Requirements for Assisted Living Facilities

An assisted living facility.

Choosing the right long-term care facility for you or your loved one can be exhausting. There are many options of care providers to choose from, as well as much preparation to be done before moving in. In this article, we will go over how to choose the right facility for your needs, and exactly what are the requirements for an assisted living facility. 

What is Assisted Living?

If you clicked on this article, you probably have a good inclination that an assisted living facility is what you are after. Assisted living is a long-term care facility that ensures more senior independence by providing limited day-to-day care. There is less medical treatment than a nursing home or skilled nursing facility, and more focus on assisting seniors in activities of daily living (ADLs). ADLs include things like bathing, toileting, dressing, eating, and mobility.

For many, an assisted living facility (ALF), also known as a residential care home, feels like a more safe living environment than a nursing home. This is because they can maintain their privacy, independence, and keep a routine lifestyle of their design. Assisted living services are extremely flexible and can be tailored to your loved one’s wants and needs.  Having a loved one in an assisted living facility provides their family with peace of mind, knowing that they have 24-hour access to help if there is an emergency. This is much less stressful than knowing a senior is living alone at home.

Making Sure Assisted Living is the Right Choice For You

So we have established that assisted living is a great choice for those that want to maintain independence. And who doesn’t want to be independent? But the truth is, these kinds of facilities are not meant for everyone. Assisted living simply does not provide an advanced level of care for everyone. We do not recommend an assisted living facility for the following cases:

  • Those who use a wheelchair for mobility
  • Those who have a severe of late-state cognitive disability, like Alzheimer’s disease
  • Those with complex or involved medical needs
  • Those with dangerous behaviors, including wandering
  • Those with extensive medical needs

Analyze other health care options and determine whether a nursing home, skilled nursing facility, or a hospital might be a better fit for any of the above cases. A nursing home is a long-term care facility that provides medical treatment as well as ADLs. Skilled nursing facilities are more often short-term and focus on the recovery of an illness or injury after leaving a hospital and before returning home. And of course, hospitals provide the most advanced medical support but are short-term. Alternative care options to an assisted living facility could also include home care, adult day care, family care homes, supportive services,  independent living facilities, and medical alert systems. For an early-stage Alzheimer prospective resident, an assisted living facility could be a good option. Keep in mind, however, as the disease progresses, the resident will need to be transferred to a facility with a higher level of care, such as a memory care facility or nursing home. So now that we have an idea of what needs assisted living facilities do not provide for, let’s take a look at some of the reasons people choose these facilities over other options:

  • Personal needs and preferences are the priority. Personal care and medical attention are only provided on an as-needed basis, ensuring that seniors stay independent.
  • Residents can alter care plans as their needs shift.
  • Residents feel more self-sufficient, dignified, and in control as compared to other options.
  • Assisted living services facilitate interaction with residents’ friends, family, and community so they will maintain social support networks, good mental health, and thus better quality of life.
  • Residents do not need frequent medical assistance, but still need some help to a degree.
  • Residents may need help with specific, minimal tasks on a day-to-day basis.
  • Residents don’t yet need nursing home type of services but aren’t completely able to live on their own. 
  • Residents want to maintain their independence and privacy as long as possible.
  • Residents are still able to be active members of the community.

Assisted Living Accommodations and Services 

Accommodations in residential care facilities often consist of the resident’s semi-private or private apartment. These apartments include either a furnished or unfurnished bedroom, kitchen, and bathroom. It is also possible to obtain a private studio apartment, one-bedroom private apartment, one-bedroom shared apartments or a dorm-style bedroom. Services offered at assisted living facilities vary from state to state, but here is a list of the most common services:

  • Personal care services, including ADLs
  • Educational activities
  • Meal preparation
  • Emergency call systems in private and common areas
  • Exercise activities
  • 24-hour security
  • 24-hour supervision and support
  • Transportation arrangements
  • Laundry services
  • Housekeeping and maintenance
  • Health care services and medication administration
  • Dementia and disability care
  • Recreational activities
  • Social services and religious activities
  • Wellness programs

Many residential care facilities also work with home health agencies to provide skilled nursing care or hospice services.

