Staffing, Memory Care Dominate New Assisted Living Regulations

Assisted living regulations have shifted in focus in the last three years, with states now focused on staffing and training requirements rather than disclosure and reporting.

The 2016 regulations are seen in the latest edition of the Assisted Living State Regulatory Review, issued by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) .

The Washington D.C.-based AHCA/NCAL represents providers in the senior living community including skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and development disabilities.


The association complied this report after reviewing each state and the District of Columbia between March 2016 and June 2016 on their assisted living regulations and statutes.

Acuity continues to rise among assisted living communities, which is pushing state representatives to make changes and implement news rules surrounding staffing and training.

Eight states reported changes to requirements for general staffing and training, including California, Florida, Iowa, Idaho, Louisiana, Massachusetts, Minnesota, and South Carolina, according to the report.


“The most common changes that were seen in this year’s report had to do with staffing and training,” Lilly Hummel, author of the report and senior policy director at NCAL, told Senior Housing News. “Though the requirements vary by state.”

For example, South Carolina now requires staff and direct care volunteers actively on duty to be present in the facility, awake and dressed at all times, the report said.

On the training side, requirements among assisted living facilities are increasing.

“Communitties in those states are building up training requirements and adding on hours that staff will have for training per year,” Hummel explained.

Florida updated its requirements to include additional pre-service training requirements for staff before they even interact with residents. The state also increased training from four hours to six hours for unlicensed staff who assist residents with medications.

In Louisiana assisted living facilities, staff are now mandated to complete 12 hours of in-service training each year, in addition to training specific to dementia patients.

Focus on Memory Care

A number of the staffing and training regulations across the country specifically implemented new policies surrounding memory care.

“It was clear that states are continuing to work on the same topics around training and staffing around dementia care requirements,” Hummel said. “It wasn’t coincidental that they were all doing it. It’s an ongoing trend because acuity in communities is increasing around the country.”

There were five states in particular that made changes to requirements for units that serve people with Alzheimer’s or other dementias. Those states include Iowa, Louisiana, Massachusetts, Nebraska, and Oregon.

Louisiana proposed new regulations to establish specialized dementia care programs for assisted living communities, and Nebraska created a voluntary state endorsement for memory care units.

Another regulation put in place in Iowa addresses sexual relationships in memory care facilities, which brings into play the tough decision on setting boundaries for dementia patients and sex.

In Iowa, the policy addresses sexual relationships between tenants with a Global Deterioration Scale greater than five, and also addresses relationships between staff and residents. The policy also included specific training for staff on this topic to help workers develop procedures concerning patients’ risk for elopement.

Several states also reported making changes to comply with the 2014 home- and community-based services (HCBS) waiver rule, the report found. A handful of senators from various states took action recently due to concern that the rule may cause residents in assisted living facilities to move out.

“I’ll be watching the extent of the home- and community-based service provider waiver rule and how it affects all assisted living communities,” Hummel said. “I don’t have a prediction as to how it will turn out, but I’m very curious to see because I know it will vary greatly by state.”

Aside from the future of the HCBS waiver rule, the focus on staffing will continue to be modified by state, Hummel explained.

“Staffing will continue to be a top issue in assisted living because communities will have to respond to the level of acuity as well as ensure they offer person-centered care,” Hummel said. “I expect to see the same level of focus in the coming years. ”

Many of the regulations being implemented in assisted living communities are fine tuning, which make them easier to adapt, said Hummel.

“Generally most new assisted living regulations are fine tuning of aspects of the state’s requirements, which is why we believe the state regulatory model works well for the profession,” she said. “We have every confidence that assisted living providers are equal to the task of meeting these changes.”

Written by Alana Stramowski

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