State Assisted Living Policy: 1998

SECTION II

June 1998


SECTION II, TABLE OF CONTENTS

GENERAL LICENSING CHARACTERISTICS
ASSISTED LIVING PHILOSOPHY AND INDICATORS
POLICY DEALING WITH RESIDENTS WITH ALZHEIMER'S DISEASE
ADMISSION/RETENTION CRITERIA
REQUIREMENTS FOR ADMINISTRATORS
STAFF TRAINING REQUIREMENTS
COMPARISON OF STATE MEDICAID POLICY AND REIMBURSEMENT


COMPARISON OF STATE ASSISTED LIVING AND BOARD AND CARE REGULATIONS
State Category Facilities Units/ Beds NF Conversions Units/Beds Converted CoN Apts Required Choice 1 Max # Occupants Size - Single Size 2 2+
AL Assisted living facilities 261 6,222 Unknown --- N N N 2 80 130*
AK Assisted living homes 77 1,075 0 0 N N Y NA* NA NA
AR Residential long term care facilities 130 4,800 --- --- M N* N 2 100 80
AZ Assisted living facilities 880* --- 5 --- N N Y 2 80/220 60/320
CA Residential care facilities for elderly 5,879 123,238 Unknown --- N N Y 2 ** **
CO Personal care boarding homes 469 10,071 Unknown --- N N N 2 100 60
CT Assisted living service agencies 22 NA Unknown --- Y Y Y --- --- ---
DE Rest residential facilities 7 277 Unknown --- N N N 4 100 80
Assisted living --- --- --- --- N N Y 2 ** **
FL Assisted living facilities standard 2,056 66,293 Unknown --- N N N 4 100 80
Limited nursing services N 4
Assisted living extended congregate Y 2
GA Personal care homes 1,881 19,939 Unknown --- N N N 4 80 60
HA Assisted living facilities --- --- --- --- N Y Y Not stated 220 ---
Adult residential care home 532 2,766 --- --- N N N 4 90 70
ID Residential care 227 4,902 0 0 N N N 2 100 80
IL Shelter care facilities 137 7,606 Unknown --- Y N N 4 70 60
Supported residential living (demo) 16 1,486 2 planned 46 N Y Y 2 350 500
Community based residential fac. (pilot) 2 220 --- --- N N Y 2 --- ---
IN Residential facilities 104 8,979 Unknown --- N N N 5 100 80
IA Assisted living facilities 32 1,455 24 1,114 N N Y 2 190/70 5 290/70
KS Assisted living 66 3,510 38 952 N Y Y 2 200 200
KY Assisted living (voluntary) --- --- --- --- N N Y Not specified
Personal care homes 199 6,926 0 0 Y N N 4 Not specified
LA Adult residential care (draft) 96 1,234 0 0 N N N 2 100 80
Assisted living (draft) --- --- --- --- N Y Y 2 310* 390*
ME Assisted living: congregate housing 1 12 --- --- N Y Y NA NA NA
Assisted living: residential care I & II 747 6,257 31 Unknown N N N 2 100 80
MD Assisted living programs (draft) 4,000 13,554 --- --- N N N 2 80 60
MA Assisted living residences 93 5,116 2 --- N ** - 2/br ** **
MI Homes for the aged 155 10,000 Unknown --- N N N 4 100 80
Adult foster care: Large group homes 443 8,149 Unknown --- N N N 2 80 65
MN Board and lodging NR NR None --- N N N - 70 60
Registered housing with services 400 NR Unknown --- N ** ** ** ** **
MO Residential care facilities (I & II) 711 22,796 Unknown --- Y N N 4 70 70
MS Personal care homes 180 3,519 0 0 N N N 4 80 80
MT Personal care facilities 52 NR 0 0 N N N 4 100 80
NE Assisted living --- --- --- --- N N N 2 100 90
Residential care facilities 117 4,703 Est 40 --- N N N 3 80 60
NV Residential care facilities 305 2,914 0 0 N N N 3 80 60
NH Supported residential care facilities 60 1,816 0 0 N N N 2 80 70
Residential care home facilities 80 960 0 0 N N N 2 80 70
NJ Assisted living residences 33 2,772 0 0 Y Y Y 2 150 230
Assisted living programs 4 --- --- --- Y NA Y NA NA NA
Comprehensive personal care homes 20 1,147 1 51 Y N Y 2 80 130
NM Residential shelter care 260 --- Unknown --- N N N 2 100 80
NY Adult care homes 439 30,221 Unknown --- N N N 2 100 160
Enriched housing programs 52 1,622 Unknown --- N Y N 2 85 140
Residences for adults 9 811 Unknown --- N N N 2 100 160
Assisted living programs 36 1,932 Unknown --- Y Y/N N 2 Note Note
NC Adult care homes 7+ beds 514 25,784 1 59 M N N 4 100 80
Family care homes 757 4,194 0 0 N N N 3 100 80
DDA group homes 213 1,225 0 0 N N N --- 100 80
ND Basic care facility 41 1,488 Unknown --- M N N None 100 80*
OH Adult care facilities 838 5,544 0 0 N N N 4 80 60
Residential care facilities 355 20,000 0 0 N N N 3 100 80
OK Residential care homes 189 6,710 0 0 N N N 2 80 60
Assisted living centers --- --- --- --- N N N 2 ** **
OR Assisted living facilities 95 4,583 1 --- N Y Y 1 220 NA
Residential care facilities 132 4,779 Est 15-20 --- N N N 2 70 120
PA Personal care homes 1,696 62,241 Unknown --- N N N 4 80 60
RI Assisted living facilities 54 --- 9 --- N N N 2 100 80
SC Community residential care facilities 490 11,688 Unknown --- N N N 4 80 60
SD Assisted living centers 100 2,000 Unknown Unknown N N N 2 120 100
TN Assisted living facilities --- --- --- --- N N N 2 80 80
Homes for the aged 274 7,183 Unknown --- N N N 2 80 80
TX Personal care homes 900 25,203 Unknown --- N N Y 4 100 160
UT Assisted living facilities 8 260 1 33 N N Y 2 100* 80*
Residential health care 109 1,956 5 173 N N N 2 100 80
VA Adult care residences 589 28,416 Unknown --- N N N 4 100 80
VT Adult care residences (draft) --- --- --- --- N Y Y --- 225 NA
Residential care facilities 129 2,279 0 0 N N N 2 100 80
WA Boarding homes 439 18,515 Unknown --- N N N 2 80 140
Assisted living facilities (Medicaid) 104 1,500 Unknown --- N Y Y 1 220 ---
WV Personal care homes 65 2,414 Unknown --- N N N 2 80* 80
Residential care homes 76 641 Unknown --- N N N 3 80 60
Residential care community (pending) --- --- --- --- --- --- --- --- --- ---
WI Residential care apartment complexes 43 1,339 Unknown --- N Y Y 2 250 ---
WY Assisted living facilities 5 406 0 0 N N N 2 120 80
Total 28,131 612,063 Total include family care homes, DDA group homes in North Carolina; exclude ALP in New York and Medicaid AL in Washington which are counted in other categories.

