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Assisted Living Regulations
Each state has specific regulations for assisted living.

Assisted Living facilities, regulated by each state, has different guidelines, requirements and procedures for classifying senior living. From the size requirements of room to the actual regulatory term, the regulations vary. Even though there are many similarities amongst the states as to various requirements, there are still 50 (51 counting DC) different sets of regulations for assisted living.

In our assisted living directory, we detail the most vital regulations for each state. In addition, we break down the differences in how states handle: Medication Management, Staffing Requirements, Medicaid Waivers, Memory Care Requirements, Administrative Requirements and Physical Building Requirements, among other things.

Regulatory Agencies

Below, we have listed each state and link to the regulatory agency that oversees assisted living. While we try to maintain the accuracy of our information, state guidelines are constantly changing, and we ALWAYS recommend reviewing the state's documentation when seeking clarification of the assisted living regulations.

As we mentioned, each state has its own regulations, concerning how an Assisted Living Community's licensed and maintained, and you can get those specific regulations above. Every aspect, from meals to staffing requirements, are different from state to state. As of 2014, there are no Federally listed rules or regulations that encompass all Assisted Living Facilities in America - though there are some regulations include in certain bills that cover Nursing Facilities.

Where does this leave residents that want to understand their rights in an assisted living residence?

For many, it leaves them in the dark. Not every senior has access to a computer or understands that they have a right to join organizations that help reinforce their basic rights.

National Center for Assisted Living's Annual Regulatory Review

The National Center for Assisted Living publishes an Assisted Living Regulatory Review each year and encourage families to download and print. It gives complete details on resident rights in each state. State Regulations Review.

Our Adaptation of the National Center for Assisted Living State Regulatory Review

In our assisted living directory, we have summarized what we feel are the most important aspects for each state from the National Center for Assisted Living review. We list the following assisted living requirements for each state:

  • The state's assisted living definition
  • The state's facility scope of care
  • Admission Requirements
  • Care Plan Requirements
  • Medication Management Requirements
  • Physical Building Requirements
  • Staffing Requirements
  • Alzheimer and Dementia Information
  • Medicaid and Medicare Waivers and Policies

We feel this information gives consumers an understanding of what's required from an assisted living community in their state. Everyone should know what rights they have and what changes will affect their rights in assisted living. One major change in this year's review - many states have changed the laws pertaining to Medicaid coverage and Assisted Living. Those individuals that previously could not afford to live in an assisted living facility are eligible for assistance and/or coverage through their state's Medicaid program. Another example - new regulations in place for residents that have some level of dementia. Alzheimer's sufferers and other dementia victims now have (in some states) stronger protections than previously.

Other places you can find information

There are many agencies and organizations around the United States that offer additional information and help for residents of Assisted Living facilities. Some require membership - which can come with a yearly fee - and some do not require any type of fee/payment. All of these agencies or organizations have information on the rights and regulations of assisted living facilities in each state. Choosing an organization in your area proves the most practical and if you need advocacy, then the local members are able to help you or your loved one.

You may also want to contact the following:

  • Your local Medicaid office
  • Your local Health Department
  • Some Doctor's offices
  • Your local Community Center
  • Your local Council on Aging office

Federal Regulations for Assisted Living

Assisted Living Regulations are State-based
Assisted Living Regulations are State-based

Are assisted living facilities regulated by the Federal Government?

The short answer is: No.

A Lack of Federal Involvement

Of course, a negative statement or comment lead to questioning. Almost immediately the next question raised is: "Why not?" and there are many potential answers to that.

Do State Regulations Suffice?

Probably the best explanation is that each state has different regulations on the books regarding Assisted Living at this time. This type of regulatory governing allows a state to add more restrictions while enabling more choices for consumers. Yes, residents and their families are consumers! These facilities offer a range of services that customers can choose and customize according to their needs.

Big Business

Private funding and state regulations, demanded by consumers, give way to more choices. In some instances, more restrictive regulations stunt the growth of a facility. For example, Consumer 'A' prefers private meals in their room, unsupervised. Consumer 'B' would rather eat in the common cafeteria and their family feels it is the only safe option. If Consumer 'B' and their family lobby for a regulation that all meals be supervised and enough people support this-Consumer 'A' could lose their right to dine privately.

This is only an example, but in the described scenario, Consumer 'A' loses the right based on a blanket regulation. When an idea presents itself as the only logical choice and done so compellingly, a regulation is born. Any number of federally enforced regulations could affect more independent consumer residents without regard to the keyword: Independent.

Right now, some progressive states are listening with an attentive ear tuned to consumers. The senior population is not the same as even a decade ago. Consumers themselves are more educated, in tune with their bodies, and refuse to quietly age in a drab room while aides bring them sips of warm milk. We are a vibrant society with differences not only from person to person on what is a high quality of life, but from state to state. Groups of seniors in New York state may not enjoy the same activities and foods as the groups of seniors in Alabama.

To combat the potential loss of rights that blanket federal regulations could cause, become more aware of what the regulations for your state are. Read them thoroughly and insist they be met. If you live in an ALF, organize a group of your peers and draft personal preferences into a petition for your current assisted living facility. Grassroots movements can have a greater effect while allowing you to keep your freedom of choice.

Unlicensed Assisted Living Facilities

With the rise in costs of both Assisted Living Facilities and Skilled Nursing Facilities, older Americans are searching for ways to cut costs. Sometimes at the risk of their own health.

In some states it is illegal to offer care to anyone outside of family for more than twenty-four to forty-eight hours. This has not stopped the unscrupulous from taking advantage of the elderly by claiming to provide Assisted Living from their own residences.

Beware of Unlicensed Care Options

Regulations Offer Verification & Oversight
Regulations Offer Verification & Oversight

There are numerous instances all over the country about unlicensed senior care options and it's offerings and the substandard care given. Sometimes, the facility offers quality care and services and does no harm to residents. However, without proper licensing and inspections, there is no way to know if the state requirements remain compliant for resident care, disaster planning, medication management, etc.

Assisted living has many forms to fill out to meet local Health Department approval. Failing to meet the code results in fines or even the closure of the facility.

Ensuring an assisted living facility is properly licensed by the state doesn't guarantee the highest quality of care, however it does ensure that the facility filed the proper paperwork, passed the required inspections and staff requirements, and operated within the state's guidelines. We always encourage potential assisted living residents to conduct their own due diligence while researching all available options.

Those facilities operating unlicensed, are not governed by the state and have not had the proper inspections to ensure it is sufficient to offer care. If a home is not up to code on wiring, fires can break out. If there is a natural disaster, emergency escape routes help residents or the employees find their way to safety.

Unlicensed facilities may have staff without the proper licensing or training. Non-trained staff is a dangerous spice added into the mix of an illegal facility. Abuse, wandering residents with dementia are only small problems that can happen if the required policies and procedures are not in place and followed in such a facility.

Carol Marak
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.