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Comprehensive Guide to State Regulations for Assisted Living

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regulations for assisted living facilities

Last Updated on June 15, 2022 by ashley.davis


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

Regulations for Assisted Living Facilities: How They Are Regulated

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

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 Medicaid-certified facilities. 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 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, 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. In addition, 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.

What To Be Aware Of When Looking For Assisted Living Facilities

Assisted living is an intermediate level of long-term care that varies widely by state, so gaining even a cursory understanding of some of the unique rules these providers must follow will be invaluable when making senior living decisions.

Be certain to research rules and requirements specific to the state where an aging loved one is seeking care. Then, once you’ve narrowed your search, carefully read a facility’s contract or admission agreement for detailed information on their policies and protocols.

The Band-Aid Application Ban

Most assisted living facilities (ALFs) do not provide medical care, but some are specifically licensed to provide “limited health care services,” which are carefully regulated.

For example, ALFs in the state of Rhode Island are not allowed to provide even basic wound care, such as the application of a Band-Aid, unless they obtain a limited health services license from the state’s Center for Health Facilities Regulation. From there, the wound treatment must be ordered by a physician and administered by a qualified, licensed staff member, such as a certified nursing assistant (CNA), a licensed practical nurse (LPN), or a registered nurse (RN).

While this regulation may seem frivolous, it clearly defines and controls what level of care an assisted living community can legally provide. In addition, compared to skilled nursing facilities, which provide around-the-clock skilled nursing care, ALFs follow less strict staffing, licensing, and training requirements.

It’s important to educate yourself on what medical care services a particular community can provide—especially when accounting for future changes in your loved one’s condition—before deciding to move them there.

Care Plan Management

Many states require assisted living staff to conduct a comprehensive needs assessment of each resident upon admission to develop a written care plan. For example, in Georgia, this must be done within 14 days of an elder’s admission, and the personalized plan must be reevaluated at least once a year (or every three months for those residing in specialized memory care units) and whenever a resident’s care needs change.

In California, ALFs, memory care units, and continuing care retirement communities (CCRCs) are all referred to as residential care facilities for the elderly (RCFEs). However, when it comes to care planning, state regulations specify that RCFEs must also include an assessment of an aging adult’s “likes and dislikes and interests and activities, to determine if the living arrangements in the facility will be satisfactory, and to suggest the program of activities in which the individual may wish to participate.”

It’s important to inquire about prospective facilities’ care plan policies. You should be able to receive a written copy of a loved one’s current plan at any time and request care team meetings to discuss any issues and potential changes.

Regulations for Assisted Living Facilities
Regulations for Assisted Living Facilities

The Continuous Medical Care Threshold

In most states, if a senior requires access to around-the-clock skilled nursing care, their care needs exceed what can be legally provided in an assisted living community, and they are not suitable for admission. However, the exact definition of skilled nursing services may vary from state to state, and some ALFs may be able to offer residents increased help with certain medical tasks, such as medication management, insulin administration, and blood glucose testing, at an increased cost.

However, even facilities that employ licensed/certified nursing staff are not allowed to admit residents who require full-time medical care. If your loved one requires 24/7 skilled care, hiring around-the-clock home health care services or seeking placement in a memory care unit or nursing home is probably a better fit for their needs.

The Leisure Activities Requirement

Assisted living communities in Georgia require residents to be capable of participating in the social and leisure activities they provide. Obviously, staff members cannot demand that your loved one engages in community programs and events. Still, it’s often advisable to encourage an elder to pursue an active social life when moving to senior living.

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. 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 do I 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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