Notes:

  • M: moratorium
  • NR: not reported
  • NA: not applicable
  • 1. Indicates whether residents share units by choice.
  • 2. Square footage per resident in multi-occupancy units/rooms.

State notes:

  • AL: Private room with sitting areas, 160 square feet. Double room with sitting area, 200 square feet.
  • AK: rules do not specify unit space requirements and the maximum number that may share a room.
  • AZ: Figures represent combined supply under categories that will be replaced by proposed new rules. Unit size figures are for rooms/apartment units. Apartments are required for contracts with the ALTCS (Medicaid) Program.
  • CA: Choice whenever possible. No requirements for size of bedrooms.
  • CT: Rules only address requirements for assisted living service agencies. Unit requirements specified by the housing funding source.
  • DE: Space requirements are not specified.
  • LA: Draft rules require 190 square feet of living space and 120 square feet for bedrooms. Bedrooms shared by two people in an apartment unit must have 200 square feet. Efficiency units must have 120 square feet.
  • MA: New construction requires private bathroom and kitchenette or access to cooking capacity. Existing construction requires private half bathroom. Full bathrooms may be shared by up to 3 residents. Bedrooms may be shared.
  • MN: Licensing rules apply to service providers. Local codes apply to the building based on their use.
  • NJ: ALPs operate in conventional publicly subsidized senior housing complexes.
  • NY: Assisted living program numbers are included in adult home and enriched housing program figures. Since ALPs are found in both licensed settings, they comply with the rules of those settings.
  • ND: Rooms for three or more must have 70 square feet per resident.
  • OK: Regulations do not specify requirements for the size of bedrooms.
  • PA: Conversions: most nursing homes have converted beds or partial areas to personal care beds.
  • TX: Type A facilities require 80 square feet for single occupancy and 60 square feet per resident in multiple occupancy rooms.
  • UT: 160 and 200 square feet required for single and double occupancy units with a bedroom and additional living space. (Check)
  • WV: Apartments must have a minimum of 300 square feet.
  • WI: Allows sharing with a spouse or a roommate chosen by the tenant.


