State Assisted Living Policy: 1998. Tennessee



Assisted Care Living Facilities: Rules of the Department of Health Chapter 1200-8-9 et seq.

Homes for the Aged: Chapter 1200-8-11

General Approach

Rules implementing a bill signed in 1996 were effective in April 1998 creating an assisted care living facility category. Regulations were developed by the Health Care Facilities Board through a 13 member task force consisting of six members of the Board, three Department of Health representatives and four associations (Tennessee Health Care Association, Association of Homes for the Aging, Home Care Association and the Assisted Living Association). The new rules allow a higher level of care and require new facilities to meet the 1997 edition of the standard building code. Existing Homes for the Aged are grandfathered from meeting the higher building code if they choose to convert their license.

There were 244 residential homes for the aged with 5,200 beds and 30 institutional homes for the aged and 1,963 beds in 1998.


Assisted care living facility means a building, establishment, complex or distinct part thereof which accepts primarily aged persons for domiciliary care and which provides on site to its residents, room, board, non medical living assistance services appropriate to the residents' respective needs, and medical services as prescribed by each resident's treating physician, limited to the extent not covered by a physician's order to a home care organization and not actually provided by a home care organization. An ACLF may directly provide such medical services as medication procedures, topicals, suppositories and injections (excluding intravenous) pursuant to a physician's order, and emergency response. All other skilled nursing services (part time or intermittent nursing care, physical occupation and speech therapy, medical social services, medical supplies other than drugs and biologicals, and durable medical equipment) that a home care organization is licensed to provide may be provided in the facility only by a licensed home care organization, except for home health aide services.

Home for the aged: a home which accepts aged persons for relatively permanent, domiciliary care. It provides room, board and personal services to one or more non-related persons. A home for the aged may be any building, section or a building, or distinct part of a building, a residence, a private home a boarding home for the aged or other place, either for profit or not, which provides, for a period exceeding 24-hours, housing, food services and one or more personal services for one or more aged persons who are not related to the owner or administrator by blood or marriage. Homes for the aged must have agreements with a physician who is available to render care or who will come to the home to visit residents when necessary and with a nursing home that will accept its residents who must be discharged.

Unit Requirements

Assisted care living facility A minimum of 80 square feet of bedroom space must be provided for each resident. No more than two residents may share a bedroom. No more than six residents may share a toilet, lavatory, bath or shower.

Home for the aged Each resident must have at least 80 square feet of bedroom space. Bedrooms may not have more than two beds, and privacy screens or curtains must be provided and used when requested by the resident. Beds with full side rails, potty chairs, bedpans, or urinals shall not be used routinely in residents' rooms. Residents' rooms must always be capable of being unlocked by the resident.

Tenant Policy

Assisted care living facilities may not admit or retain anyone who: is in the later stages of Alzheimer's disease, requires physical or chemical restraints, poses a serious threat to self or others, requires nasopharyngeal and tracheotomy aspiration, requires initial phases of a regiment involving administration of medical gasses, requires a Levin (or nasogastric) tube, requires arterial blood gas monitoring or is unable to communicate his or her needs.

Residents in all but the latter stages of Alzheimer's disease may be admitted only after determination by an interdisciplinary team that care can be safely and appropriately provided. This determination must be reviewed quarterly.

Facilities may not admit, but may retain for 21 days, any resident requiring intravenous or daily intramuscular injections or intravenous feedings; gastronomy feedings; insertion, sterile irrigation and replacement of catheters, except for routine maintenance of Foley catheters; treatment of extensive stage 3 or 4 decubitus ulcer; exfoliative dermatitis; or requires sterile wound care.

Residents with these conditions may be retained longer than 21 days if the Health Department is notified and does not object. However, residents may not be retained after 21 days if they require four or more skilled nursing visits per week for any other condition.

Home for the aged Residents who need continual professional medical/nursing observation and/or care cannot be admitted or retained. Residents who require more technical nursing care or medical care than the personnel and the facility can lawfully provide shall be transferred to a hospital or nursing home. Homes for the aged cannot admit a person whose primary diagnosis is a mental health condition which clearly endangers himself or others and/or who is receiving active treatment from a mental health facility for a condition which clearly endangers himself and others. Homes for the aged may serve people with mental health conditions, but these residents may not make up more than 50% of the home's residents. Persons in the early stages of Alzheimer's disease and related disorders may be admitted if an interdisciplinary team made up of a physician who is experienced in the treatment of Alzheimer's disease, a social worker, registered nurse, and a family member (or patient care advocate) determines that care can appropriately and safely be given in the home for the aged. Such residents must be reviewed at least quarterly as to the appropriateness of placement in the home.


Assisted care living facility Non-medical living assistance and some medical services may be provided. Medical services include part time or intermittent nursing, physical, occupational and speech therapy, medical social services, medical supplies, durable medical equipment may be provided but only by a licensed home care agency. Home health aide services may not be provided by a licensed home care agency because they would duplicate services provided by the facility.

Home for the aged Assistance and supervision with medications is allowed and medications may be administered by a licensed nurse. Homes for the aged may not care for residents who require restraint, and so must not use restraints. Homes may provide personal care such as bathing, dressing, and grooming of hair, fingernails and toenails. Laundry and linen services, food service and recreational activities are also provided.


Assisted care living facilities The law does not authorize Medicaid coverage for medically necessary home care services provided in an assisted care living facility. Legislation providing funding for home care services including Assisted Care Living Facilities and Homes for the Aged is pending before the legislature.

Home for the aged Personal care is not funded by Medicaid either as a state plan service or as a waiver service. There is an SSI pilot program paying up to $9/day/quarter per resident, with an overall spending cap of $525,100.


Assisted care living facility staff may assist with self-administration of medications. A licensed professional may administer medications within the scope of their license.


Assisted care living facilities Must be sufficient to meet the needs, including medical services of residents. Facilities must have a licensed nurse available.



Assisted care living facilities Administrators must be certified biannually. Certification requires 24 hours of classroom hours of continuing education courses approved by the board that includes instruction in the following: state rules and regulations for homes for the aged/ACLFs; health care management; nutrition and food service; financial management; and healthy lifestyles.

Homes for aged The licensee of a home for the aged must be at least 18 years old. The chief administrator of the home must be certified by the Board as a residential home administrator, unless the administrator is currently licensed in Tennessee as a nursing home administrator. The licensee must have a high school diploma or equivalent; persons serving as a chief administrator of a licensed home for a continuous period of at least nine months prior to January, 1990 are exempt from this requirement. Licensees must have at least 24 hours of continuing education each year. Personal care attendants must be at least 18 years old. Facilities with five or more residents whose level of evacuation capability is classified as "slow" must have a responsible attendant on duty and awake at all times.



Assisted care living facilities No continuing education is required for direct care staff.

Homes for aged staff must attend any training program which may be required by the Department when such programs are offered without charge, in each of the three regions of the state, and no more frequently than annually.

Background Check

The administrator must not have been convicted of a criminal offense involving abuse or intentional neglect of an elderly or vulnerable individual. Facilities may not employ any peson listed on the Department's abuse registry.


Inspections are conducted each year. Deficiencies must be addressed by plans of correction. Homes must comply with local fire safety authority regulations.


Fees for assisted care living facilities vary with the number of beds: < 50: $400; 50-74: $500; 7599: $600; 100-124: $700; 125-149: $800; 150-174: $900 and 175-199: $1000. Facilities over 200 are charged $1000 plus $60 for every 25 beds or fraction thereof.


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