When visiting potential assisted living facilities for your loved one, be sure to be aware of what services are and aren’t provided. The service coordinator should also make an initial evaluation of your loved one to determine what he or she needs. Upon moving into the facility, your loved one should also undergo evaluations regularly to modify the services received as needed. Your loved one should have copies of these evaluations for his or her records. Residents generally can choose which services they are provided. Having this control over their lifestyle allows seniors to relax and enjoy their day-to-day routine that suits their needs.  So now that we have covered what assisted living facilities are all about, and you’re still reading, let’s cover the next step of finding the right facility for you.

What to Look for in an Assisted Living Facility:

Types of Assisted Living Facilities: When looking for the right facility for you or your loved one, it is important to distinguish between the varying facilities. Once you can identify the type of facility that is best for your situation, your search will narrow down immensely. Keep in mind the following types of assisted living facilities are not clear-cut and followed by all states. Here are some examples of types of facilities you may be looking for: 

Type A Facility: In this facility, a resident is physically and mentally capable of evacuating unassisted. This may include mobile, non-ambulatory persons such as people in wheelchairs or electric carts. These are people who don’t require routine care during nighttime hours and can follow directions during an emergency.

Type B Facility: In this facility, a resident may require a staff assistant to evacuate. However, they are capable of following directions during an emergency. They may require attendance during nighttime hours or not permanently bedridden but require assistance in transferring to and from a wheelchair.

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

Type E Facility: This type of facility limits the number of residents, all of whom are physically and mentally capable to evacuate in an emergency unassisted. This could include people who are mobile, and non-ambulatory, like people in wheelchairs or electric carts with the ability to transfer and evacuate themselves during an emergency. They do not require routine attendance during nighttime hours and are capable of following directions during an emergency. 

Abiding by State Laws

While nursing homes and skilled nursing services are regulated and rated by the federal agency Centers for Medicare & Medicaid Services (CMS), assisted living facilities are regulated by the states, not the federal government. Each state’s health department or social services office regulates assisted living communities, depending on the state. The CMS does, however, offer some guidance to the state Medicaid services for those assisted living facilities that are Medicaid-certified, which is about half of them. When researching your assisted living community, verify that the facility has obtained licensure, as well as make sure they have undergone the appropriate inspections required in your particular state. Here are some areas the state enforces regarding facilities’ assisted living requirements:

  • Resident agreements which inform potential residents of associated costs of care before move-in
  • Resident admission and retention policies which are clearly defined, and based on needs and/or behavior
  • Support services and service plans that which describe the type of care residents receive in detail
  • Required medication provisions, stating who can administer certain medications, and to what degree unlicensed staff can administer those medications
  • Foodservice and dietary provisions, as in how many meals residents receive daily, and any dietary recommendations the facility must follow
  • Staffing requirements, as in rules on background checks, training, and requirements of continuing education
  • Size of apartments, roommate rules, and the number of people allowed to share a bathroom
  • Inspection and monitoring requirements
  • Consequences to facilities for noncompliance

Even though all these aspects are all covered by state assisted living regulations, the specifics of these assisted living requirements vary for each state. One example is that 40 states enforce “direct care worker” training, but the required training hours can range from one to 80. This is a gaping difference that can determine the likelihood of competent and incompetent staff. Get to know the assisted living requirements in your state to see what are the mandatory requirements. 

Be aware that some facilities choose to remain unlicensed. Sometimes the facility offers quality care, not harming the residents. But keep in mind that without proper licensing and inspections, there is no way of knowing whether the facility is following standards for resident care, disaster planning, medication management, and so forth. It is also important that the facility complies with the Department of Health regulations. Not following these procedures and regulations may result in fines and eventual closure of the facility. Although a properly licensed facility doesn’t mean they will provide the highest quality of care, it does mean they are following the state guidelines. Be sure to verify the facility you are interested in is licensed to your satisfaction.