COMPARISON OF STATE ASSISTED LIVING AND BOARD AND CARE REGULATIONS continued...
State Category #/Toilet #/Bath or Shower Awake Staff* Assessment Minimum Update Negotiated Risk Dementia Rules
AL Assisted living facilities 8 8 1:6 30 days prior to move Annually N Study
AK Assisted living homes --- --- N Within 30 days 3 months Y N
AR Residential long term care facilities 6 10 1 Prior to admission --- N N
AZ Assisted living facilities 8 8 Needs Within 14 days Varies by license N Y
CA Residential care facilities for elderly 6 10 Varies Prior to admission As necessary N Y
CO Personal care boarding homes 6 6 Needs None None N Y
CT Assisted living service agencies --- --- --- On admission 120 days Y ---
DE Rest residential facilities 4 4 N Within 14 days Not specified Y N
Assisted living NA NA Needs Within 14 days As needed Y **
FL Assisted living facilities standard 6 8 1 (17+) 60 days prior/30 post Six months Y Y
Limited nursing services 4 4 1 (17+) 60 days prior/30 post Six months Y Y
Assisted living extended congregate 4 4 1 (17+) 60 days prior/30 post Annual Y Y
GA Personal care homes 4 8 1:15 30 days prior Annual N N
HA Assisted living facilities 1 1 Y* Prior to and in 30 days Annual Y N
Adult residential care home 8 14 Y* Yes, not specified Not specified N N
ID Residential care 6 8 Y 14 days Annually N Y
IL Shelter care facilities 10 15 1 5 days prior/3 post --- N N
Supported residential living (demo) --- --- 1 (10-75), 2 (76-150) W/in 24 hours of adm. Q health status & annual assessment Y N
Community based residential fac. (pilot) Ea. unit Ea. unit Y Prior to admission Annually Y N
IN Residential facilities Scale Scale Y Prior to admission 6 months N N
IA Assisted living facilities 1 --- N Prior to admission 90 days* Y N
KS Assisted living NA NA Y Prior to admission Annual Y Y
KY Assisted living (voluntary) Not specified N Upon admission Not specified N N
Personal care homes 8 12 N N N N N
LA Adult residential care (draft) ** ** Y Y Quarterly N N
Assisted living (draft) 1 1 Y Y Quarterly N N
ME Assisted living: congregate housing NA NA N Y 6 months N Y
Assisted living: residential care I & II 6 15 2 Within 30 days Annual N Y
MD Assisted living programs (draft) 4 8 N Prior to admission 6 months N N
MA Assisted living residences ** ** Needs Prior to move in 6 months Y N
MI Homes for the aged 8 15 Y Not stated Not stated N N
Adult foster care: Large group homes 8 8 N Prior to move in Annual N N
MN Board and lodging 10 20 N 14 days Annual N N*
Registered housing with services --- --- NA Within 2 weeks Annual N N
MO Residential care facilities (I & II) 6 20 N Within 10 days Monthly N N
MS Personal care homes 6 12 1:10 Within 5 days Annually N N
MT Personal care facilities 4 12 N Within 3 days Quarterly N N
NE Assisted living 1* 8 Needs Required N Y Y
Residential care facilities 6 16 Needs Required N N N
NV Residential care facilities 4 6 1:20 Required Annual Y Y
NH Supported residential care facilities 6 6 Y 30 days prior 6 months N N
Residential care home facilities 6 6 Y 30 days prior 6 months N N
NJ Assisted living residences 1 1 1 14 days Quart. & bi-annual Y N
Assisted living programs NA NA 1 14 days Quart. & bi-annual Y N
Comprehensive personal care homes NA NA 1 14 days Quart. & bi-annual Y N
NM Residential shelter care 8 8 1 5 days Quarterly N Y
NY Adult care homes 6 10 Scale 30 days prior Annual N N
Enriched housing programs 3 3 N 30 days prior Annual N N
Residences for adults 6 10 Scale 30 days prior Annual N N
Assisted living programs ** ** N 30 days prior 45 days & 6 mos N N
NC Adult care residences 5 10 Y 30 days Annual N N
ND Basic care facility 4 15 Y Within 14 days Quarterly N N
OH Adult care facilities 8 8 N Within 14 days Annual N N
Residential care facilities 8 8 Y Within 14 days Annual Y Y*
OK Residential care homes 6 10 N None None N N
Assisted living centers 4 4 Needs 30 days prior & adm 14 days & annual Y Y
OR Assisted living facilities 1 1 Y Yes Quarterly Y Y
Residential care facilities 6 10 1:30 Yes 6 months Y Y
PA Personal care homes 6 15 1 (16+) 30 days Annual N N
RI Assisted living facilities 8 10 1 Not stated Not stated N Y
SC Community residential care facilities 8 10 1:44 Admission Annual N Y
SD Assisted living centers 4 15 2 Admission & 30 days Annual N Y
TN Assisted living facilities 6 6 Y Upon admission Annual N Y
Homes for the aged 6 6 Y* Upon admission Annual N Y
TX Personal care homes 6 10 1:40 Within 14 days Annual N Y
UT Assisted living facilities 4 10 Needs Within 7 days 6 months N N
Residential health care 6 10 Needs Prior to admission Annual N N
VA Adult care residences 7 10 1 Within 90 days prior Annual N Y
VT Adult care residences (draft) NA NA ** Within 14 days 6 months Y Y
Residential care facilities 8 8 0 On admission Annual N N
WA Boarding homes 8 12 Y On admission 6 months N Y
Assisted living facilities (Medicaid) 1 1 Y On admit & 30 days 6 months Y Y
WV Personal care homes 5 10 1* 30 days As needed N N
Residential care homes 6 10 1 30 days Annual N N
Residential care community (pending) TBD TBD --- TBD TBD N N
WI Residential care apartment complexes NA NA ** Prior to admission Annually Y N
WY Assisted living facilities 2 10 1 7 days prior/30 post Annually N N

General notes:

  • * Indicates whether the regulations specifically require that one or more staff must be awake at night. States with a notation of "needs" do not specifically require awake staff but do require that staffing be appropriate to the needs of residents and therefore may require awake staff.
  • Assessment updates: most rules specify that an assessment is needed when the resident's condition changes. The entry in this column specifies the requirement in the absence of change.

State notes:

  • AZ: Staffing must be consistent with the needs of residents.
  • CO: At least one staff is required when residents needs supervision, assistance with ADLs or assistance with medications.
  • DE: If required based on resident needs. Dementia is not specifically mentioned however, staff must be trained to meet the needs of consumers.
  • HA: No specific requirements for awake staff but the facility must meet the needs of residents which may require awake staff.
  • IA: Residents receiving personal care or skilled nursing must be reviewed every 90 days.
  • MA: New construction requires private bathroom and kitchenette or access to cooking capacity. Existing construction requires private half bathroom. Full bathrooms may be shared by up to 3 residents. Bedrooms may be shared.
  • ME: Awake staff for facilities with more than 10 beds.
  • MN: Regulations apply to the service provider.
  • NE: For new facilities, a toilet and sink is required adjoining each bedroom.
  • NH: Must have awake staff in facilities with 17+ residents.
  • NY: Assisted living programs may exist in adult homes and enriched housing programs and they meet the requirements of the settings in which they are located.
  • TN: Awake staff are required if the facility has five or more residents whose level of evacuation capability is "slow."
  • UT: Awake staff are required based on the needs of the residents.
  • VT: Awake staff are required based on the needs of the residents.
  • WV: Requires one awake staff per floor in facilities larger than 10 beds.


