Section III: State Summaries (continued, 2)

Residential Care and Assisted Living

New Mexico

Approach

The Department of Health licenses adult residential care facilities. The survey staff performs on‑site survey/monitoring visits at all adult residential care facilities to determine compliance with the regulations, investigate complaints, and investigate the appropriateness of licensure for any alleged unlicensed facility. When violations are found, the facility submits a plan that addresses how violations will be corrected, when they will be corrected, how the facility will identify other residents that potentially could be affected by the same deficient practice, and how the facility will monitor its corrective actions.

Communicating with Consumers

The Department of Health Web site has links to the licensing regulations, caregiver criminal background check manual, and incident reporting forms.

The State's Aging and Long Term Services Department Web site contains a brief description of assisted living under the section on long-term care services. There is also a link to a list of facilities compiled by the New Mexico Health Care Association. 

Top of Page

New York

Approach

The Department of Health, Division of Home and Community Based Care licenses adult care facilities. Licenses are issued for 4 years. Facilities are inspected annually or more often as needed. Inspections include, but are not necessarily limited to, examination of the medical, dietary, and social services records of the facility, as well as the minimum standards of construction, life safety standards, quality and adequacy of care, rights of residents, payments, and all other areas of operation. Two inspections per year are conducted for private proprietary adult homes. Other types of inspections include:

  • Complete inspections prior to certification or renewal.
  • Complete inspections when there are serious or continual deficiencies.
  • Summary inspections to determine compliance with key regulatory provisions in all areas of operation.
  • Partial inspections to examine specific areas of operation.
  • Inspections in response to a complaint to determine the validity of the complaint.
  • Followup inspections to determine whether deficiencies noted during a previous inspection have been corrected.
  • Other inspections as necessary.

In October 2002, the State implemented new policies regarding the oversight of adult homes. These new policies include: reinforcement of mandatory death reporting by homes and immediate investigations of such reports; multi-agency created profile of deaths at the homes to identify patterns; and increased surveillance. The Department offers training to operators and select staff. Training on medication administration was held in 2004. The Department distributes letters to administrators that address new developments or requirements such as: reporting of deaths, attempted suicides, and felony crimes; notice of regulation (failure in systemic practices and procedures); maintenance of safe and comfortable temperature levels within adult homes; influenza prevention and control; establishment of a complaint hotline; emergency preparedness guidelines; statistical reporting requirements; case management obligations; facility access by individuals who are not residents; sprinkler head recall; waiver request/equivalency notification; guidelines for dementia units; availability of free or low-cost resources to residents; and notice of law (e.g., Long-term Care Resident and Employee Immunization Act).

Communicating with Consumers

The Department of Health Web site has a description and definition of the various types of residential facilities: adult homes, enriched housing, and assisted living programs. The Department posted a list of facilities by county that includes the name, address, phone number, type of facility, and number of beds. A list of facilities surveyed is posted quarterly. The list includes the name of the facility, the report date, and areas in which violations were found (e.g., admission-retention, environmental, resident services, food service). Details about the content of the report are not posted. A "do not refer" list is also posted which identifies facilities that have closed, may not accept new admissions, or are not certified. The site also has links to relevant press releases.

The Office for the Aging Web site has two resource buttons on the home page. A click on "senior housing" leads to a page with links to the definitions of 13 types of housing including adult homes, enriched housing, enriched housing/adult homes with limited home care agency, and assisted living programs. It also leads to a list of questions consumers should ask and a search function by county and type of housing. The search results display the name, address, and phone number of the facility and a link to the facility's Web site. The "find help" button leads to a Senior Citizen Resource Guide that describes adult care homes, assisted living, congregate housing, supportive housing, and enriched housing. 

Top of Page

North Carolina

Approach

The Department of Health and Human Services, Division of Facility Services (DFS) licenses adult care homes. County Departments of Social Services (DSS) monitor adult care homes at least every other month. State staff members provide consultation, technical assistance, and training to the county monitors. State staff members also provide monitoring oversight and perform selected surveys of homes based on compliance history or lack of previous county monitoring.

