how often the state inspects or surveys assisted living communities.

Note: Each state agency shares licensure information and inspection survey results differently. In many states, you can verify a provider’s license(s) and read their inspection reports online. However, in other states, you must request to have this information mailed to you. You may also request the latest survey or inspection report directly from individual assisted living communities.

Methodology for the state guide ratings

Rating criteria

We assessed each state and the District of Columbia using more than a dozen objective criteria, including whether:

  • The state lists assisted living communities online and if so,
    • whether the list is updated frequently (within 60 days)
    • whether the information is searchable
  • Information about inspections, complaints, violations, etc. are available online, and if so:
    • whether it’s updated frequently
    • whether it’s searchable or whether this information is integrated with the list of licensed communities, or whether it’s in a separate location
  • Information about special licensing for care is available
  • The community’s pricing is available
  • The capacity of the assisted living community is available
  • The community’s administrator or owner’s name is shown
  • Payment types are shown online (i.e. Medicaid, private pay)
  • The state can fine the facility
  • The frequency of mandatory inspections

Rating system

After our regulatory licensing team established each state’s adherence to the criteria, we applied a rubric that assigned a value to each particular criterion based on its relative importance. This allowed us to apply an objective score for each level of transparency, in turn defining a rating:

  • Exceptional: Has a unified online searchable database for assisted living facilities and licensing and regulation data. Includes assisted living provider background and contact information.
  • High: Has separate searchable databases for assisted living facilities and licensing and regulation data. May lack information about inspections and regulatory actions.
  • Moderate: Has directories of licensed communities online but does not have a searchable database. May lack information about inspections and regulatory actions.
  • Basic: Lists assisted living facility information in a PDF or Excel file. Information about regulatory actions is usually not available. A Freedom of Information Act(FOIA) request may be required to get information about the community.

Data collection

Data were compiled by A Place for Mom’s regulatory licensing team, part of the company’s legal department. The team is charged with confirming, twice a year that all communities in A Place for Mom’s referral network are licensed and in compliance with applicable state and federal regulations.

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This ongoing audit of communities requires using various methods of gathering public information released by each state. The process ranges from utilizing state websites and searching public databases to completing Freedom of Information Act request forms and speaking with numerous state representatives.

Auditing over the years has provided immensely valuable insight into the quality of agencies’ processes currently in place to provide this critical information to families.

How do I report a violation of assisted living regulations?

Regulations exist for a good reason,­ but they may not always be followed. If you suspect neglect, elder abuse, or lack of compliance with state guidelines, contact Adult Protective Services (APS). This map of APS agencies by state provides contact information.

It’s important to note that although state-specific regulations may overlap with broader assisted living regulations, the specifics of the requirements can vary considerably. Researching these regulations can help you to better understand what is required of a community and how to identify potential red flags.

When in doubt, remember our 400 dedicated local experts are here to answer any questions you may have during the process. We can work together to find a welcoming, safe community both you and your loved one can feel confident about.

Sources:

U.S. Department of Health & Human Services, Office of the Assistant Secretary for Planning and Evaluation. “Compendium of Residential Care and Assisted Living Regulations and Policy: 2015 Edition.”

U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. “Home and Community-Based Settings Regulation – Heightened Scrutiny.”

Meet the Author
Noah Bandt

Noah Bandt is a copywriter at A Place for Mom. He focuses on regulatory issues relevant to senior living and writes about emerging trends, including the benefits of voice-activated technology for those with dementia. Noah was the vice president of the Philosophy Club at Seattle University, where he earned a bachelor's degree in philosophy.

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The information contained in this article is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom and the reader.  Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter and do not act or refrain from acting on the basis of anything you have read on this site.  Links to third-party websites are only for the convenience of the reader; A Place for Mom does not recommend or endorse the contents of the third-party sites.