ASSISTED LIVING PHILOSOPHY AND INDICATORS
- AL AK AZ AR CA CO CT DE FL GA HI ID IL 3 IN IA KS KY 4
Philosophy described - - X - - - - X X - X - X - X X X
Apartments required - - X 2 - - - - - - - X - X - - X -
Units/bedrooms shared only by choice - - X 2 - - - X X X - X - X - X X -
Training - - - - - - X - X - X - - - - X -
Shared risk process - - - - - - X X X - X - - - X X -
- LA ME MD MA MI MN MS MO MT NE NV NH NJ NM 1 NY NC ND
Philosophy described X X X X - - - - - X - - X X - - -
Apartments required X M - M - - - - - - - - M - - - -
Units/bedrooms shared only by choice X - - - - - - - - X - - - X - - -
Training - - - X - - - - - - - - X - - X -
Shared risk process - - - - - - - - - - - - X - - - -
- OH OK OR PA RI 1 SC SD TN TX UT VT VA 1 WA 5 WV WI WY -
Philosophy described - - X - X - - - - X X X X - - X -
Apartments required - - X - - - - - - M X - X - - - -
Units/bedrooms shared only by choice - - X - X - - - - X X - X - - - -
Training - - X - - - - - - - X - X - X - -
Shared risk process X X X - - - - - - X X - X - - - -

Notes:

  • M = states may require apartments for new construction, certain settings or categories and bedrooms in other settings.
  • 1. The policy is contained in Medicaid rules or contract requirements rather than the licensing rules.
  • 2. AZ: Contained in regulations implementing a supportive living residential centers program.
  • 3. IL: These provisions are included in a demonstration program.
  • 4. KY: Applies to the voluntary certification program.
  • 5. WA: The policy is contained in the Medicaid contract regulations (WAC 388-110).


REQUIREMENTS FOR FACILITIES SERVING RESIDENTS WITH ALZHEIMER'S DISEASE
- AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY
Training - - X - X - - - X X - X - - - X -
Activities - - - - X - - - X X - X - - - - -
Environment - - X - X - - - X X - X - - ** - -
Disclosure - - - - X - - - X X - - - - ** - -
Other - - - - - - - X - - - - ** - ** - -
- LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND
Training - X X X - - - - - X X - - X - X -
Activities - X - - - - - - - - X - - X - - -
Environment - - - - - - - - - - X - - X - - -
Disclosure - - X - - - - - - - - - - - - - -
Other - - - - - - - - - - - - - - - - -
- OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY -
Training X X X - - - X - X - X X X - - - -
Activities - - X - - - X - X - - X X - - - -
Environment - - X - - - - - X - - X X - - - -
Disclosure - - X - X X - - X - - - X - - - -
Other - - - X - - X - - - - - - - - X -
  • Delaware: Facilities must develop policies to prevent wandering away and safe storage of medications.
  • Illinois: An Alzheimer's facility has been selected for one pilot program and it must meet all applicable state, federal and local requirements.
  • Iowa: These policies are covered by language stating that facilities must be appropriate for the needs of the residents. Requirements are not specified in regulation but are negotiated.
  • Pennsylvania: Internal policy, not in regulations.
  • South Dakota: Also has fire safety/evacuation provisions.
  • Tennessee: An interdisciplinary team must review residents with early stage Alzheimer's disease to quarterly to examine appropriateness of placement.
  • Wyoming: Facilities must provide cuing with guidance for ADLs for people who are intermittently confused and/or agitated and require occasional reminders to time, place and person.


ADMISSION/RETENTION CRITERIA (General Descriptions Only--See State Summaries for Details)
- AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY
General Criteria
Needs can be met by facility/agency - - - - X - X X* X X X - - - - X -
Health Related Conditions
Do not need hospital/nursing home care X - - X - - - - X - - X X - - - -
Must have stable medical conditions - - - - - - X X* X - - X - - - - -
Do not need 24 hour nursing care X X X* X* X X - - X X - X - - <8 ** -
Nursing care limited to # days - 45 1 - - - - - - X - - - - - 21 - -
Don't need daily medication supervision - - - - - - - - - - - - - - - - -
May provide p/t, intermittent nursing - X - - - - - - - - - - - - X* - -
Must self-administer medications - - - X X - - - - - - X - - - - -
Must be continent unless controlled - - - - - X - - - - - - - - - - -
May not have:
Gastronomy tubes - - - X X - - - - ** - X - - - - -
Intravenous tubes/feeding - - - X - - - - - ** - X - - ** - -
Naso-gastric tubes - - - - X - - - - ** - X - - ** - -
Tracheotomies - - - X X - - - - - - X - - - - -
Catheters (unless self-maintained) - - - - - - - - - ** - X - - - - -
Suctioning - - - - - - - - - ** - X - - - - -
Sterile wound care - - - - - - - - - - - X - - ** - -
Stage III, IV ulcers X - X* - X - - - X - - X - - ** - -
Communicable disease X - - X X X - - X X - X X - - - -
Ventilator dependent - - - - - - - - - - - X - - ** - -
Cannot require tx for alcohol, drug abuse X - - X - - - X - - - - - - - - -
Functional Criteria
Able to evacuate without assistance - - - - - - - - - - - - - - - - -
Must be able to feed self - - - - - - - - - X - X - - - - -
Cannot be bedridden more than ... days - - - - 14 3 - - ** 14 - - - - - 21 - -
Cannot need more than 1 person assist X - - - - - - X - - - - - - - X* -
Cannot be totally bedfast/bedbound - - X* - - X - - X - - X - - - - -
Must be ambulatory - - - X - - - - X X - - - - - - X*
Must be able to direct care - - X* - - - - - - - - X - - - - -
Cannot have 4 or more ADLs - - - - - - - - X - - - - - - - -
Alzheimer's/Dementia Related
Can't serve severe symptoms of senility X - - - ** - - - - - - ** - - - - -
May admit persons with mild dementia - - - - X - - - X X - - - - X - -
Late stage of Alzheimer's disease - - - - X - - - - - - - - - - - -
Must be able to make simple decisions - - - - - - - - - X - - - - - - -
Behaviors
Cannot be danger to/violence self/others X - X X - - - X X - - X X - X - -
Cannot need restraints X - - X - X - - X - - - - - - - -
Must be able to communicate needs - - - X - - - - - - - - - - - - -
Other (see summaries) X - - X X - - - X - - X X - - - -