Legislation passed in 2005 (SB 622) requires that DFS inspect adult care homes at least annually. The new law also gives DFS new responsibilities for reviewing the performance of county DSS functions. DFS will conduct annual reviews of county oversight activities. DFS may apply a range of corrective actions for failure to appropriately monitor adult care homes, such as providing technical assistance, advising staff about policies and procedures, and establishing a plan of correction. The law sets minimum training requirements for county adult home specialists.

SB 622 directs the Division of Aging and Adult Services to develop a quality improvement consultation program. The Division will implement a pilot quality improvement program and file a report with the legislature that addresses principles and philosophies that are resident-centered and promote independence, dignity, and autonomy; approaches to developing a continuous quality improvement process; dissemination of best practices; the availability of standardized instruments to measure adult care home performance on quality of life indicators; the training needs of county DSS staff; clarification of the roles of the DFS and county DSS offices; and the staffing needed to carry out the program.

Communicating with Consumers

The Department of Health Human Services, Division of Facility Services Web site has links to the statute and regulations, as well as a listing all adult care homes, which includes the name of the facility, address, phone number, and numbers of beds. It also includes a step-by-step explanation of the process for obtaining a license but notes that there is a moratorium on new licensed facilities. The site has links to requirements for administrators, an application, and a schedule for tests for administrators; a list of courses for continuing education credits; and information about exams for staff who assist with medication administration. A log of penalties assessed against adult care homes is posted.

To find information on the Division on Aging and Adult Services Web site, click on the long-term care options/ombudsman link or the housing link. The long-term care link leads to adult care homes. This page describes adult care homes, has a link to a list of licensed facilities, contacts in county Department of Social Service offices, a description of residents rights, information about the ombudsman program, and answers to frequently asked questions about long-term care options. The housing link leads to a statutory definition of assisted living and a description of multi-unit assisted housing, including independent housing units with services. 

Top of Page

North Dakota

Approach

The Department of Health, Division of Health Facilities licenses basic care facilities annually. Facilities are inspected every 2 years. Complaints are investigated as they occur. The inspections cover quality of life, quality of care, dietary services, medications, the environment, social services, personal care, and nursing services and include a life safety code inspection. Inspectors talk to residents about resident rights and whether they are receiving the services they need. The number of residents interviewed varies with the size of the facility.

In 2005, legislation was passed directing the Department to conduct a pilot study to determine whether announced or unannounced inspections have an impact on the number of deficiencies found. A report was due to the legislature for consideration during the 2005-2006 interim sessions, including a recommendation as to whether the unannounced survey process should continue for all basic care facilities.

Communicating with Consumers

The Department of Health Web site has links to the regulations and a file that lists the name, address, phone number, administrator's name, and number of beds for each basic care facility. The site also allows users to search a database by city to obtain this information.

The Adult and Aging Services Division uses the Department's Web portal. The "Senior Information Line" includes a glossary with definitions of assisted living and adult residential care homes. The site includes provider information, as well as a list of facilities; the name, address, and phone number of each facility; links to facility Web sites; and other information. 

Top of Page

Ohio

Approach

The Department of Health licenses residential care facilities. Facilities are inspected at least once prior to the issuance of a license, at least once every 15 months, and as the Department considers necessary. The inspections may be announced or unannounced, except that one unannounced inspection is conducted at least every 15 months. The State fire marshal or a township, municipal, or other legally constituted fire department approved by the fire marshal also inspects a residential care facility prior to issuance of a license, at least once every 15 months thereafter, and at any other time requested by the director. Inspections are compliance-based and do not incorporate a consultative or collaborative component.

The Department formed a speaker's bureau that is available to address topics related to the regulations and requirements, including the survey process and rules or statistical review of care issues cited in Ohio.

Communicating with Consumers

The licensing regulations are available on the Department of Health's Web site. The site also has a link to a searchable database of licensed facilities. The information listed includes the name, address, and phone number of the facility; the name of the administrator; an E-mail address; the license status, date of issue, and date of expiration; licensed capacity; the date the facility opened; and the special services that are available, such as "dementia," "adult day care," or "hospice."

