Law & Regulations
State Regulations for Assisted Living: Comprehensive Guide

State Regulations for Assisted Living: Comprehensive Guide

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regulations for assisted living facilities


Did you know that about 64% of staff in different long-term care facilities have admitted to perpetrating some type of elder abuse, according to World Health Organization? That may sound scary if you are considering moving your senior loved one to a nursing home or assisted living facility. However, long-term care facilities are often subject to federal or state-level regulations to ensure a safe and quality care arrangement for the residents. 

Though there are federal regulations to regulate and monitor nursing homes, for assisted living facilities, there are no federal regulations in place. That means the federal government will set no rules or standards for assisted living. Instead, assisted living facilities only follow the rules set by the state government, and rules may vary depending on each state. 

Assisted living regulations are important and something you should be aware of when looking into centers for your parents. So, now that you know that the Federal Government will not enforce any regulations for assisted living, what should you do in that scenario? In this blog, we will address some of these key questions that you may have regarding the licensing and inspection reports for assisted living facilities in your state. 

Regulations for Assisted Living Facilities: How They Are Regulated?

Assisted living communities or “residential care settings” are regulated by the state health department or social services office. No federal government ratings are in place for these communities.

Assisted living is a type of senior care that combines housing, support services, assistance with activities of daily living (ADLs), and various levels of health care for older adults. 

Residential care homes (also known as “personal care homes” or “board and care homes”) are regulated by most states. These communities typically have a home-like setting and fewer residents than assisted living facilities.

The CMS or Centers for Medicare & Medicaid Services is a federal agency that rates nursing homes and skilled care facilities. However, they do not provide ratings for assisted living communities.

However, CMS has put out some helpful guidance for states on the rules they must follow when it comes to Medicaid-certified services. This only applies to about half of all such places according to the National Center for Assisted Living which provides professional senior care options in America today.

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 the 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 non-compliant facilities 

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. 

Do Assisted Living Facilities Need a License? 

The state must approve assisted living communities before it starts operating. So in simple words, the answer is yes, assisted living facilities must obtain a license for operation. In addition, the government bodies may inspect and interview the community residents and staff regularly. They may also pay visits when someone lodges a complaint.

During these surveys, deficiencies are found during inspections and noted in the report. These deficiencies are also called violations or citations in some cases. For each of those noted deficiencies, the provider must provide a plan of correction with a timeline outlining how they will address the issue. Failure to comply with requirements may result in suspension or revocation of license by the states.

License requirements vary from state to state, but some facilities are still able to operate without a license if they provide less intensive level care or different services than what’s usually available in a licensed assisted living setting.

What To Be Aware Of When Looking For Assisted Living Facilities?

When looking for assisted living facilities, it is important to be aware of a few key things. The first thing is to consider the needs of the person moving into the facility. Plus, researching the state-specific rules and requirements where your aging loved one is seeking care is crucial too. Additionally, the quality of staff and reputation of the facility should be checked. Once you have narrowed down your search, visit several facilities in person so that you can get a sense of what each one has to offer as well as their policies and protocols.

1. The Band-Aid Application Ban

Assisted living facilities are designed to provide help with activities of daily living. They are not skilled nursing homes with advanced medical care capacities. But in many states, they function like it because residents are often reluctant to relocate. However, in several states, assisted living facilities (ALFs) are prohibited from providing basic wound care to their residents. So, one must first understand the extent of their own state’s wound care policies and procedures to know what kind and level of care they can provide according to their state laws.

For example, in the state of Rhode Island, ALFs are not allowed to provide even basic wound care unless they have a limited health services license from the Centre for Health Facilities Regulation.

While these regulations may appear very strict, they are important to protect the rights and safety of assisted living residents and their overall well-being. To make an educated decision about where to move your loved ones, you should research what medical care services are available in that area. If there’s a chance it could affect their condition or health needs down the line then find out how those communities deal with change over time on residents like them!

2. Care Plan Management

Assisted living staff are required by many states to conduct a comprehensive needs assessment of each resident upon admission. The care plan for each resident must be tailored to their individual needs and reviewed at least annually to ensure that their care needs are still being met.

RCFEs in California which include, ALFs, memory care units, and continuing care retirement communities (CCRCs) must assess an aging adult’s likes and dislikes to ensure that they will be satisfied with the living arrangements. The activity programs that the individual may wish to participate in may also be suggested. This assessment is used to help make care plans that cater to the individual’s needs.