ADMISSION/RETENTION CRITERIA (General Descriptions Only--See State Summaries for Details) continued...
- LA ME MD MA MI MN MS MO MT NE NV NH* NJ NM NY NC ND
General Criteria
Needs can be met by facility/agency X - - - - X - - - - - - - - - X -
Health Related Conditions
Do not need hospital/nursing home care - - - - - - - - - - - - - - - X X
Must have stable medical conditions - - - - - - - - - ** - - ** - - - -
Do not need 24 hour nursing care X* - X X X - - - - - X X ** X - X X
Nursing care limited to # days - - - - - - - - 20* - - - - - - - -
Don't need daily medication supervision - - - - - - - - - - - - - - - - -
May provide p/t, intermittent nursing - - - - - - - - - - - X - - - - -
Must self-administer medications - - - - - - - - ** - - - - - - - -
Must be continent unless controlled - - - - - - - - ** - - - - - - - -
May not have:
Gastronomy tubes - - - - - - - - - - X - - - - - -
Intravenous tubes/feeding - - - - - - - - - - X - ** - - - -
Naso-gastric tubes - - X - - - - - - - - - - X - - -
Tracheotomies - - - - - - - - - - - - - X - - -
Catheters (unless self-maintained) - - - - - - ** - - - - - - - - - -
Suctioning - - - - - - - - - - - - - - - - -
Sterile wound care - - - - - - - - - - - - - - - - -
Stage III, IV ulcers - - X - - - - - - - - - ** X - - -
Communicable disease - - X - X - X - - - X - - X - - -
Ventilator dependent - - X - - - - - - - - - X X - X -
Cannot require tx for alcohol, drug abuse - - - - - - - - - - - - - - - - -
Functional Criteria
Able to evacuate without assistance - - - - - - - X - - - X - - - - X
Must be able to feed self - - - - - - - - - - - - - - - - -
Cannot be bedridden more than ... days - - - - - - - - - - - - ** - - - -
Cannot need more than 1 person assist - - - - - - - - - - - - - - - - -
Cannot be totally bedfast/bedbound - - - - - - - - ** - X - - - - - -
Must be ambulatory - - - - - - X - - - - - - - - - -
Must be able to direct care - - - - - - - - - - - - - - - - -
Cannot have 4 or more ADLs - - - - - - - - - - - - ** - - - -
Alzheimer's/Dementia Related
Can't serve severe symptoms of senility - - - - - - - - - - - - - - - - -
May admit persons with mild dementia - - - - - - - - - - - - - - - - -
Late stage of Alzheimer's disease - - - - - - - - - - - - - - - - -
Must be able to make simple decisions - - - - - - - - - - - - ** - - - -
Behaviors
Cannot be danger to/violence self/others X - X - - - X - - - - - ** X X X -
Cannot need restraints - - - - - - - - ** - X - - - - - -
Must be able to communicate needs - - - - - - - - - - - - - - - - -
Other (see summaries) - X X - X - - X ** - - X - X - X -


ADMISSION/RETENTION CRITERIA (General Descriptions Only--See State Summaries for Details) continued...
- OH OK OR PA RI SC SD TX TN UT VT VA WA WI WV WY
General Criteria
Needs can be met by facility/agency X X - X - X - - - - X X X X* - -
Health Related Conditions
Do not need hospital/nursing home care - - - X X X - - - - - - - - - -
Must have stable medical conditions - - - X - - - - - - P - - - - -
Do not need 24 hour nursing care - X - X - X X - - X P X X - X -
Nursing care limited to # days - - - - - - - - - - - - - - ** -
Don't need daily medication supervision - - - - - - - - - - - - - - - -
May provide p/t, intermittent nursing X X - X - - - - - - - - X - X -
Must self-administer medications - - - - - - - - - - - - - - - -
Must be continent unless controlled - - - - - - - - - - - - - - - X
May not have:
Gastronomy tubes - - - - - - - - - - - X* - - - -
Intravenous tubes/feeding - - - X - - - - ** - - X - - - -
Naso-gastric tubes - - - X - - - - ** - - X* X - - -
Tracheotomies - - - - - - - - - - - - - - - -
Catheters (unless self-maintained) - - - - - - - - ** - - - - - - X
Suctioning - - - - - - - - X - - - X - - -
Sterile wound care - - - - - - - - - - - - - - - X
Stage III, IV ulcers - - - X - - - - ** - P X* - - - X
Communicable disease - - - - - - - - - - - X - - - -
Ventilator dependent - - - X - - - - - - - X X - - -
Cannot require tx for alcohol, drug abuse - - - - - - - - - - - - - - - X
Functional Criteria
Able to evacuate without assistance - - - - ** - - - - - - - - - X -
Must be able to feed self - - - - - - - - - - - - - - - X
Cannot be bedridden more than ... days - - - - - - - - - - P - - - - -
Cannot need more than 1 person assist - - - - - - - - - - - - - - - -
Cannot be totally bedfast/bedbound - - - - - - - - - - - - - - - -
Must be ambulatory - - - - - - - - - - - - - - X -
Must be able to direct care - - - - - - - - - - - - - - - -
Cannot have 4 or more ADLs - - - - - - - - - - P - - - - -
Alzheimer's/Dementia Related
Can't serve severe symptoms of senility - - - - - - - - - - - - - - - -
May admit persons with mild dementia - - - - - - - - - - - - - - - -
Late stage of Alzheimer's disease - - - - - - - - ** - - - - - - -
Must be able to make simple decisions - - - - - - - - - - P - - - - -
Behaviors
Cannot be danger to/violence self/others - ** X X - - - - X X X X - - - -
Cannot need restraints - X - - - - - - X - - - - - X -
Must be able to communicate needs - - - - - - - - - - - - - - - -
Other (see summaries) X - - X - - X - X X X - - - - X

State notes:

  • AS: Limitation of bedridden may be extended with physician and RN approval.
  • AR: Cannot require nursing care.
  • AZ: Residents with the indicated conditions may be served if services are provided by a licensed home health or hospice agency and other are met. See state summary.
  • CA: May serve people needing incidental medical services. May admit people with Alzheimer's disease who are not able to respond to verbal instructions under special conditions. May retain longer than 14 days with a physician's statement that the condition is temporary.
  • DE: Agencies may serve people with these conditions based on their capacity.
  • FL: Has separate requirements for admission and retention. Those listed cover retention in Extended Congregate Care Facilities. See state summary for complete discussion.
  • GA: Absence of a need for continuous skilled care implies that residents may not have conditions noted by an asterisk.
  • ID: See summary for Alzheimer's disease provisions.
  • IA: Temporary exceptions are available to allow facilities to serve tenants needing more than part time or intermittent health care. Residents may only receive skilled services on a daily basis for up to 21 days.
  • KS: May serve residents with specified conditions if a negotiated services plan involving hospice, family or other agencies is negotiated.
  • LA: Residents may receive continuous nursing care for 90 days. All health related services must be arranged by the resident/family with an outside agency.
  • ME: Residents in residential care facilities II who meet the nursing home criteria may be served if they receive skilled services from the licensed home health or hospice agency.
  • MS: No indwelling catheters.
  • MT: May be served if a physician agrees to the admission.
  • NJ: Facilities may admit persons with conditions noted by an asterisk if they note this type of care in their licensing application.
  • NM: Exceptions are allowed when agreed to by a team.
  • OR: May be asked to leave for behavior problems.
  • RI: Unless facility meets more stringent life safety code.
  • SD: Residents must be in reasonably good health with no chronic illness or disability requiring more than cuing, supervision and limited physical assistance.
  • TN: May retain residents for 21 days with these conditions or longer if approved by Department of Health. Residents with Alzheimer's disease must be reviewed by a team quarterly.
  • VA: Residents with conditions noted with an asterisk may be served under certain conditions.
  • VT: Residences may, but are not required to, move residents with unstable medical conditions and other conditions indicated by P.
  • WI: Cannot serve residents who need more than 28 hours of supportive, personal and nursing services a week.


CRITERIA FOR ADMINISTRATORS (see note)
- AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY
None stated - - - - - - X X - - - - - - - - -
Age 19 21 21 21 - 18 - - 18 21 - - 18 - 21 21 21
High school diploma/GED - - - X - - - - X - - - - - - X X
Advanced degree - - - - ** - - - - - - - - - - - -
Experience - X X - X - - - - X* X - - - - - -
License/certification - - X X X - - - - X X* X - X - X -
Specified abilities/knowledge X - - - X - - - - - - X - - - - -
Criminal or background check - X X X X X - - X X - X - - X - -
CEUs/hours of training 6 - 12 - 20 - - - 12 16 - - - - - - -
Other - - - X - - - - - - - - - - - - -
- LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND
None stated - - - - - - - - - X - - - - - - X
Age 25 - 21 21 21 - 21 - - - 18 21 21 21 - 18 -
High school diploma/GED - - X - - - - - X - - X 1 X X - X -
Advanced degree X* - - X - - - - - - - X 1 - - - - -
Experience X* - - X - - - - - - - X 1 - - - X -
License/certification - - - - - - - - - - X - X - - - -
Specified abilities/knowledge - - X - - - - - - - X - - X - X -
Criminal or background check X - X - - - - - - - X X - - - X X
CEUs - - - - 16 - - - 6 - 8 12 10 - - 15 12
Other - - - - - - - - - - - - - - - X -
- OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY -
None stated - - - - - - - - - - - - - - X - -
Age 21 21 - 21 21 21 - 18 - 21 21 21 21 21 - 21 -
High school diploma/GED - - - X - X X X X - - X X - - - -
Advanced degree - - - - - - - - - X - X* X* - - - -
Experience - - - - - - - - - X X - - - - - -
License/certification - X* - - X X X* X - X - - X* - - - -
Specified abilities/knowledge X - - X X X - - - X - - - - - X* -
Criminal or background check X X* X X X - - X - - X X X X - - -
CEUs/hours of training 9 - 20 40 16 - - 24 12 X 20 20 10 10 - - -
Other - - X X - X - - - - - - - - - - -

Notes:

  • In states with two or more licensure categories, the criteria apply to assisted living facilities, if licensed, or the category that offers the highest level of care.
  • CA: Requirements vary by the size of facility.
  • GA: This requirements applies to administrators in homes that participate in the Medicaid HCBS waiver.
  • HA: Must complete an assisted living administrators course or equivalent acceptable to the Department.
  • LA: Experience or a bachelor's degree.
  • NH: The experience requirements vary with the degree: HS + five years in a facility; AB + 3 years in health setting; BA + none. Also need 3 references.
  • OH: Must be licensed or have 2000 hours of operation experience in a related facility, 100 hours of post high school credit in gerontology, a licensed health professional or have a baccalaureate degree.
  • OK: the items noted with an asterisk apply to both licensure categories.
  • OR: Must demonstrate competency in the provision of services and the principles of assisted living.
  • PA: Must complete 40 hours of training/CPR/first aid or be a licensed nursing home administrator and complete 6 CEUs every year.
  • SC: Requires three references.
  • SD: Administrators must be licensed or have completed a training and certification program.
  • TN: 24 CEUs every two years.
  • UT: A degree is required depending on the size of the facility. Administrators must have appropriate experience, a degree or a license.
  • VA: High school diploma and at least 2 years post secondary education or 1 year of human service study in an accredited college opr department approved curriculum is required for administrators providing an assisted living level of care.
  • WA: May have high school diploma, and 2 years experience, or advanced degree or certification.
  • WY: Must have knowledge of and pass a test on regulations and be a CNA or equivalent.