A consumer guide to long-term care is available on the Department of Aging Web site. It has a section on housing and care options with a link to the Ohio Assisted Living Association's Web site. The State legislature directed the Department to expand the information available about assisted living. The work plan includes developing a satisfaction survey and a tool to measure regulatory compliance that was scheduled to be ready in the spring of 2006. 

Top of Page

Oklahoma

Approach

The Department of Health (DOH) is responsible for licensing and inspection of assisted living centers and continuum of care facilities. DOH conducts an unannounced inspection of each facility at least once every 15 months. DOH provides written notice of all violations, and the facility has 10 business days to respond with a written plan of correction. After review, the State provides the facility with its response. If an assisted living center provides or arranges for skilled nursing care, the State must assess the quality of that care against applicable national standards of practice adopted by the American Nurses Association and specialty nursing organizations.

Each center must have a quality assurance committee that meets at least quarterly to monitor trends and customer satisfaction and document quality assurance efforts and outcomes. The committee must include an RN or physician, the administrator, a direct care staff member or person responsible for administering medications, and a pharmacist consultant if a medication problem is to be monitored or investigated. The Department may inspect centers whenever it deems it necessary.

Communicating with Consumers

The Department of Health Web site has a listing of facilities, including the name of the facility, address, phone number, number or beds, number of Alzheimer's beds, and the facility's identification number.

The Aging Services Division home page has a link to housing information, which includes a brief description of assisted living, continuum of care facilities, and residential care. This page also includes a link to the list of facilities maintained by the Department of Health. A guide on long-term care options presents brief explanations of residential resources. 

Top of Page

Oregon

Approach

The Oregon Division of Seniors and People with Disabilities (SPD) licenses assisted living facilities and residential care facilities. The licensing agency conducts periodic monitoring visits at least every 2 years. The facility must develop and conduct an ongoing quality improvement program that evaluates services, resident outcomes, and resident satisfaction. Staff of the Department may visit, inspect, and monitor assisted living facilities at any time (but no less often than once every 2 years) to determine whether they are maintained and operated in accordance with these rules.

Communicating with Consumers

The SPD Web site has a database that allows users to search by facility type, name, and county. The search generates the name, address, phone number, administrator's name, original date of license, capacity, and whether the facility accepts Medicaid. The site also lists facilities that have received an endorsement for Alzheimer's Care Units. The Web site has several links to tools for consumers, including an overview, what it means to be licensed, the types of facilities that might be considered, what the different types of facilities have in common, and how to start a search for a facility. A consumer's guide and uniform disclosure form are also posted. 

Top of Page

Pennsylvania

Approach

Personal care homes are licensed by the Department of Public Welfare, Division of Personal Care Homes. Licenses are issued for 1 year or less, and homes are inspected at least annually. The survey guidelines are being revised to reflect changes in the regulations. The draft guidelines, which are not final, describe the procedures to follow for record reviews, staff and resident interviews, recording techniques, and methods for determining compliance. The guidelines also include interpretations of the regulations, examples of best practices, and recommendations and information that may be helpful to the personal care home staff. Complaints are triaged and must be investigated according to timeframes that are based severity. Inspection reports are available to the public upon request. The results of complaint investigations are available after redacting. The Department plans to post survey findings on its Web site within 2 years.

New regulations effective in October 2005 require homes to establish a quality assessment and management plan that includes incident reports, complaint procedures, staff training, monitoring of licensing violations and plans for correction, and establishing resident and/or family councils. The quality management plan includes the development and implementation of measures to address the areas needing improvement that are identified during the periodic review and evaluation.

Communicating with Consumers

The Department of Public Welfare maintains a Web site that has general information about personal care homes, a guide for choosing a personal care home, and information about filing complaints. The site allows users to search for personal care homes by county and find the name of the facility, address, phone number, capacity, and whether it is for profit or non-profit.

