The Consumer Consortium on Assisted Living points out that unlike skilled nursing care facilities; the federal government does not regulate the nation's assisted living communities. Instead, each state regulates the facilities within its jurisdiction. As a result, regulations and standards for accountability can vary widely from state to state. For this reason, consumers need to gather adequate information about several assisted-living communities before making a final choice.
Occupancy
The focus of today's assisted-living units is to give residents more privacy and control over their daily activities. The new model for residential care provides single-occupancy rooms or apartments as opposed to the previous room and board philosophy, which allowed for two, three and sometimes four residents to share a bedroom and toilet and bathing facilities. Medicaid policy and many state policies now require that facilities must provide private rooms and apartments that may only be shared by choice. Although new regulatory policies call for facilities to offer single-occupancy units, some states continue to allow dual occupancy in assisted-living units. While states can make their own laws regarding assisted living facilities, most state Medicaid programs now cover the cost of assisted living for some individuals. However, state eligibility requirements may vary and not all facilities will accept Medicaid reimbursement.
Resident Agreements
Most states require that a facility's resident agreement must provide information about the services included in the basic rate, in addition to the cost of the service package. Some states also require that resident-care agreements include details about a facility's refund policy, services not included in the basic rate, cost of additional services, rate changes, resident rights and grievance procedures. Only a few states require that a resident agreement provide information about the terms of occupancy, accommodations, temporary absences from the facility, termination of care and services that are not available.
Admission Criteria
No state guidelines permit residential facilities to admit individuals whose conditions warrant a skilled level of nursing care. While most states allow assisted living facilities to provide a wide range of services, some states do not allow facilities to admit individuals who have specific medical needs that the facility does not provide. Likewise, if an individual's health deteriorates at some time following admission, the resident will be discharged from the facility. Individual facilities can establish their own admission and discharge criteria as long as the criteria are within the regulations set by the state.
Federal Mandates
Although the federal government is not responsible for the direct regulation of assisted-living communities, there are a number of federal laws affecting these facilities. As part of the Older Americans Act, federal legislation authorizes that advocates known as ombudsmen must represent residents of assisted-living facilities. An ombudsman must respond to complaints issued against an assisted-living facility by residents or their families. Under the Americans with Disabilities Act, federal law requires that public areas that are part of an assisted-living community must provide reasonable accommodations for disabled residents and visitors. As a consequence of the federal government's Medicare and Medicaid requirements, many state guidelines require that an assisted living facility must inform an individual of his rights as a resident both verbally and with a copy of a Resident's Bill of Rights.
References
- Assisted Living Federation of America: Assisted Living Regulations and Licensing
- Federal Statutes that Impact Assisted Living
- U.S. Department of Health and Human Services: State Residential Care and Assisted Living Policy
- CCAL: Frequently Asked Questions
- South Dakota Department of Health: Assisted Living Residents Rights