STATE ASSISTED LIVING TRAINING REQUIREMENTS
- AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY
Direct Care Issues
Approved course - - - - - - - X X - - - - - - - -
General requirements - - - - - - X - X - X - X - X - -
Principles of assisted living - - X - - - X - X - X - - - - X -
Personal/direct care skills X - X - - X - - X X 1 - X - X - - X
Meetings needs of consumers/residents - - X - - - - - X X - - - - X - -
Appropriate, related to tasks/duties - - - - X - - X - X - - - - X - -
Hygiene - - X - - - - - X X 1 - - - - - - -
Housekeeping/sanitation - - X - X - - - - X - X - - - - X
Nutrition/food preparation/diets - - X - X X - - X - - - - - - - X
Social/recreation activities - - - - - X - - - X - - - - - - -
Dementia/Alzheimer's care - - X - - - - - X X - - - - - X -
Mental health/emotional/behavior needs - - X - - X - - X X - - - - - - X
Related to restraints - - - - - - - - X - - - - - - - X
Health Related Issues
Basic nursing skills - - - - - - - - - - - - - X X 2 - -
Prevention/restorative services - - - - - - - - - - - - - - X 2 - -
Observation/reporting skills - - - - X - - - - X 1 - X - - X 2 - -
Medication administration/assistance - - X X X - - - X X - X - X X 2 - X
Knowledge Areas
Residents rights X - X X - X - - X X - X - X - X X
Aging process/gerontology - - X - - - - - - X - X - - - - X
Working with/needs of elderly - - - - - - - - - X - - - - - - X
Death and dying - - - - - - - - - - - X - - - - -
Psycho-social needs - - - - - - - - - X - - - X - - -
Assessment skills - - - - - X - - - X 1 - - X - - - -
Care plan development - - X - - - - - - X 1 - - X - - - -
Communication skills - - - - X - - - - - - - - - - - -
Knowledge of community services - - - - X - - - - - - - X - - - -
Safety/Emergency Issues
CPR X - X - - - - X X X X - - - - - -
First aid X - X - - X - X X X X X - - - - -
Fire, safety, emergency procedures - - X X - X - X - X - X X X X X -
Infection prevention/control X - X - - - - X X X - X - X - X -
Process Issues
Agency/facility policies - - X - - - X - - - - X - X - - X
Regulations/law - - - - - - X - X - - - - - - - -
Reporting abuse/neglect - - X X - - - - X X - - - - X X X
Complaint procedures - - - - - - - - X - - X - - - - -
Record keeping - - X - - - - - X X - - - - - - X
Confidentiality - - X - - - - - X - - - - X - - -
Legal/ethical issues - - - - - - - - X X - - - X - - -
Survey process X - - - - - - - X - - X - - - - -
No requirements described - X - - - - - - - - - - - - - - -


STATE ASSISTED LIVING TRAINING REQUIREMENTS continued...
- LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND
Direct Care Issues
Approved course - X - - - X - - - - - - X - X X -
General requirements - - - - - - X - - - - - X X - X -
Principles of assisted living - - - X - - - - - - - - X - - X -
Personal/direct care skills - - X X X X - - X - - X X - X X -
Meetings needs of consumers/residents - - - - X - - - - - X - X X X X -
Appropriate, related to tasks/duties - - X X - - - X - - - - X - X X -
Hygiene X - - X - X - - X - - - X - - X -
Housekeeping/sanitation X - X X - X - - - - - - - - - - -
Nutrition/food preparation/diets X - X X X X - - X - - - X - - - X
Social/recreation activities X - - - - - - - - - - X - - - X X
Dementia/Alzheimer's care - X - X - - - - - - X - - - - X -
Mental health/emotional/behavior needs X - - - - - - - - - - X - - - X X
Related to restraints - - - - - - - - - - - - - - - X -
Health Related Issues
Basic nursing skills - - - - - - - - - - - - X - - X -
Prevention/restorative services - - - - - - - - - - - - X - - X -
Observation/reporting skills - - X X - X - - X - - - X - - X -
Medication administration/assistance - - X X - X - - X - X X X X - - -
Knowledge Areas
Residents rights X X X X X X - X - X - X X - X X X
Aging process/gerontology X - - X - - - - - - - - X - - X -
Working with/needs of elderly - - - - - - - - - - - - X - - X -
Death and dying - - - X - - - - - - - - X - - X -
Psycho-social needs - - X - - - - - - - - - X - - X -
Assessment skills - - X - - - - - - - - - - - - X -
Care plan development X - X - - - - - - - - - - - - - -
Communication skills - X - X - - - - - - - - X - - X -
Knowledge of community services X - - - - - - - - - - - - - - - -
Safety/Emergency Issues
CPR - - X - X - - - - X - - - - - - -
First aid X - X - X - - - - X - X - X - X -
Fire, safety, emergency procedures X X X - X X - X - - - X X - X - X
Infection prevention/control - X X X X X - X - - - - X - - X X
Process Issues
Agency/facility policies - X - - - - - - - - - - X - X X -
Regulations/law - - - - - X - - - - X - X - - - -
Reporting abuse/neglect - - - X X X - X - - - - X - - - -
Complaint procedures - - - - - X - - - - - - X - - - -
Record keeping X - - - - - - - X - - - - - - - -
Confidentiality - X - - - - - X - - - - X - - - -
Legal/ethical issues - - - - - - - - - - - - X - - - -
Survey process - - - - - - - - - - - - - - - - -
No requirements described - - - - - - - - - - - - - - - - -