The State's Intra-Government Long-term Care Council prepared two reports with recommendations on assisted living: Assisted Living: A Choice for the Future, July 1999 and Assisted Living: Long Term Care and Services Discussion Finding, February 1999. These discussions and recommendations address consumer choice, defining assisted living, aging in place, shared risk, regulation and quality, and funding. 

Top of Page

Rhode Island

Approach

The Department of Health licenses assisted living facilities and inspects and investigate facilities at least once a year or as needed. Representatives of the licensing agency have the right to enter facilities at any time without prior notice to inspect the premises and services. Facilities are given notice by the licensing agency of all deficiencies reported as a result of an inspection or investigation. A consultation/collaboration model may be implemented when additional staff members are available. The licensing agency noted the importance of having registered nurses and pharmacy consultants available to monitor the assessment process, appropriateness of admission, and medication issues.

Residences are required to develop, implement, and maintain a documented, ongoing quality assurance program to attain and maintain a high quality assisted living residence. This ongoing process for quality improvement, includes monitoring, identifying areas to improve, developing methods to improve them, and evaluating the progress achieved. Areas subject to quality assurance review include at least personal assistance and resident services, resident satisfaction, and incidents (for example, resident complaints, medication errors, resident falls, and injuries of unknown origin).

The administrator must maintain a written plan that includes three areas for quality assurance/improvement review and describes the monitoring, identification, and evaluation processes; tracking methods; and the responsible individuals.

There are minimum statutory requirements for the information that must be disclosed to potential residents and their families: identification of the residence and its owner and operator; the level of license; admission and discharge criteria; the services available; financial terms including all fees and deposits and any first-month rental arrangements; the policy regarding notification to tenants of increases in fees, rates, services and deposits; and the terms of the residency agreement.

Communicating with Consumers

Facility licensing regulations are posted on the Department of Health Web site. The Board of Assisted Living Residence Administrators maintains a Web site with links to disciplinary actions taken against administrators, members of the Board, meeting dates, and the regulations for licensing administrators.

The Department of Elderly Affairs home page has a link to home care services that includes a brief description of assisted living. The Pocket Manual for Elders has additional information, including telephone numbers for the Department of Health and the Rhode Island Assisted Living Association. 

Top of Page

South Carolina

Approach

The Department of Health and Environment licenses community residential care facilities. Facilities are licensed annually. General inspections and fire, life, and safety inspections are done on alternate years. Facilities with a history of compliance and no complaints may have a general inspection every 3 years. Inspectors must have a college degree, and an RN is available to assist with clinical issues. Inspectors provide technical assistance during their site visits. Facilities may also request technical assistance independent of an inspection visit. Inspectors use a checklist during their reviews. The process includes interviews with residents based on the inspector's observations.

Facilities must submit a plan of correction to the State licensing agency when issues of noncompliance are documented. Consultations are available as requested by facilities or as deemed appropriate by the State.

Facilities must have a written quality improvement program. The program must establish desired outcomes and the criteria by which effectiveness is accomplished; identify and evaluate the causes of deviation from desired outcomes; develop action plans to prevent future deviations; establish quality indicators; analyze appropriateness of care plans; review all incidents and accidents including resident deaths, infections, or other occurrences that threaten the health and safety of residents; and create a systematic method of obtaining feedback from residents and other interested parties on the level of satisfaction with care and services received.

Communicating with Consumers

The Department's Web site includes licensing regulations, a list of licensed facilities (name, address, phone, contact person, license number and expiration date, and the licensed capacity), and information for providers. The provider documents include licensing procedures and requirements, information on criminal background checks, emergency evacuation requirements, level of care criteria, changes in medication administration training, a self-inspection guide that tracks the regulations, special care disclosure requirements, staff orientation and in-service checklist, a request for consultation form, and frequently asked questions.

The Office on Aging hosts a Web site with a searchable database of all the services available in the State. Selecting assisted living (community residential care facilities) from the drop down menu produces the list of facilities with descriptions of the services available. Each listing has a link to an array of information that sometimes varies from facility to facility. The information includes a description of services available, location, area served, intake requirements, client information (conditions, age group, sex, grievance process), fees and payment sources accepted, hours of operation (service availability), address and phone number, and additional information about eligibility and affiliated programs or agencies. 

