State Residential Care and Assisted Living Policy: 2004

SECTION 2. COMPARISON OF STATE POLICIES

March 31, 2005

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SECTION 2, TABLE OF CONTENTS

LIST OF TABLES
TABLE 2-1. Comparison of State Residential and Assisted Living Regulations: Supply
TABLE 2-2. Comparison of State Residential and Assisted Living Regulations: Characteristics
TABLE 2-3. Requirements for Facilities Serving Residents with Dementia
TABLE 2-4. Requirements for Resident Agreements
TABLE 2-5. Staff Training Requirements
TABLE 2-6. Comparison of State Reimbursement Policy


TABLE 2-1. Comparison of State Residential and Assisted Living Regulations: Supply
State Category 2004 2002 2000 CoN
Facilities Units/Beds Facilities Units/Beds Facilities Units/Beds
AL Assisted living facilities 335 9,876 327 9,738 304 8,000 N
AK Assisted living homes 162 1,650 143 1,497 123 1,346 N
AR Residential long-term care facilities 111 4,369 122 4,647 152 5,438 Y
Assisted living facilities 6 275 NA NA NA NA Y
AZ Assisted living facilities 1,509 24,500 1,524 24,002 1,242 22,848 N
CA Residential care facilities for elderly 6,543 154,830 6,207 147,580 6,152 136,719 N
CO Assisted living residences 525 13,799 538 14,291 551 13,868 N
CT Assisted living service agencies 65 NA 63 NA 48 NA N
Residential care homes 101 2,753 109 2,949 113 3,015 Y
DC Community residence facilities 200 1,866 NR NR NR NR N
DE Rest residential homes 3 NR 6 160 4 99 N
Assisted living 29 1,738 27 1,300 18 927 N
FL Assisted living facilities standard 2,250 74,762 2,328 78,348 2,361 77,292 N
Limited nursing services
Assisted living extended congregate
GA Personal care homes 1,687 25,434 1,648 25,563 1,606 24,437 Y/M
HI Assisted living facilities 7 1,008 3 354 0 0 N
Adult residential care home 542 2,882 545 2,882 552 2,866
Expanded care adult residential care home 77 157
ID Residential and assisted living facilities 266 6,160 253 5,815 226 5,185 N
IL Assisted living facilities 120 5,830 24 1,667 NA NA N
Shelter care facilities 149 8,484 156 8,240 156 8,302 N
Shared housing 13 92 NR NR NR NR N
IN Residential care facilities 147 11,767 140 11,555 127 10,098 N
IA Assisted living programs 184 5,220 154 4,180 78 3,409 N
KS Assisted living 191 7,971 129 5,658 80 4,521 N
Residential health care facility 98 2,918 43 2,355 N
KY Assisted living communities 83 NA 73 NA 6 NA N
Personal care homes 204 7,389 204 7,792 201 NR N
LA Personal care homes 44 286 29 176 33 216 N
Assisted living 67 4,157 66 3,906 66 3,119 N
ME Assisted living programs 30 1,429 24 1,133 14 799 N
Residential care facilities - 1 (I-IV 2004)
Residential care facilities - II-IV		 711 7,593 473
192		 1,711
5,220		 509
189		 1,799
4,094		 N
N
MD Assisted living programs 1,248 17,148 2,000 14,273 2,500 NR N
MA Assisted living residences 171 10,585 139 9,796 139 8,200 Y
MI Homes for the aged 190 14,588 188 14,500 NR NR N
Adult foster care: small group homes
Adult foster care: large group homes
Adult foster care: congregate homes		 4,265 32,915 4,353 33,317 3,735 26,015 N
N
N
MN Housing with services establishments 931 NA 600 NA 592 NA N
MO Residential care facilities I 280 6,363 285 6,533 313 7,030 Y
Residential care facilities II 363 15,434 363 15,106 364 15,405 Y
MS Personal care homes 194 4,197 207 5,137 197 4,568 Y
MT Personal care facilities 177 3,730 149 3,276 127 2,600 N
NE Assisted living facilities 259 9,187 227 8,369 167 7,077 N
NV Residential care facilities for groups 300 4,021 374 NR 326 4,581 N
NH Supported residential care facilities 137 4,013 148 3,936 75 2,797 N
Residential care home facilities 67 769 N
NJ Assisted living residences 152 13,696 129 11,645 91 8,672 Y
Assisted living programs 13 NA 17 NA 16 NA Y
Comprehensive personal care homes 43 2,388 41 2,642 29 1,752 Y
NM Adult residential care 346 NR 305 NR 255 NR N
NY Adult care homes 431 32,859 449 34,805 453 33,589 N
Enriched housing programs 90 7,227 83 5,308 44 3,147 N
Residences for adults 6 200 8 345 8 464 N
Assisted living programs 57 3,315 53 3,034 45 2,522 N
NC Adult care homes 629 35,247 631 34,776 610 32,995 Y
Family care homes 648 3,642 682 3,816 743 4,134 N
Multi-unit housing with services 23 1,053 20 1,538 NR NR N
ND Basic care facilities 46 1,490 47 1,490 43 1,436 N
Assisted living facilities 42 1,361 NA NA NA NA N
OH Adult care facilities (3-16) 712 5,666 805 5,783 860 6,017 N
Residential care facilities (17+) 510 36,255 462 31,937 439 28,139 N
OK Residential care home 103 3,358 210 8,620 147 8,478 N
Assisted living centers 115 6,308 8 1,253 87 NR N
OR Assisted living facilities 190 12,566 180 11,998 138 8,661 M
Residential care facilities 236 8,504 220 8,227 187 6,805 M
PA Personal care homes 1,718 76,385 1,786 79,929 1,803 73,075 N
RI Assisted living facilities 73 3,676 68 3,270 68 3,196 N
SC Community residential care facilities 504 16,641 545 17,761 553 16,119 N
SD Assisted living centers 162 3,360 153 3,084 127 NR N
TN Assisted care facilities 184 10,699 178 10,495 160 8,691 N
Homes for the aged 155 3,230 166 3,307 198 3,994 N
TX Assisted living facilities 1,378 42,245 1,324 41,424 1,304 39,596 N
UT Assisted living facilities type I 92 1,678 108 1,886 116 1,954 Y
Assisted living facilities type II 49 2,800 43 2,460 26 1,221 Y
VA Assisted living facilities 636 34,598 659 34,200 663 32,768 N
VT Residential care facilities 110 2,302 109 2,213 114 2,351 N
Assisted living residences 3 108 NA NA NA NA N
WA Boarding homes 538 24,498 525 23,830 498 22,140 Y/M
WV Personal care homes NA NA 50 2,310 52 2,342 N
Residential board and care homes NA NA 82 1,498 80 1,197 N
Residential care communities 3 88 3 88 3 88 N
Assisted living residences 113 3,197 NA NA NA NA N
WI Residential care apartment complexes 151 6,001 122 4,452 94 3,211 N
Community-based residential facilities 1,359 21,374 1,350 21,242 1,340 21,064 N
WY Assisted living facilities 15 970 14 1,005 13 960 N
Boarding homes 17 315 NR NR 26 419
Total 36,451 937,601 36,283 909,196 35,066 801,148  
NOTES:
M: Moratorium
NR: Not reported
NA: Not aplicable
AZ: Figures represent combined supply for three categories
GA: CoN applies to facilities serving more than 24 residents


