Admissions and Discharge Policies
Guide to Admission Agreements for Residential Care Facilities

More Information

Thinking of Moving to an Assisted Living Residence?

The assisted living facility model has no federal regulations. Instead, regulations are left to each state to ensure the standards are met. It's highly advisable that family members get involved and advocate for a loved one living in a facility.

When a potential resident evaluates an assisted living facility, it's necessary to carefully read the admissions and discharge agreement. By state law, the documents be written in a language and format that is clear, easily understandable, and uses words with common and everyday meaning. It must include the discharge policy and define its steps taken during the discharge process.

State Regulations

ALF Regulations

All states have their own set of regulations:

Types of assisted living,
Physical and mental status of a person,
When the facility must discharge a resident.

Types of Facilities

The following types are not clear-cut and followed by all states. Be sure to check with your state regulatory office for details.

Type A Facility - a resident be physically and mentally capable of evacuating the facility unassisted. This may include mobile, non-ambulatory persons like people in wheelchairs or electric carts; people who do not require routine care during sleeping hours and are able to follow directions under emergency conditions.

Type B Facility - a resident may require staff assistance to evacuate; yet capable of following directions under emergency conditions; may require attendance during nighttime sleeping hours; or not be permanently bedridden but require assistance in transferring to and from a wheelchair.

Type C Facility - facilities are four-bed facilities that contract with the state and provide adult foster care. They must meet specific contracting requirements.

Type E Facility limits the number of residents and each are physically and mentally capable of evacuating the facility unassisted. This may include persons who are mobile, although non-ambulatory, such as persons in wheelchairs or electric carts with the capacity to transfer and evacuate themselves in an emergency; not require routine attendance during nighttime sleeping hours; be capable of following directions under emergency conditions.

Assisted living facilities do not require a doctor's orders for admission or to create the care plan. Some states require that a resident have a medical history and physical completed thirty days before admission or within fourteen days after admission.

Typical Admission and Discharge Policies

In a national survey of Residential Care Facilities in 2010, The Center for Disease Control reported the following admissions and discharge terms in assisted living policies.

Do you admit a resident who is Unable To Leave The Facility In An Emergency Without Help? 56% of the facilities do allow residents unable to leave the facility in an emergency without help, while 29% do not.

In terms of this facility's admission policy, do you admit a resident who is Unable To Leave The Facility In An Emergency Without Help?

Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Do you admit a resident who Has Moderate To Severe Cognitive Impairment--The Resident Does Not Know Who They Are? 55% of the assisted living facilities admit residents with moderate to severe cognitive impairment, while 33% of the facilities do not.

In terms of this facility's admission policy, do you admit a resident who Has Moderate To Severe Cognitive Impairment, That Is, The Resident Does Not Know Who They Are?

Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Do you admit a resident who Exhibits Problem Behavior Such As Wandering, Temper Outbursts, or Combative Behavior To Other Residents? 35% do admit residents exhibiting problematic behavior, while 49% do not.

In terms of this facility's admission policy, do you admit a resident who Exhibits Problem Behavior Such As Wandering, Temper Outbursts, or Combative Behavior To Other Residents?

Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

71% of the facilities do not admit residents who require Nursing Home Level of Care on a regular basis, while 20% do admit them.

In terms of this facility's admission policy, do you admit a resident who Needs Skilled Nursing Care On A Regular Basis?

Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

81% of the facilities admit residents who Need Daily Monitoring For A Health Condition Like Assistance Taking Insulin or Monitoring Blood Sugar, while 12% do not.

In terms of this facility's admission policy, do you admit a resident who Needs Daily Monitoring For A Health Condition Like Assistance Taking Insulin or Monitoring Blood Sugar?

Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

82% of the facilities admit residents who are Regularly Incontinent Of Urine, while 10% do not.

In terms of this facility's admission policy, do you admit a resident who is Regularly Incontinent Of Urine?

Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

69% of the facilities admit residents who are Regularly Incontinent Of Feces, while 20% do not.

In terms of this facility's admission policy, do you admit a resident who is Regularly Incontinent Of Feces?

Responses of refusal (< 1%), and not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

33% of the facilities admit a resident who Needs Two People To Help Them Get In And Out Of Bed or Needs A Hoyer Lift To Get In And Out Of Bed, while 59% do not.

In terms of this facility's admission policy, do you admit a resident who Needs Two People To Help Them Get In And Out Of Bed or Needs A Hoyer Lift To Get In And Out Of Bed?

Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

45% admit a resident who Has A History Of Drug or Alcohol Abuse, while 26% do not.

In terms of this facility's admission policy, do you admit a resident who Has A History Of Drug or Alcohol Abuse?

