State Assisted Living Policy: 1998. Alabama



Assisted living Chapter 420-5-4

General Approach

Regulations for assisted living were effective in 1991. A task force chaired by the state Department of Public Health was appointed in 1996 and held two meetings. A transcript and comments from task force members were submitted for further action. The Department is now developing significant revisions to the regulations. The primary issues being addressed include aging-in-place, admission/retention criteria and serving people with Alzheimer's disease. Draft revisions will be issued for comment in the Spring and final rules by the Spring of 1999. The State Health Coordinating Committee is also reviewing assisted living. The Committee is interested in covering assisted living under Medicaid and determining the number of nursing facility residents that could be served in an assisted living setting.

The current regulations license three categories of facilities. Congregate assisted living facilities serve 17 or more adults, group assisted living facilities serve 4-16 adults and family assisted living facilities serve 2-3 adults. Since 1992 the number of licensed assisted living facilities has grown from 171 to 207 in 1995 and 261 by March 1998. The number of beds has increased from 3,710 in 1992 to 4,840 in 1995 and 6,222 in 1998.


Assisted living facility "means a permanent building, portion of a building, or group of buildings (not to include mobile homes and trailers) in which room, board, meals, laundry, and assistance with personal care and other services provided are for not less than twenty-four hours in any week to a minimum of two ambulatory adults not related by blood or marriage to the owner and/or administrator."

Unit Requirements

The regulations do not require separate living and sleeping quarters. Private bedrooms without sitting areas must provide 80 square feet and double rooms 130 square feet. If sitting areas are included, private rooms must be 160 square feet and double rooms 200 square feet. Bath tubs or showers must be available for every eight beds, and lavatories and toilets for every six beds. Lockable doors are permitted.

Tenant Policy

The regulations provide that assisted living facilities may serve "ambulatory adults who do not require acute, continuous or extensive medical or nursing care and are not in need of hospital or nursing home care." Facilities may not serve anyone with communicable or infectious disease, chronic health conditions requiring extensive nursing care and/or daily medication supervision, persons requiring daily professional observation or the exercise of professional judgement by staff. People who need assistance from more than one person to evacuate a building, show severe symptoms of senility, or require restraint or treatment for addiction to alcohol or drugs may not be admitted or retained. Evacuation. Residents must be ambulatory on admission either aided or unaided by prosthesis.


Assisted living facilities must provide personal care for bathing, oral hygiene, hair care and nail care. Facilities may provide for general observation and may arrange or assist residents to obtain medical attention or nursing services when needed. Home health may be provided by a certified agency as long as residents do not require hospital or nursing home care.


Other than SSI, no public financing is available for assisted living.


Assistance is limited to reminders, reading container labels to the resident, checking the dosage and opening containers. Licensed nurses are allowed to administer medications for residents who do not require acute, continuous or extensive medical or nursing care.


The regulations require at least one staff member per six residents 24-hours a day and personal care staff to meet the needs of residents.


Administrators must have 6 hours of continuing education annually on state law and rules, identifying and reporting abuse, neglect and exploitation, special needs of the elderly, mentally ill and mentally retarded, basic first aide/CPR training; business management; human resource management and plant management and safety.

Staff must receive core training that includes but is not limited to: basic first aid; CPR; bathing, grooming, handling of the elderly - 16 hours; infection control; resident's rights; and the survey process. CNAs in good standing are exempt.

Background Check

Not specified.


Facilities are monitored through licensing review and periodic inspections by the Board of Health depending on funding for inspectors.


Licensure fees are $200 plus $5 per bed over 10 beds.


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