TABLE 2-2. Comparison of State Residential and Assisted Living Regulations: Characteristics
State Category Size
Definition1		 Apt
Required		 Sharing
by
Choice?2		 Max #
Occupants		 Size-
Single		 Size
2+3		 #/
Toilet		 #/
Bath
AL Assisted living facilities 2 N N 2 80* 130* 6 8
AK Assisted living homes 3 N Y 2 80 140 NS NS
AR Residential long-term care facilities 3 N Y 2 100 160 6 10
Assisted living facilities 3 Y* Y 2 150 230 2 2
AZ Assisted living facilities <10, >10 N Y 2 80/220* 120/320 8 8
CA Residential care facilities for elderly NS N Y* 2 ** ** 6 10
CO Assisted living residences 3 N N 2 100 120 6 6
CT Assisted living service agencies NS* Y Y * * * * *
Residential care homes 2 N Y 2 150 250 4 8
DE Rest residential homes NS N N 4 100 80 4 4
Assisted living NS N Y 2 ** ** NA NA
FL Assisted living faciltiies (standard) 1 N N 2* 80 60* 6 8
Limited nursing services N 2* 6 8
Assisted living extended congregate care Y 2 4 4
GA Personal care homes 2 N N 4 80 60 4 8
Community living arrangements 2 N N 2 NS NS 4 4
HI Assisted living facilities NS Y Y NS 220 NA 1 1
Adult residential care home <6, >6 N N 4 90 70 8 14
ID Residential and assisted living facilities 3 N N 2 100 80 6 8
IL Assisted living facilities 3 N* Y NS NS NS 1 NS
Shelter care facilities NS NS NS 4 70 60 10 15
Shared housing < 12 N NS NS NS NS 4 6
IN Residential care facilities NS N N 4 100 80 8 8
IA Assisted living programs 6 N Y 2 240/70* 340/70 1 1
KS Assisted living 6 Y Y NS 200 NS 1 1
KY Assisted living communities 5 N Y 2 200 200 NA
Personal care homes NS N N 4 NS NS 8 12
LA Personal care homes 2-8 N N 2 100 70 NS NS
Assisted living 2 Y Y 2 250 250* 1 1
ME Assisted living programs NS Y Y NA NA NA NA NA
Assisted living residential care I-IV NS N N 2 100 160 6 10
MD Assisted living programs NS N N 2 80 120 4 8
MA Assisted living residences 3 ** NS 2 NS NS ** **
MI Homes for the aged > 20 N N 4 100 80 8 15
Adult foster care: small group homes < 12 N N 2 80 170 8 8
Adult foster care: large group homes 13-20
MN Housing with services establishments 1 ** ** ** ** ** 10 20
MO Residential care facilities I & II 3 N N 4 70 70 6 20
MS Personal care homes NS N N 4 80 80 6 12
MT Personal care facilities NS N N 4 100 80 4 12
NE Assisted living facilities 4 N N 2 100 80 1* 8*
NV Residential care facilities for groups 3 N N 3 80 60 4 6
NH Supported residential care facilities 2 N N 2 80 140 6 6
Residential care home facilities 2 N N 2 80 140 6 6
NJ Assisted living residences 4 Y Y 2 150 230 1 1
Assisted living programs NS* NA Y NA NA NA NA NA
Comprehensive personal care 4 N Y 2 80 130 NS NS
NM Adult residential care 2 N N 2 100 80 8 8
NY Adult care homes 5 N N 2 100 160 6 10
Enriched housing programs 5 Y Y NS NS NS 3 3
Residence for adults NS N N 2 100 160 6 10
Assisted living programs 5 Y/N Y/N ** ** ** ** **
NC Adult care homes 7 N N 4 100 80 5 10
ND Basic care facility 5 N N NS 100 80* 4 15
Assisted living facilities 5 ** ** ** ** ** ** **
Adult care facilities 3-16 N N 4 80 60 8 8
OH Adult care facilities 3-16 N N 4 80 60 8 8
Residential care facilities 17+ N N 3 100 80 8 8
OK Residential care home NS N N NS 80 60 6 10
Assisted living centers 2 N N 2 ** ** 4 4
OR Assisted living facilities 6 Y Y 1 220 NA 1 1
Residential care facilities 6 N N 2 70 120 6 10
PA Personal care homes 4 N N 4 80 60 6 15
RI Assisted living facilities 2 N N 2 100 80 8 10
SC Community residential care facilities 2 N N 4 80 60 8 10
SD Assisted living centers 2 N N 2 120 220 1 1
TN Assisted living facilities NS N N 2 80 160 6 6
Homes for the aged 1 N N 2 80 80 6 6
TX Assisted living facilities 4 N Y 4 100* 80* 6 6
UT Assisted living facilities type I 2 N N 2 100 160 6 10
Assisted living facilities type II 2 N Y 2 120 200 4 10
VA Assisted living facilities 4 N N 4 100 80 7 10
VT Residential care facilities 3 N N 2 100 80 8 8
Assisted living facilities NS Y Y 2 225 NA 1 1
WA Boarding homes 7 N N 2 80 70 8 12
Assisted living facilities (Medicaid) 7 Y NA 1 220 NA 1 1
WV Assisted living residences 4 -- -- 2 100 180 6 10