Touring the Facility 

Once you and your family have narrowed down the search a bit, select a few residential care facilities at the top of your list. Touring these facilities to learn about the different senior care services, programs, and amenities will help make you make your final decision. We have composed a list of questions you can ask as you tour the facility, particularly regarding their compliance with the required laws: 

  • How do you identify which care services my loved one needs, and how often will he or she be reevaluated?
  • Who conducts these evaluations?
  • What is the entire range of services offered at this facility?
  • How is the payment plan set-up?
  • Which services are included in the base monthly plan?
  • What is your policy regarding the use of outside services?
  • Is there a deposit, and is it refundable if my loved one needs to move?
  • If my loved one’s needs change, will the fees reflect these changes?
  • How much notice will my loved one be given if the fees change?
  • Can the fees increase if his or her needs do not?

When touring the facility, you and your family members will be met with assisted living staff. Ask the questions above, as well as any questions regarding senior living programs, activities, and other services you may be interested in. Most of these facilities offer free lunch so that you and your loved one can sample the food. If this is something you are interested in doing, make sure to inform the staff ahead of time so they can arrange that for you. 

Once you have toured the facilities that interest you, and your loved one and family have settled on their favorite, next comes the process of applying to the facility. Luckily the process to apply to an assisted living facility is much simpler than a lot of long-term care facilities. We have broken it down in the next steps to make it even easier for you. 

Requirements for Assisted Living Facilities

Room Deposit

As you’re touring the facility, it is a good idea to ask about reservations/deposit details with the staff. Oftentimes assisted living facilities are filled, so a deposit might be required as you attend to your paperwork in the next steps. You and your loved one will select a private or semi-private room depending on the availability and then pay the deposit, which varies between facilities.

Assessment of Care Needs 

A staff member or nurse at the facility will need to assess the condition of your loved one to determine what level of care he or she requires. If necessary, the assessment can even be done in the comfort of your loved one’s home. If the assisted living staff decides your loved one does not meet the required criteria, the room deposit will be refunded. 

Paperwork Submission

Once the representative has determined your loved one is an eligible candidate for their facility, you and your loved one will need to complete and submit the necessary admission paperwork, along with other documents required. Here is a list of all the required paperwork: 

  • Facility admissions forms, including a resident agreement outlining the services to be provided and the required fees
  • Medical history and physical assessment, which should be completed by the future resident’s primary care physician. Typically, the physical assessment should be done a month before the start date for services.
  • Negative Tuberculosis (TB) Test or Chest X-Ray
  • Care needs assessment is completed by a staff member. This assessment is completed to document the senior’s abilities to complete ADLs. This assessment will also record the senior’s individual needs and capacity for social interactions. It functions as a guide when determining how much assistance the senior will need.
  • The care plan, which will provide the resident with details on the services they’ll be receiving. The plan will explain when and how the services will be provided, and who will administer them. The care plan provides residents the opportunity to make adjustments as needed to fit their preferences and comfort level. Care plans are usually updated at least every six months to account for the resident’s changing needs.

After all the paperwork has been submitted, the administrator or staff at the facility will contact you to schedule the move-in date and time that will work best. Then, it will be time to review and sign the assisted living contract before move-in.

Resident Agreement Contract Signing and Payment Details

The contract is signed by the senior or their Power of Attorney. There is usually no annual contract at an assisted living community as it is usually a month-to-month basis. Carefully read all the details of the contract and be sure to ask any questions that may occur to you. The format should be clear, easy to understand, and uses words that have common and everyday meaning. Make sure any services listed in any brochures or advertising you have read are also highlighted in the contract. Be sure to specifically review the admissions and discharge agreement. The discharge policy will define the steps taken during the discharge process. Here is a list of the details your contract should cover:

  • Costs such as community fee and monthly rent payment
  • Services
  • Discharge policies
  • Grievance procedure
  • The rights and obligations as a resident

Higher Quality of Life at Assisted Living

We here at CareAsOne hope that you have learned a little bit more about what you can expect from your assisted living facility. You are also more knowledgeable about the application process and the requirements of residential care facilities. Understand that the step into assisted living is one that will ensure you and your loved one less stress. Your loved one will be able to live a functional, independent lifestyle, which is sure to promise a higher quality of life.

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