NCAL Report: More Than Half of States Made Changes to Assisted Living Regulations Last Year

Most common updates were to staffing requirements

WASHINGTON, D.C. - Assisted living regulations, statutes, and policies in 29 states were updated between June 2017 and June 2018, according to the National Center for Assisted Living’s (NCAL) 2018 edition of “Assisted Living State Regulatory Review.” The association released the latest edition of its annual review today. The report found that the most common changes to state regulations were in the area of staffing, such as additional training requirements and expanded background check requirements.

“As assisted living grows in its role within the long term care continuum, it is no surprise to see state regulations increase as well,” said Scott Tittle, NCAL Executive Director. “NCAL supports developing state regulations with a measured approach, in collaboration with providers and other stakeholders, while continuing to promote person-centered care.”

Nine states made a wide range of changes that affect training or qualifications for assisted living staff: Colorado, Florida, Louisiana, New Hampshire, North Carolina, Ohio, Oklahoma, Oregon, and Texas. For example, Louisiana added a requirement that orientation for direct care staff includes an evaluation to ensure competence to provide assistance with activities of daily living (ADLs) and instrumental ADLs. Meanwhile, Oklahoma passed legislation to require all medical and direct care staff to complete in-service training on Alzheimer’s and dementia-related care.

NCAL’s Assisted Living State Regulatory Review summarizes key selected state requirements for assisted living licensure or certification. It includes information on 20 categories, including which state agency licenses assisted living as well as recent legislative and regulatory activity. Additional categories cover requirements for resident agreements, admission and discharge policies, scope of care, life safety, among others.

Additionally, this year’s review found that a number of states made updates to requirements in the areas of residents’ rights, emergency preparedness, and defining or reporting resident abuse and neglect. Of note:

  • California passed a law enacting the Lesbian, Gay, Bisexual, and Transgender Long-Term Care Facility Residents’ Bill of Rights that, among other things, makes it unlawful for assisted living communities to take certain actions such as deny admissions based on a person’s actual or perceived sexual orientation, gender identity, gender expression, or human immunodeficiency virus (HIV) status.
  • Colorado conducted a comprehensive review of its assisted licensure rules, which resulted in updating the definitions of abuse and mistreatment, new reporting and investigation provisions, and a requirement for providers to have policies and procedures that address the investigation of abuse, neglect and exploitation allegations.
  • Florida regulators issued a new rule that each assisted living community was to prepare a detailed plan to supplement its Comprehensive Emergency Management Plan, in order to address emergency environmental control in the event of the loss of primary electrical power in that facility.

NCAL anticipates the trend for increasing state regulations to continue, with exactly half of the states reporting that over the next year they will be proposing, formally reviewing, or considering changes that would affect assisted living communities.

“The potential changes range from a complete review of the licensure requirements to targeted regulatory updates to implementation of new legislation, as well as changes to Medicaid requirements for participating assisted living communities,” said Lilly Hummel, NCAL’s senior policy director and the report’s author.

The full report along with each states’ summary is available at​.