States Updating Assisted Living Regulations as Industry Evolves

Because assisted living is regulated on the state level, there are multiple efforts under way at any given time to update and refresh assisted living rules and regulations. Even when legislators are not in session, they are still making progress on aligning regulations with the changing needs of assisted living residents.

“States, usually on an annually basis, make regulatory and legislative assessments, and are constantly tweaking regulations to meet a dynamic industry like assisted living,” says Paul Williams, senior director of government relations at ALFA. “Considering regulatory changes and adding new laws to statute happens on an almost continual basis.”

Although legislators are between sessions currently, the time period after the legislative session has ended provides the opportunity for ALFA and other senior living provider organizations to get together to have “rule workshops.”


Ideally, the rule workshops provide the ability for organizations representing both providers and consumers to collaboratively work together to create rules and regulations that ultimately enhance the quality of life for senior residents.

During these periodically-held sessions, every state examines current administrative rules and regulations to see what might be obsolete as the dynamics of providing care change.

“Communities today are much different than ones 10 or 15 years ago,” says Williams. “Many times it’s a matter of updating previous rules and taking a fresh look.”


Adjusting or creating new regulations also keep in mind consumer preferences to ensure that state government and other state partners are meeting the needs of assisted living residents, with consumer safety of paramount concern for any regulatory change.

Two states in particular are currently in the process of updating existing regulations to better define assisted living, and address the kind of care communities are qualified to provide and Florida is looking at a legislative change.

Top of Mind in Florida

Florida has been working on legislation for the past couple of years that gives regulatory agencies at the state level the ability to give appropriate sanctions, fines, or even close a community if there is cause for concern for residents’ quality of life.

The state is also looking to take this legislation a step further by including additional rule proposals that take into account what services Florida seniors will need.

Current Florida statutes and rules prohibit trained staff at assisted living communities from administering certain medications if they are not licensed health care professionals. In other states, assisted living staff can become medication technicians with the ability to administer certain medications once they go through training and pass a competency and skills test.

It can be expensive if only licensed health care professionals are allowed to administer medications, says Williams, which is why updating this rule to allow properly trained staff the same capability can provide greater service to both providers and residents at less cost.

Also on the regulatory radar in Florida is a need to update the state’s definition of assisted living, as it currently applies to care services for the elderly and those with mental health issues.

Since a more age-diverse population of mental health residents have entirely different needs than frail seniors, according to Williams, there needs to be a demarcation for consumers when talking about assisted living so that there is greater transparency in the type of services available.

These are a few key points that ALFA and other assisted living organizations would like to include into legislation already filed by Florida Senator Eleanor Sobel (D-Hollywood) that grants the state the ability to enforce rules and act expeditiously in doing so.

While Senator Sobel has not yet written her bill for next year, she has indicated a willingness to review the proposals and concepts brought forth by ALFA.

“Senator Sobel is gracious and willing to look at the proposals from our point of view,” says Williams. “We have had very good conversations with her about our mutual desire to advance care provided in Florida’s assisted living communities to those of the leading states in the country.”

Caring for Seniors in Rhode Island

Rhode Island is also working to develop new rules and regulations in accordance with residents’ changing needs.

Partnering with the Rhode Island Department of Health, the Rhode Island Assisted Living Association’s (RIALA) Health Services Committee helped introduce a bill in June 2013 that calls for an additional level of licensure for limited nursing services in assisted living.

The bill allows for some residents in assisted living and other long-term care settings to age in place without having to transfer to costlier, institutionalized settings.

As Rhode Island is a heavily populated state with a substantial senior population, the forthcoming regulations aim to provide a better definition of what residents in assisted living and skilled nursing should look like, according to Karen Peck, vice president of healthcare services for Brookdale Senior Living.

“Some of the things we’re looking at are how the assisted living resident has changed today, such as the current needs of the resident as well as future needs,” says Peck.

Composed of various senior living providers in Rhode Island, including Brookdale Senior Living, Benchmark Senior Living and Atria Senior Living, the Health Services Committee is working with the state Department of Health to devise preliminary regulations and expects to have a draft of what these regulations might look like in further detail by early September.

Though it is hard to say what the preliminary regulations are at the moment, Peck says they will address a list of definitions of what limited health services would look like, including allowance for some nursing services, extra staff training components and adding some medical oversight for quality assurance.

While Florida and Rhode Island are but a few slices of the larger industry-wide regulatory efforts, other states like Arizona and Maryland are also working taking proactive approaches toward improving assisted living rules and regulations.

“It’s ludicrous to say that states go years and years without looking at assisted living,” says Williams. “Bills are filed every year and rules are updated on a frequent basis.”

Written by Jason Oliva 

This article is sponsored by the Assisted Living Federation of America (ALFA) as part of its efforts to advance excellence and explore topics impacting the future of senior living. For more information about ALFA, visit

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