Responses of don't know (< 1%), and not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

61% admit residents who Requires End Of Life Care, while 26% do not.

In terms of this facility's admission policy, do you admit a resident who Requires End Of Life Care?

Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

42% of the facilities said there are "other reasons" for refusal.

Are there any other reasons for which the facility would refuse to admit someone?

Responses of don't know (< 1%), and not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Resident Agreements

Resident agreements cover all the terms that a resident and the assisted living provider agree to, such as:

Costs,

Services,

Discharge Policies,

Grievance Procedure and

The Rights and Obligations as a Resident.

TIP: Remember, what you read in brochures and other advertising information from the assisted living provider may not show up in your contract. Check them against each other to ensure that any and all advertised services that you want to have--be in the actual Resident Agreement.

Discharge Policy

TIP: Be certain that the contract covers refunds or adjustments made when the assisted living changes owners, or when it closes down. You should insist that your contract includes a statement about when any refunds or adjustments in your bill, especially if discharged.

In a national survey of Residential Care Facilities in 2010, The Center for Disease Control reported the following discharge terms in assisted living policies.

15% of the facilities discharge residents Unable To Leave The Facility In An Emergency Without Help, while 71% do not.

In terms of this facility's discharge policy, do you discharge a resident who is Unable To Leave The Facility In An Emergency Without Help?

Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

18% of the facilities discharge a resident who Has Moderate To Severe Cognitive Impairment--The Resident Does Not Know Who They Are, while 65% do not.

In terms of this facility's discharge policy, do you discharge a resident who Has Moderate To Severe Cognitive Impairment, That Is, The Resident Does Not Know Who They Are?

Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

43% of the facilities discharge a resident who Exhibits Problem Behavior Such As Wandering, Temper Outbursts, or Combative Behavior To Other Residents, while 40% do not.

In terms of this facility's discharge policy, do you discharge a resident who Exhibits Problem Behavior Such As Wandering, Temper Outbursts, or Combative Behavior To Other Residents?

Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

57% of the facilities discharge a resident who Needs Skilled Nursing Care On A Regular Basis, while 28% do not.

In terms of this facility's discharge policy, do you discharge a resident who Needs Skilled Nursing Care On A Regular Basis?

Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

8% of the facilities discharge a resident who Needs Daily Monitoring For A Health Condition Like Assistance Taking Insulin or Monitoring Blood Sugar, while 86% do not.

In terms of this facility's discharge policy, do you discharge a resident who Needs Daily Monitoring For A Health Condition Like Assistance Taking Insulin or Monitoring Blood Sugar?

Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

5% of the facilities discharge a resident who is Regularly Incontinent Of Urine, while 87% do not.

In terms of this facility's discharge policy, do you discharge a resident who is Regularly Incontinent Of Urine?

Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

12% of the facilities discharge a resident who is Regularly Incontinent Of Feces, while 75% do not.

In terms of this facility's discharge policy, do you discharge a resident who is Regularly Incontinent Of Feces?

Responses of legitimate skip (< 1%), and not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

44% of the facilities discharge a resident who Needs Two People To Help Them Get In And Out Of Bed or Needs A Hoyer Lift To Get In And Out Of Bed, while 41% do not.

In terms of this facility's discharge policy, do you discharge a resident who Needs Two People To Help Them Get In And Out Of Bed or Needs A Hoyer Lift To Get In And Out Of Bed?

Responses of don't know (< 1%), and not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

34% of the facilities discharge a resident who Abuses Drugs or Alcohol, while 50% do not.

In terms of this facility's discharge policy, do you discharge a resident who Abuses Drugs or Alcohol?

Responses of legitimate skip (< 1%), don't know (< 1%), and not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

9% of the facilities discharge a resident who Requires End Of Life Care, while 75% do not.

In terms of this facility's admission policy, do you discharge a resident who Requires End Of Life Care?

Responses of refusal (< 1%), and not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

38% say there other reasons for discharge.

Are there any other reasons for which you would discharge someone?

Responses of don't know (< 1%), and not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Ombudsman Help

TIP: Use your state Ombudsman to help negotiate problems between residents and the facility or between individual residents if needed. This is the most successful approach to resolve issues with agreement or otherwise. However, if you want to consult with others about concerns or problems before actually filing a grievance, the residents' rights include the right to confidentiality and access to writing instruments, postage, and reasonable access to the private use of a telephone within the facility. Residents also have to right to have an attorney and to meet in privacy with visitors of their choice.

Carol Marak

After seven years of helping her aging parents, Carol Marak has become a dedicated senior care writer. Since 2007, she has been doing the research to find answers to common concerns: housing, aging and health, staying safe and independent, and planning long-term.