How New Mass. Regulations Are Changing Assisted Living

New assisted living regulations in Massachusetts address a growing trend nationwide: An increasing number of frail residents with dementia. However, authorities backed away from a controversial provision that would have barred assisted living placement for people with certain care needs.

The Executive Office of Elder Affairs issued the new regulations in late January, marking the first update since 2006. Consumer advocates had pressed authorities for this new revision, saying that the rules had not kept pace with changes such as more residents in memory care. While some of the new regulations specifically address this issue, they are a comprehensive update and impact nearly all aspects of assisted living.

Notable changes include:

  • Increased activities for residents with dementia: Under new “Special Care” provisions, providers that market specific dementia-related services must have a multipurpose activity space. They must have structured activities offered three times in a 24-hour period, as opposed to simply “on a daily basis,” as previously stated. All Special Care residents that begin an initial certification process after Oct. 1, 2015, must have a secure outdoor space.
  • More intensive resident screening: A nurse now will be required to conduct a screening of prospective residents that includes an assessment of functional abilities based on cognitive status. The nurse should evaluate whether the person is capable of self-administering medication.
  • Upgraded disaster and emergency planning: Plans now must include specific evacuation strategies for different types of events, as well as protocols for participating in the Silver Alert system for locating missing people who have dementia.
  • Tighter management of controlled substances: Providers now must document and implement policies to prevent theft or diversion of prescription medications taken by certain residents, including safe storage and disposal methods for the controlled substances.
  • Distribution of end-of-life care information: Facilities now are called on to furnish “culturally and linguistically suitable” information on end-of-life care options, such as hospice and palliative care, to certain residents, including those who have a terminal diagnosis.

Other states, including California, recently have updated their assisted living regulations as well. Reform efforts have been spurred in part by a scathing Frontline/ProPublica documentary that aired in 2013, which claimed that some assisted living facilities are providing inadequate care for high-acuity patients who really belong in a skilled nursing facility.

An earlier draft of the new Massachusetts regulations called on assisted living providers to discharge residents who needed skilled care for 90 consecutive days. Providers protested that transferring frail seniors of out assisted living to a nursing home or other setting would be traumatic, and this provision was scrapped, according to The Boston Globe. Provider association Mass-ALFA is supportive of the final version of the regulations.

“While there are a number of aspects to these new regulations that will require changes in the way residences operate, we feel confident that the final regulations strike the right balance between the desire for safe residence environments and the values of dignity, choice, and independence that make assisted living an option that older adults want and deserve,” states Michael Banville, acting president of Mass-ALFA, in an email to Senior Housing News.


Banville says Mass-ALFA will work with the Executive Office of Elder Affairs to implement the regulations. The roughly 200 Bay State assisted living facilities must be in compliance with the revised regulations by July 1, 2015.

Click here to access a complete copy of the regulations, released Jan. 30.

Written by Tim Mullaney

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