Staff training requirements are a key component of quality assurance. A national study found that the types of required staff training and orientation varied across facilities, but for the most part, relatively little training was required. 18 Three-quarters of unlicensed personnel were required to attend some type of pre-service training or orie
As facilities are allowed to serve residents with greater needs, regulators have cited medication administration and assistance with self-medication as a major concern.
In 2003 and 2004, hearings held by the U.S. Senate Special Committee on Aging, reports by the GAO, and newspaper articles all raised concerns about the quality of care in residential care settings, and the challenges providers and state oversight agencies face in assuring quality. In April 2004, the GAO issued a report on quality assurance initiat
One of the attractive philosophical tenets of assisted living is that it allows aging-in-place--meaning that as individuals age and become more disabled, additional services can be provided so that they will not have to move to another residential care setting or to a nursing home. States seeking to facilitate aging-in-place and to offer consume
States typically have two or more levels of nursing home care and not all persons served in nursing homes may be served in residential care. States distinguish among levels of care primarily for payment purposes. As noted in the discussion of admission and retention policies, above, states typically do not allow facilities to serve persons who req
Several states--Arizona, Arkansas, Idaho, Maine, Maryland, Mississippi, Missouri, and Vermont--have two or more levels of licensure based on the needs of residents or the services that may be provided. Examples of this approach follow.
Discharge triggers are used by states to regulate the specific medical needs or treatments that can and cannot be provided by certain kinds of facilities and to determine when a resident can no longer reside in a facility. Most prohibited treatments require performance by skilled nursing personnel. States that use these triggers include: Californi
States using a full continuum approach have broad criteria that allow facilities to serve residents with a wide range of needs, permitting residents to age in place. However, providers are not required to serve everyone who meet these criteria and can establish their own admission and discharge standards within state parameters. They are required
States regulations pertaining to admission and retention typically consider applicants' or residents' general condition, health-related need including the need for nursing care, physical and cognitive function, and behavioral problems.
State Residential Care and Assisted Living Policy: 2004. Disclosure Requirements and Residency Agreements
A GAO study of assisted living facilities in four states concluded that while most facilities provide information about the services available, they do not routinely provide information about discharge criteria, staff training and qualifications, services not available from the facility, grievance procedures, and medication policies. The GAO repor
Historically, the physical character of a substantial portion of residential care was quite institutional--as permitted by state regulation--with two to four persons sharing a bedroom, and as many as eight to ten residents sharing toilet and bathing facilities. The new assisted living model of residential care became popular with older people in l
As illustrated in the examples above, assuring resident autonomy is a central concept in the assisted living philosophy.
Twenty-nine states and the District of Columbia reported that they include provisions regarding assisted living concepts such as privacy, autonomy and decision making in their residential care regulations or Medicaid standards. (See ">Table 1-3.) Some states regulations are more detailed in these matters, others are less so.
The widespread use of the term assisted living and the considerable state variability in its definition continues to fuel debate about what assisted living is and should be, how it should be regulated, particularly as the number of residents with higher levels of need increases, and whether facilities that do not support key assisted living princi
In 2004, states reported 36,451 licensed residential care facilities with 937,601 units/beds compared to 36,283 facilities with 909,196 units/beds in 2002; these numbers do not include facilities licensed as adult foster/family care or facilities licensed by Departments of Mental Retardation/Developmental Disabilities (MR/DD) or Mental Health. 1
This compendium describes regulatory provisions and Medicaid policy for residential care settings in all 50 states and the District of Columbia. It updates an earlier report completed in 2002. Information was collected between February and June 2004 by reviewing state web sites and regulations and calling key state contacts to verify information.
We would like to acknowledge the following for their contributions to this project: the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services for its financial support; Christine O'Keeffe for her extensive research assistance; and the many people in state agencies through the country who answer
Robert Mollica and Heather Johnson-Lamarche National Academy for State Health Policy Janet O'Keeffe RTI International PDF Version: http://aspe.hhs.gov/daltcp/reports/2005/04alcom.pdf (510 PDF pages)
U.S. Department of Health and Human Services International Evidence on Disability Trends among the Elderly Timothy A. WaidmannThe Urban Institute Kenneth G. MantonDuke University June 18, 1998 PDF Version: http://aspe.hhs.gov/daltcp/reports/1998/trends.pdf (40 PDF pages)