STATE ASSISTED LIVING TRAINING REQUIREMENTS continued...
- OH OK OR 3 PA RI SC SD TN TX UT VT VA WA WV WI WY
Direct Care Issues
Approved course - X - - - - - - - - - X X - - -
General requirements X - X X - - - - - - - - - - - X
Principles of assisted living - - X - - - - - - - X - X - X -
Personal/direct care skills X X X - X - - - - X X - X X X -
Meetings needs of consumers/residents - - - - - - - - X - - - X X - -
Appropriate, related to tasks/duties X X - - - X - - - - - X X X X -
Hygiene - - - X - - - - - - - - - X - -
Housekeeping/sanitation - - - X X X - - - X - - X - - -
Nutrition/food preparation/diets - - - X X X - - - X - - X - - -
Social/recreation activities - X - X - X - - - - - - X - - -
Dementia/Alzheimer's care X X - X - - X - - - X X X - - -
Mental health/emotional/behavior needs X - - X - - - - X - X X X - X -
Related to restraints - - - X - - X - - - - X X - - -
Health Related Issues
Basic nursing skills - - - - - - - - - - - - - - - -
Prevention/restorative services - - - - - - - - - - - X - - - -
Observation/reporting skills X X - - - - - - X X - X - - - -
Medication administration/assistance - X - X X X - - - X - X X - - -
Knowledge Areas
Residents rights X X - X X X X - - - X X X X X X
Aging process/gerontology - - - X - - - - X - - - X - X -
Working with/needs of elderly - - - X - - - - - - - X - X X -
Death and dying - - - - - - - - - - - - - - - -
Psycho-social needs - - - - - - - - - - - - - - X -
Assessment skills - X - - - - - - X - - - - - X -
Care plan development - - - - - - - - - - - - - - - -
Communication skills X - - - - - - - X X X - X - - -
Knowledge of community services - - - - - - - - - - - - - - - -
Safety/Emergency Issues
CPR - X - X - - - - - - - X X X X -
First aid X X - X X X - - - - - X X X X -
Fire, safety, emergency procedures X X - X X X X - - X X X X X X X
Infection prevention/control - - - X X X X - - - X - X X - -
Process Issues
Agency/facility policies X - - - X - - - - - - - X X X -
Regulations/law - - - - X X X - - - - - X - - -
Reporting abuse/neglect X X - - - - X - X - X X X X - -
Complaint procedures - - - - - - - - - - - - X X X -
Record keeping X X - X X - - - - - X - X - - -
Confidentiality - X - - - - X - X - - X X X - -
Legal/ethical issues - - - - - - - - X - - - X - - -
Survey process - - - - - - - - - - - - - - - -
No requirements described - - - - - - - X - - - - - - - -

State notes:

  1. GA: Items with an asterisk are required for facilities serving Medicaid waiver beneficiaries.
  2. IA: Health related task requirements are included in the state's nurse practice act.
  3. OR: These requirements apply to the administrator of the facility.
  4. ND: Requirements apply to Medicaid HCBS waiver providers.


COMPARISON OF STATE MEDICAID POLICY AND REIMBURSEMENT
State Reimburse Type Coverage Payment Methodology 300% Eligibility "Bed Hold" Policy # Facilities Contracting Number Participants Occupancy Limits
AK X Waiver Setting X N 76 @175 N
AZ X Waiver Tiered X N NR 92 Recommend 20/30
AR X State plan FFS NA N NR @1,000 N
CO X Waiver Flat N N 179 1,400 N
CT Pilot Waiver TBD --- --- --- --- ---
DE Planned Waiver Tiered 250% 18 days 1 --- --- N
FL X Waiver Flat 2 X N 91 520 -
GA X Waiver Flat X 7 days 117 1,154 N
HA Planned Waiver -
IL Pilot Waiver Flat X N 16 1,300 3 N
IA X Waiver Care plan X N NA --- N
KS X Waiver Care plan - N - - N
LA Planned Waiver TBD -
ME X Waiver/plan Flat 4 - N 182 3,759 N
MD X Waiver Flat 200% N --- 44 N
MA X State plan Flat NA N 30 312 N
MI Pilot Waiver Flat Y N 1 5 N
MN X Waiver Case mix Pending N NA 260 N
MO X State plan Care plan NA N 600 6,390 N
MT X Waiver Care plan N N NA 130 5 N
NE Planned Waiver Flat N N NA NA NA
NV X Waiver Flat N N 54 52 N
NH Planned Waiver -
NJ X Waiver Setting 2 Y N 21 120 N
NM X Waiver Flat 200% N 6 0 N
NY X State plan Case mix NA 30 days 6 35 2,100 (6)
NC X State plan Flat 4 NA 60 days/year 1,800 7 20,000 8 N
ND 9 X State funds Care plan NA NR NR NR N
OR X Waiver Tiered Y N 35 1,500 N
RI X Waiver Flat Y 1 month 10 19 20 N
SC Planned Waiver -
SD X 11 Waiver Flat - 15 days 38 65 N
TX X Waiver Setting 300% N 179 565 N
UT Planned Waiver -
VA X Waiver Flat N N 165 1,400 N
VT 12 X Waiver Flat X N 26 88 N
WA X Waiver Tiered X 30 days 104 1,500 N
WI X Waiver Tiered X N 15 25 N

State notes:

  1. DE: 18 days for social absence.
  2. FL and NJ: Considering a tiered methodology.
  3. IL: Sixteen sites have been selected with a capacity of 1,300 residents. The authorizing legislation limited the pilot to 2,000 participants.
  4. ME and NC: Developing a case mix methodology.
  5. MT: Figures include participants in adult foster care and personal care homes.
  6. NY: The bed hold policy is stated in the resident agreement which requires 30 days notice. The number of units is limited through the Medicaid bidding and contracting process.
  7. NC: Figures include mental health group homes licensed by the state. A break out for elderly residents was not available.
  8. NC: This is the total number of residents eligible for state/county special assistance and, therefore, automatically eligible for Medicaid.
  9. ND: Uses state general revenues rather than Medicaid but is considering covering services under the Medicaid waiver.
  10. RI: Facilities receive one month prospective payment and would hold the unit for the remained of the month.
  11. SD: Presently provides Medicaid payment for medication administration under its waiver and is considering covering personal care as a state plan service.
  12. VT: Residential care facilities are presently covered and assisted living facilities will be added when the assisted living regulations are adopted. A tiered payment system will be implemented in 1998. A flat rate is presently used for enhanced residential care.


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