Residential care communities 17 Y Y 2 300 * NS NS
WI Residential care apartment complexes NS Y Y* 2 250 NA NS NS
Community-based residential facilities 5 N N 2 100 80 8 8
WY Assisted living facilities NS N N 2 120 80 2 10
Boarding homes
NOTES:
M: Moratorium.  NR: Not reported.  NA: Not applicable.  NS: Not specified.  */** See state notes below.
  1. This column presents the number of units/beds included in the definition of the licensing category, e.g., serving four or more individuals.
  2. Indicates whether residents share units by choice.
  3. Square footage in shared units is total square footage for two residents or square footage per resident in rooms for two or more.
*/** STATE NOTES:
AL: Private room with sitting areas, 160 square feet. Double room with sitting area, 200 square feet.
AR: Rules for assisted living require apartments.
AZ: Unit size figures are for rooms/apartment units. Apartments are required in centers that contract 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 are specified by the housing funding source.
DE: Space requirements are not specified.
FL: Facilities licensed after October 1999. Four persons may share a room in standard facilities licensed prior to 1999.
IA: Additional habitable rooms in any unit must be at least 70 square feet.
IL: Nursing homes converting a portion of a facility to supportive living must offer apartments with 160 square feet for single occupancy and 320 square feet for units shared by two persons.
LA: Rules require 250 square feet of living space. Units with two bedrooms must have 190 square feet of living/dining/kitchen space and 120 square feet for each bedroom.
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 three residents. Bedrooms may be shared.
MN: Licensing rules apply to service providers. Local codes apply to the building based on its use.
NE: New construction facilities must have a toilet and sink adjoining each bedroom. Existing or new facilities may have shared toilet rooms provided the following: one toilet for every six beds in existing facilities; one toilet per four beds in new facilities. Facilities must provide a bathing facility consisting of a tub and/or shower adjacent to each room or provide a central bathing room. In existing facilities, rooms must have 80 square feet and in multiple occupancy rooms 60 square feet per bed with no more than four persons occupying a room. In new construction, apartments must have 150 square feet for one resident and 110 square feet for each additional resident. In existing facilities, apartments must have 120 square feet for one resident and 100 square feet for each additional resident.
NJ: ALPs operate in conventional publicly subsidized senior housing complexes.
NY: Assisted living programs comply with the relevant requirements under which the contracting facility is licensed (i.e., adult home or enriched housing program).
ND: Rooms for three or more, 70 square feet per bed. There are no unit requirements for assisted living facilities. New rules define a living unit as a portion of an assisted living facility occupied as the living quarters of an individual who has entered into a lease agreement with an assisted living facility.
OK: Regulations do not specify requirements for the size of bedrooms.
TX: Type A facilities require 80 square feet for single occupancy and 60 square feet per resident in multiple occupancy rooms.
UT: A single occupant unit without additional living space shall be a minimum of 120 square feet. A double occupant unit without additional living space shall be a minimum of 200 square feet. A single occupant bedroom in a unit with additional living space shall be a minimum of 100 square feet. A double occupant bedroom in a unit with additional living space shall be a minimum of 160 square feet..
WV: Multi-occupancy apartments must have at least 80 square feet of bedroom space per resident and no more than two residents may occupy an apartment.
WI: Allows sharing with a spouse or a roommate chosen by the tenant.


