A Comprehensive Guide to Assisted Living Regulations

By Noah BandtMay 14, 2020

Elderly man and woman sitting in the courtyard of an assisted living facility that meets regulations

While there’s a national nursing home website to view the audit and licensing history of Medicare-approved nursing homes, no such website exists for assisted living communities. That’s because states — not the federal government — regulate assisted living communities. Let’s 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.

How are assisted living facilities regulated?

The state health department or social services office regulates assisted living communities, sometimes more broadly referred to as “residential care settings.” There are no federal government ratings for these communities.

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Assisted living communities provide senior housing, supportive services, personalized assistance with activities of daily living (ADLs), and various levels of health care.

Most states also regulate residential care homes, also called personal care homes or board and care homes. These typically have a home-like 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. This is about half of all assisted living facilities, according to the National Center for Assisted Living, a professional senior care organization.

What are the requirements for an assisted living facility?

The exact assisted living regulations vary by state. For the most part, every state has a number of regulations concerning:

Resident agreements that inform consumers on the associated costs of care prior to move-in
Clearly defined resident admission and retention policies based on needs and/or behavior
Support services and service plans which describe in detail the type of care provided to residents
Required medication provisions, which establish who can administer certain medications as well as the degree to which unlicensed staff may participate in the administration of those medications
Food service and dietary provisions, including number of meals provided to residents and dietary recommendations a facility must follow
Staffing requirements, including rules on background checks, training, and continuing education requirements
Apartment sizes, roommate rules, and number of people sharing a bathroom
Inspection and monitoring requirements
Remedies and sanctions for facilities that are noncompliant

While state regulations cover many of the same aspects of assisted living, the specifics of the requirements vary considerably from state to state. For example, 40 states require “direct care worker” training, but the number of training hours required ranges from one to 80.

Who regulates memory care facilities?

Many states have specialized requirements for communities that provide memory care to people with Alzheimer’s and other types of dementia. These requirements concern basic living unit features, staff-to-resident ratios, staff training, and methods of behavior management. 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 facilities need a license?

Yes — before opening, assisted living communities must have a license from the state. Going forward, state agencies inspect, or survey, communities on a routine basis, often annually as well as when someone files a complaint.

During these surveys, deficiencies, sometimes called violations or citations, are noted. For each deficiency noted during a survey, a provider must provide a plan of correction with a timeline. States can suspend or revoke a license and impose penalties for failure to comply with requirements.

In some states, including Michigan and Indiana, a facility may operate legally without a license if it provides a lower level of care or different services than a licensed assisted living facility.

A Place for Mom refers families to licensed assisted living facilities. Twice a year, our regulatory licensing team confirms that all communities in the company’s referral network are licensed and compliant with applicable regulations.

How do I file a complaint?

There are three options to discuss and file a complaint if you suspect neglect, elder abuse, or a community isn’t following state guidelines.

Your local long-term care ombudsman is a volunteer advocate of nursing home and assisted living facility residents. They are trained to research and resolve problems and file complaints to the agency in charge of licensure.
The Adult Protective Services (APS) agency in your state is another way to report a violation. This map of APS agencies by state provides contact information.
State agencies in charge of regulating assisted living communities may also handle complaints.

A state-by-state guide to assisted living licenses and violations

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, but not always. In some cases, 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.

A Place for Mom has compiled a State Guide to Assisted Living Records & Reports. The guide summarizes how to get records, and it links you to search forms for facilities (where available). It also rates each state 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.

Click on your state to find out more about assisted living rules and oversight, and how to find licensure inspection reports for individual facilities in your state.

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: https://aspe.hhs.gov/basic-report/compendium-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. 2019: https://www.medicaid.gov/sites/default/files/Federal-Policy-Guidance/Downloads/smd19001.pdf

Author

Noah Bandt