State Assisted Living Policy: 1998. Iowa



Assisted living programs Iowa Code 231C and 321 IAC Chapter 27; IAC 661--5.626 Assisted Living Housing (Life Safety)

Residential care facilities IAC Chapter 57 and Chapter 60.

Related Codes that affect but do not specifically reference assisted living: 655 IAC Chapter 6 Nurse Practice; 645 IAC Chapter 63 - Salons; Iowa Code Chapter 155A - Pharmacy; 481 IAC Chapters 30 & 32 - Food Service Establishments

General Approach

Legislation passed in 1996 created a certification process for assisted living. Regulations were effective in 1997 implementing the new category. The law allows acceptance of accreditation from other organizations but developed its own process for facilities that might not be able to afford the associated fees. Programs are certified for two years. Those with above standard or exemplary operations may be certified for three or four years.

Residential care facilities provide protective supervision and minimal assistance with ADLs to people with mental retardation or chronic mental illness.


96 Acts, Chapter 1192 "Assisted living means provision of housing with services which may include but are not limited to health related care, personal care and assistance with instrumental activities of daily living to six or more tenants in a physical structure which provides a home-like environment. Assisted living also includes encouragement of family involvement, tenant self-direction, and tenant participation in decisions that emphasize choice, dignity, privacy, individuality, shared risk and independence. Assisted living does not include the provision of housing and assistance with instrumental activities of daily living which does not also include provision of personal care or health related care."

Unit Requirements

Assisted living programs may have private dwelling units with lockable doors and individual cooking facilities. Each dwelling unit must have at least one room with not less than 120 square feet of floor area. Other habitable rooms must have at least 70 square feet. Each dwelling unit must have at least 190 square feet of floor area, excluding bathrooms. Units used for double occupancy must have at least 290 square feet, excluding bathrooms.

Tenant Policy

Programs may not admit or retain tenants who require more than part time or intermittent health related care, are dangerous to self or others, are in an acute stage of alcoholism, drug addiction or mental illness, under 18 or who meet the program's transfer criteria. Exceptions may be sought for tenants who need more than part time or intermittent health care. Managed risk statements must be used. An occupancy agreement must be signed with each tenant that describes the rights and responsibilities of the tenant and the provider, fees, charges and rates, the services covered, and occupancy and transfer criteria. It also describes the program's staffing policy, whether or not staff are available 24-hours a day, whether delegation will be used and how staffing will be adapted to meet changing needs.


Programs must provide some personal care or health related services and at least one meal a day must be provided. Health related services means less than daily skilled nursing services and professional therapies for temporary but not indefinite periods of time of up to 21 days a month. Skilled services and therapies combined with personal care and nurse delegated activities may not total more than eight hours a day. Service plans must be developed for each tenant and plans for tenants needing personal care or health related services must be developed by a multidisciplinary team.


Certified or accredited assisted living programs may be providers of Medicaid home and community based waiver services. About 60%, or 18, of the programs have committed to provide Medicaid waiver covered services. Services are reimbursed on a fee for services basis according to the care plan.


Written medication plans are required. Medications may be administered in accordance with state rules governing administration.


Programs administering medications or providing health related services must provide for a registered nurse to monitor medications, ensure physician orders are current (30 days) and assess and monitor health status (90 days). Sufficient staff are required to meet tenant needs. Each program must provide access to a 24-hour emergency response system.


Administrators The owner or sponsor of the assisted living program is responsible for ensuring that both management and direct service employees receive training appropriate to the task.

Staff The assisted living program shall have a training and staffing plan on file and shall maintain documentation of training received by staff. All personnel of the assisted living program shall be able to implement the assisted living program's accident, fire safety and emergency procedures.


Programs are monitored at least once during the certification period and on complaint.

Residential Care Facilities

A maximum of four people may share rooms providing 80 square feet per bed. Services include personal care, assistance with self-administration and administration of medications by qualified staff. Residents may be admitted if a physician signs a statement that the resident requires no more than personal care and supervision but does not require nursing care. Medications may be administered by approved registered nurses who have passed a medication administration course.

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