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Federal Regulations for Assisted Living Facilities

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regulations for assisted living facilities


Did you know that there’s a national nursing home website to view the audit and licensing history of Medicare-approved nursing homes. But there are no such website for assisted living facilities? That’s because it’s the job of your state to oversee Regulations for Assisted Living Facilities. Crazy, right?  

You’d think the federal government wanted to be more involved in this process, but that’s not the case. So, what should you do then? Assisted living regulations are essential and should be well aware of when looking into centers for your parents. 

Let’s look at some typical questions concerning assisted living rules. This includes how to verify senior care facility licenses and inspection reports in your state.

Regulations for Assisted Living Facilities: How They Are Regulated

Assisted living communities, sometimes known as “residential care settings,” are regulated by the state’s health department or social services agency. These communities do not have any federal government ratings.

They have assisted living communities that provide:

  1. Senior housing
  2. Supportive services
  3. Personalized assistance with activities of daily living (ADLs)
  4. Various levels of health care

Residential care facilities, also known as personal care homes or board and care homes, also falls under regulation by states. These offer a more homelike atmosphere and fewer occupants than assisted living facilities.

The Centers for Medicare & Medicaid Services (CMS) is a federal agency. It regulates and rates nursing homes and skilled nursing facilities. It does not oversee or rate assisted living communities.

But, CMS does offer guidance to state Medicaid services regarding rules for facilities that have Medicaid certifications. According to the National Center for Assisted Living, this covers about half of all assisted living facilities.

Requirements for an Assisted Living Facility

The exact assisted living regulations vary by state. Yet, 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 
  • Admission and retention policies for residents that have clear definitions and are based on requirements and/or behaviors
  • Support services and service plans that detail the type of care provided to residents are available
  • Required medication provisions, which specify who can provide specific medications and to what extent unlicensed personnel can participate in their delivery
  • 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 facilities that are non-compliant 

While many areas of assisted living are covered by state legislation, the specifics of the criteria vary significantly from state to state. For example, 40 states mandate “direct care worker” training, but the required number of hours varies from one to eighty.

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, defects, sometimes known as infractions or citations, are identified. A provider must give a remedy plan with a timetable for each defect identified during a survey. Failure to comply with requirements can result in license suspension and other penalties.

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. 

Things to be Aware of about Regulations for Assisted Living Facilities

Assisted living is long-term care that varies significantly by state, so even a brief awareness of some of the unique requirements that these providers must follow will be quite helpful when making senior living options.

Make sure you understand the rules and regulations in the state where an elderly relative is seeking care. Then, after you’ve narrowed down your options, read the contract or admission agreement for complete information about the facility’s policies and procedures.

The Band-Aid Application Ban 

The majority of assisted living facilities (ALFs) do not provide medical care. But, some are licensed to provide “limited health care services,” which are strictly regulated.

In Rhode Island ALFs are not permitted to conduct even basic wound care, such as applying a Band-Aid, unless they first receive a limited health services license from the state’s Center for Health Facilities Regulation. A physician must then order wound treatment. A skilled, licensed staff member like a licensed practical nurse (LPN)certified, a registered nurse (RN), or a nursing assistant (CNA) must confirm the services.

While it might seem like a minor regulation, it clearly defines and regulates the degree of care that an assisted living community can legally provide. ALFs have less stringent staffing, licensing, and training standards than skilled nursing facilities, which provide round-the-clock professional nursing care.

Before deciding to relocate your loved one, it’s critical to educate yourself on the medical care options that a specific region may provide—especially when considering future changes in their condition.

Care Plan Management 

Assisted living staff in many states need to undertake a complete needs assessment of each resident prior to admission. They must do it within 14 days of an elder’s admission in Georgia. In addition, the tailored plan needs reevaluation at least once a year (or every three months for those in specialist memory care units) and if a resident’s care needs has alterations.

ALFs, memory care units, and continuing care retirement communities (CCRCs) are all terms to describe senior residential care facilities (RCFEs). According to state regulations, “RCFEs must also include an assessment of an aging adult’s likes and dislikes, interests, and activities in order to determine if the living arrangements in the facility will be satisfactory and to suggest a program of activities in which the individual may wish to participate.”

It’s critical to investigate the policies of potential facilities’ care plans. At any time, you should be able to obtain a written copy of a loved one’s current plan and seek meetings with the care team to discuss any difficulties or prospective modifications.

Regulations for Assisted Living Facilities
Regulations for Assisted Living Facilities

The Continuous Medical Care Threshold 

In most places, if a senior requires round-the-clock skilled nursing care, their care demands exceed what an assisted living community can lawfully provide, and they are not eligible for admission. The precise definition of skilled nursing services varies by state, and some ALFs may be able to provide residents with more assistance with medical activities such as medication management, insulin administration, and blood glucose testing for a fee.

Residents who require full-time medical care are not authorized to be admitted to facilities that employ licensed/certified nursing personnel. So, if your loved one needs round-the-clock specialized care, you should hire around-the-clock home health care services or consider placing them in a memory care unit or nursing home.

The Leisure Activities Requirement 

Residents of assisted living residences in Georgia must be able to participate in the social and recreational activities offered. Unfortunately, staff members can’t force their loved ones to participate in community programs and events. Still, it’s usually a good idea to encourage an elder to have an active social life when they move to senior housing.


State Regulations for Assisted Living Facilities, as well as requirements at particular institutions, differ significantly. Also, some of these may have no direct impact on your loved one or their treatment. However, understanding the many laws that govern assisted living will assist you in finding senior housing, determining which questions to ask when evaluating possible providers, and avoiding confusion and complications after a loved one has moved in.

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