To ensure that you are able to make the best decision for your loved one, be sure to ask about the care plan policies of any prospective facilities. You can ask for a written copy of the current plan at any time and request care team meetings to discuss any issues and potential changes.

assisted living federal regulations


Regulations for Assisted Living Facilities

3. The Continuous Medical Care Threshold

In most states, assisted living communities are not allowed to provide 24-hour nursing care, so if a senior needs that level of care, they are not suitable for admission. However, skilled nursing services definition can vary from state to state and some assisted living facilities may be eligible to provide medical help with things like medication management, insulin administration, and blood glucose testing. This can come at an increased cost for residents of ALFs.

Please keep in mind that even if ALFs have licensed staff, they are not allowed to admit residents who need 24/7 medical care. In case your senior loved one needs round-the-clock medical attention, it would be better to hire full-time health care services or seek placement in a memory care unit or nursing home.

4. The Leisure Activities Requirement

Those who live in assisted living facilities are often able to participate fully in social and leisure activities. In some states, residents must meet certain criteria regarding exercise levels before they may be admitted into the home – this means there is no lack of options available!

When a resident cannot participate in activities, they may be declining to the point where relocation is necessary. However, the activity requirement varies by state; make sure you know what’s required of you before trying anything.

State regulation and transparency for assisted living 

Individual states regulate assisted living through government-authorized state agencies that ensure the facilities meet the state’s standard for providing quality care. Usually, they are regulated by the state health department or social services office. As for determining their transparency in assisted living, the providers need a license and certification from the appropriate state agency that conducts yearly audits and inspections to examine whether an assisted living facility is meeting the standard set by the state. The inspection results or licensure information can be accessed online or may be requested to have them mailed to you. 

Assisted Living Disclosures and Costs 

Assisted living costs vary depending on location, services, cares needs, and many other factors. Therefore, all assisted living facilities must provide a disclosure outlining the fees or payment requirements in writing to the resident or their representatives in advance. Be sure to review the disclosure document carefully before signing the contract. 

Medicaid, Assisted Living, and Spotty State Regulations 

Whether a person in assisted living will or will not receive Medicaid benefits depends on their financial situation and care needs. Many facilities accept Medicaid payments directly, while some get the payment through a waiver program or Supplemental Security Income (SSI)

Spousal protection assisted living and nursing homes 

Spousal protection or Spousal impoverishment is a federal law that ensures a healthy spouse, capable of living in their home, can protect some of their assets instead of spending it all for the other spouse’s long-term care costs. Since Medicaid has specific income and asset limits for applicants to prove their eligibility, a significant amount of the couple’s finances may get used up to cover the nursing home care cost. That is why the impoverishment rules were introduced to prevent non-applicant spouses from becoming poverty-stricken. The impoverishment mainly applies to nursing homes but may also be applicable for assisted living. 

The limitations of rules and regulations 

Unfortunately, rules and regulations have some limitations and do not fully guarantee protection to assisted living residents. Here are some of the limitations of rules and regulations: 

  • Unpreparedness: Unpreparedness for unusual or unexpected circumstances and be a limitation (e.g., COVID19 pandemic). 
  • Sampling error: Inspections are often done by surveying a certain number or sample of residents. So, it may not show the whole picture, and rules violations can go unidentified. 
  • Inconsistency: Since inspections are usually done annually, facilities may drop their guard immediately after the inspection is done and only upgrade before the next one. 
  • Lengthy procedure: If violations are identified, it may take a while to take actions, and often facilities do not face any penalties. 
  • Human error: Inspections are a team effort, and it is possible that an individual overlooks inconsistencies or errors. 


State Regulations for Assisted Living Facilities, as well as requirements at particular institutions, differ significantly. The regulations ensure that residents receive quality care while living in an assisted living setting. Typical regulations cover topics such as staff-to-resident ratios, training requirements for staff, health and safety standards, and resident rights. Also, some of these may not directly impact your loved one or their treatment.

If you find it difficult to understand all the complexities of the rules and regulations of assisted living, you may consult a senior living advisor. BoomersHub’s local advisors are always there working alongside you to find the best-assisted living facilities near you and help you understand the regulations as well. Call us at +(877) 409-0666 or get in touch through info@boomershub.com  and take advantage of our services absolutely free of charge! 

FAQs related to Assisted Living Rules and Regulations

Which agency regulates assisted living facilities?  

Assisted living facilities are regulated by the states. So the agencies regulating assisted living vary state-to-state. 

How to report a violation of assisted living regulations? 

Any violation of assisted living regulations should be reported to the facility manager or facility in charge first. Then report to the state agencies who are overseeing assisted living communities. Finally, the complaints can be directed to Adult Protective Services (APS) and Long-Term Care Ombudsman of each state. You can report it through their hotlines, online forms, or mail your complaint to their office. Make sure you report as soon as possible and make it as detailed as possible. 


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