State Assisted Living Policy: 1998. Nebraska



Assisted living facilities NAC Title 175, Chapter 4.

General Approach

Rules for a new assisted living category are effective in 1998.

Grants for nursing home conversions Legislation providing $40 million in grants or loan guarantees to nursing homes to convert wings or entire facilities was approved by the legislature and signed by the governor in April 1998. The program will be administered by the Department of Health. Grants will be made when it is efficient and economical. Grantees must agree to maintain specified occupancy levels of Medicaid beneficiaries for a period of 10 years. The Department will develop rules specifying minimum occupancy rates, allowable costs and refund methods. Grants may cover capital or one time costs and operating losses for the first year to facilities that have participated in the Medicaid program for at least three years. Facilities must provide 20% of the cost of conversion.

Facilities may convert existing space or construct additional space to include assisted living or other alternative services. Construction of a new assisted living facility may be funded if the nursing home beds are de-licensed and it is more cost effective than conversion of existing space.

LB 608, passed in 1997, replaces residential care facilities and domiciliary facilities with a new assisted living program. Regulations developed by the Department of Health and Human Services will be effective July 1, 1998.


Assisted living facility means any institution, facility, place or building in which there are provided for a period exceeding twenty-four consecutive hours, through ownership, contract or preferred provider arrangements, accommodation, board, and an array of services for assistance with or provision of personal care, activities of daily living, health maintenance activities or other supportive services, for four or more non-related individuals who have been determined to need or want these services. Assisted living promotes resident self-direction and participation in decisions which emphasize independence, individuality, privacy, dignity and residential surroundings. This definition does not include (a) those homes, apartments, or facilities providing casual care at irregular intervals and (b) those homes, apartments or facilities in which a competent resident provides or contracts for his or her own personal or professional services in no more than twenty-five percent of the residents receive such services. A competent resident is someone who has the capability and capacity to make an informed decision.

No facility may hold itself out to be assisted living unless it is licensed.

Unit Requirements

Existing facilities may have single bedrooms with 80 square feet and multiple occupancy rooms with no more than 4 beds per room and 60 square feet per bed. Bathing facilities are required for every 16 residents. Toilet facilities may be provided adjacent to each bedroom or shared facilities must be available for no more than six residents.

New facilities must provide rooms of 100 square feet for a single resident in an apartment of dormitory-like room; 80 square feet per resident in rooms occupied by more than one residents with a maximum of two residents; and 60 square feet per resident in rooms occupied by more than one resident in an apartment, maximum of two residents. Facilities must provide a bathing facility adjacent to each room or central bathing facilities. Central bathing facilities must be available for every eight residents. A toilet and sink must be provided adjoining each resident's bedroom.

Tenant Policy

Anyone needing complex nursing interventions or whose conditions are not stable and predictable may not be admitted unless:

  • The resident, or the resident's designee if the resident is not competent, the resident's physician or the registered nurse agree that admission or retention is appropriate;

  • Care is arranged through private duty personnel, a licensed home health agency, or a licensed hospice agency; and

  • The resident's care does not compromise the facility operations or create a danger to others in the facility.

Complex nursing interventions are defined as those requiring nursing judgement to safely alter standard procedures in accordance with the needs of residents, which require nursing judgement to determine how to proceed from one step to the next, or which require a multidimensional application of the nursing process. Facilities will be able to develop their own admission and retention policies within state guidelines.

The administrator has discretion regarding admission or retention of residents.


Services are to be provided in accordance with resident agreements which maximize resident's dignity, autonomy, privacy and independence. The rules list several indicators that measure whether resident needs are being met. Services include personal care, health maintenance activities, transportation, laundry, housekeeping, financial assistance/management, behavioral management, case management, shopping, beauty/barber and spiritual services. Health maintenance activities are defined as non-complex nursing interventions which can safely be performed according to exact directions, which do not require alteration of the standard procedure and for which the results and resident responses are predictable.

Facilities serving special populations must assess each resident to identify their abilities and needs, provide specially trained staff, prepare service agreements and provide a physical environment that conforms to and accommodates the special needs.


A Medicaid waiver will be developed when the regulations are effective.


Medications may be administered by licensed staff or medication assistants approved by the department.


The facility must maintain a sufficient number of staff with the required training and skills necessary to meet the resident population's requirements for personal care, activities of daily living, health maintenance activities, supervision and other supportive services.


Staff Orientation must be given within two weeks to each direct care staff person of the facility and shall include as a minimum, but is not limited to, residents rights; resident service agreement; emergency procedures including information relating to availability, notification and advance directives; information on abuse, neglect and misappropriation of money or property of a resident; information on any physical and mental special care needs of the residents of the facility; and disaster plan preparedness.

Ongoing training must be given to each direct care staff person and shall consist of at least twelve hours per year on topics appropriate to the employee's job duties including meeting the physical and mental special care needs of residents.

Background Check

Criminal background checks must be completed on all direct care staff. Evidence of contact with the nurse registry, adult central registry of abuse and neglect and the child central registry of abuse and neglect must be obtained to verify no adverse findings concerning abuse, neglect or misappropriation of resident property.


Facilities will be inspected bi-annually or more frequently for cause.


$50 plus $1 for each bed.

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