Privacy is primarily measured by the type of unit, the ability of residents to lock their doors, and the behavior of staff. States which have based their policy on privacy have emphasized apartments with attached bath. Autonomy is promoted by the availability of cooking facilities within the unit. Of the states that have established or proposed assisted living policy in this area, the following require apartments: Arizona, Connecticut, Hawaii, Kansas (draft), Louisiana (draft), Minnesota, New Jersey,5 North Dakota, Oregon, Vermont (draft), Wisconsin andWashington. (Note: States in italics require apartments under the Medicaid program rather than the state's licensing requirements).
Thirty-one states have rules that allow two people to share a unit or bedroom, and eleven of these states allow sharing of units only by choice of the residents. Several of these states have multiple licensing categories, and the two-person limit may apply to only one of the categories. Fifteen states have licensing categories that allow four people to share a room; five states allow three people to share units, and one state allows up to five people to share a room.
Washington requires private apartments shared only by choice. New Jersey's policy requires apartments for newly constructed units but allows two people to share an apartment. Florida now has two types of assisted living, one which allows up to four people to share a bedroom, and extended congregate care, which requires private apartments, private rooms or semi-private rooms or apartments, shared by choice of the residents. Massachusetts allows two people to share a room or apartment. Kentucky's statute requires apartments or home-style units. A home-style unit is a private room with a semi-private bathroom and use of kitchen facilities.
States which have developed a multiple-setting assisted living model vary the requirements by the setting. New York allows sharing for board-and-care facilities participating in the Medicaid program but requires apartments in the "enriched housing category," which includes purpose-built residences and subsidized housing.
New Mexico's Medicaid assisted living waiver covers two types of facilities offering "home-like" environments which are either units with 220 square feet of living and kitchen space (plus bathroom) or single or semi-private rooms in adult residential care facilities; however, rooms may be shared only by choice.
Regulations in Maine allow residential care facilities and congregate housing projects to operate as assisted living. Residential care facilities may offer shared rooms, and congregate housing projects are typically built as elderly housing projects. North Carolina allows up to four residents to share a room in adult care residences, but the multi-unit assisted housing with services category contains apartments in elderly housing projects. Texas covers assisted living services through Medicaid to residents in three settings: assisted living apartments (single occupancy); residential care apartments (double occupancy allowed); and residential care non-apartments (double occupancy rooms). Utah also establishes separate requirements based on the units offered rather than the setting. Facilities offering apartments must be single or double occupancy with a bathroom, living room, dining space, and kitchen facilities. Facilities may also provide double occupancy rooms. Virginia's new rules for assisted living also build on board-and-care requirements which allow four people to share a room.
Shared rooms, toilet facilities, and bathing facilities are the rule among states with board-and-care regulations. Board-and-care rules generally allow bedrooms shared by 2-4 residents and bathrooms shared by 6-10 residents. Board-and-care and/assisted living rules in Alabama, California, Colorado, Idaho, Nevada, New Hampshire, New Mexico, New York, South Dakota, Utah, and Wyoming limit sharing of units to two residents. South Dakota requires a toilet room and lavatory in each room. Three people may share a room in West Virginia. A few states do not specify a limit on the number of people sharing a room.
Four people may share a room under board-and-care rules in Delaware, Georgia, Indiana, Iowa, Michigan, Mississippi, Missouri, Nebraska, Pennsylvania, Rhode Island, South Carolina, and Virginia.
TABLE 2. State Policy Concerning Living Units1
|Assisted Living Rules||Shared Rooms|
|Apartment Units||Multiple Settings||Assisted Living Rules||Board-and-Care|
|Illinois (pilot)||Iowa||Rhode Island||Georgia|
|Minnesota (Medicaid)||Maryland (draft)||Wyoming||Michigan|
|North Dakota (Medicaid)||New Mexico (Medicaid)||Missouri|
|Oregon||New York (Medicaid)||Montana|
|Vermont (draft)||North Carolina||Nevada|
|Washington (Medicaid)||Oklahoma||New Hampshire|
- The first two columns describe the policy of existing or draft assisted living regulations that require apartments or license multiple settings (apartment units and rooms). The last two columns list states whose policy addresses only bedrooms through assisted living or board-care regulations.
- Arizona's new regulations require apartments in assisted living centers (facilities with eleven or more units) and allow shared rooms in assisted living homes (<10).
Space requirements under board-and-care rules typically require 80 or 100 square feet for single units and 60 or 80 square feet per resident in shared units. Alabama requires 130 square feet for double units, and New Hampshire requires 140 square feet. Several states with assisted living rules that require apartments do not specify a square footage (Connecticut, New Jersey), while Arizona, Oregon, and Washington require at least 220 square feet of living space, not including closets or bathrooms.
Table 2 presents state policy concerning living units. States that allow shared units generally have developed policy that broadens the scope of residential options and may create two or more types of buildings, each with different requirements (eg., Florida, New York, Texas, Utah). The table may also be expressed as a continuum. On one end are residences that offer single occupancy units with kitchenette and skilled services to residents. On the other end are residences that provide shared units without cooking capacity to residents who cannot receive skilled services in an assisted living setting. While a state's policy sets the parameters for what may be offered and provided, the actual practice may be more narrow. Shared units may be allowed, but the market may produce very few or no projects that offer shared units. Further, facilities constructed prior to the development of assisted living may offer shared units while most, if not all, newly constructed buildings have private units.
5. New Jersey's rules require apartment settings for all new construction but allowed existing Personal Care Homes with shared rooms to convert to assisted living.