TABLE 2-3. Requirement for Facilities Serving Residents with Dementia
  AL AK AZ AR CA CT CO DE* FL GA HI ID IL* IN IA KS KY*
Training X   X X X   X   X     X   X X X  
Staffing X   X X                 X   X    
Activities X   X   X       X     X X        
Environment     X X X   X   X     X X   X X  
Disclosure       X X     X X X   X X       X
Other X     X       X                 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 X X X       X X X
Staffing     X X     X X X X X       X X  
Activities   X X       X X     X         X  
Environment   X X       X X X X X       X X  
Disclosure   X X   X X   X X     X       X  
Other     X X     X X X X X       X    
  OH OK OR PA RI* SC SD* TN* TX UT VA VT WA WV WI WY*  
Training X   X X X X X   X X X X X X X X  
Staffing   X X X X       X   X     X   X  
Activities X   X X     X   X   X   X X   X  
Environment X   X   X       X   X   X X   X  
Disclosure X X X X X X   X X     X          
Other     X X     X       X         X  
*STATE NOTES:
DE: Facilities must develop policies to prevent wandering and safe storage of medications.
IL: An Alzheimer's facility has been selected for one pilot program, and it must meet all applicable state, federal, and local requirements.
KY: Lease agreements contain a description of special programming, staffing or training for serving clients with special needs.
MT: Requirements for administrators.
NE: Admission and discharge criteria.
NV: Administrators have three years experience serving people with Alzheimer's disease or equivalent education and training.
NY: See state summary. May not operate dementia units without written authorization from the Department of Health.
RI: Philosophy and criteria for placement.
SD: Also have fire safety/evacuation provisions.
TN: An interdisciplinary team must review residents with early stage Alzheimer's disease to examine appropriateness of placement on a quarterly basis.
WY: 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.


TABLE 2-4. Requirements for Resident Agreements
  AL AK AZ AR CA CT CO DE FL GA HI ID IL IN IA KS KY
Services included in the basic rate X X X X X X X X X X X X X X X X X
Cost of the basic service package X X X X X   X X X X X   X X X   X
Accommodations included   X             X