Top of Page

South Dakota

Approach

The Department of Health licenses assisted living centers for 1 year. Facilities are inspected at least annually, with surveyors using a protocol based on the regulations. The protocol reviews observation of staff passing medications, four record reviews (including one closed record), and interviews with three residents using a list of questions that address resident rights, staffing, meals, activities, and medications. Surveys and deficiency reports are computerized.

The governing body of each facility must develop a process to evaluate the quality of services provided to residents. Quality assurance evaluations must include the establishment of facility standards, interdisciplinary review of resident services to identify deviations from the standards and plans of correction, resident satisfaction surveys, use of services provided, and documentation of the evaluation. The Department also implemented a quality assurance process. Staff members review completed surveys to determine if the regulations cited are correct, whether there is sufficient evidence to issue the citation, and whether the plan of correction will prevent further violations.

The Department provides education and support to facilities regarding quality of care and compliance with the regulations during monitoring visits. Licensing staff are invited regularly to present at the semiannual association meetings. The State licensing office distributes to facilities up-to-date information concerning quality and trends in assisted living. The Department holds an annual public hearing for providers to discuss current issues and concerns.

Communicating with Consumers

The Department of Health Web site has links to the licensing regulations and a list of licensed facilities.

The Office of Adult Services and Aging Web site describes assisted living and links to the State licensing regulations, presents a consumer's guide to assisted living, and links to Medicaid eligibility information. The guide has sections on requirements for assisted living, considering assisted living, looking for the right facility, staffing and services, costs, extra costs to consider, admissions agreement, what to know before signing an agreement, complaints, notice of non-discrimination, and contact information. Several of the sections include questions to ask facility staff. 

Top of Page

Tennessee

Approach

The Department of Health, Division of Health and Environment licenses assisted living centers. Inspections are conducted annually (9-15 months). Revised rules in 2003 added language concerning the reporting of unusual events. A facility must report the abuse of a patient or unexpected occurrence or accident that results in death or a life-threatening or serious injury to a patient to the Department of Health within 7 business days. Circumstances that could result in an unusual event are outlined in the regulations. Specific incidents that may result in a disruption of the delivery of health care services at the facility also must be reported within 7 business days. The facility must file with the Department of Health a corrective action report within 40 days of the identification of the event

Survey staff members have a regulatory focus but do provide education about the requirements. The State inspection and monitoring process serves as a regulatory function only. However, when the State develops policy or interpretive guidelines, they do request the input of industry providers. If through the oversight process a particular problem area is identified, the State will work with the assisted living association to provide training and education at association meetings, rather than provide one-on-one consultation and training to individual providers.

The Department of Health develops interpretive guidelines for regulations. Department policy was issued to all ALFs in January 2004, to provide criteria for hospice waivers in the facilities. Another policy bulletin was issued concerning T.C.A. 68-11-20(5)(A)(i), which prohibits residents with later stages of Alzheimer's disease or related disorders from being admitted or retained in an ALF.

Communicating with Consumers

The Department's Web site includes links to the licensing rules, a description of the process to apply for a license, and a list of facilities (name, address, phone, administrator, ownership information, the license number, the licensed capacity, the date of the last survey, the date of the original license, and the expiration date).

The Commission on Aging and Disability Web site has a link to the list of licensed facilities posted on the Department of Health's site. 

Top of Page

Texas

Approach

The Department of Aging and Disability Services (DADS) licenses assisted living facilities. Facilities are licensed annually and are inspected by a team consisting of a registered nurse, social workers, and a life safety code specialist. Each member of the team has assigned tasks. During the inspection, surveyors meet with the person in charge, review the process, and request lists of residents and staff, schedules, training records, incident reports, policies and procedures, the services provided, and the facility's disclosure form.

During a tour, the surveyor observes the general operation of the facility and resident activities. General interviews are held with a sample of residents, family members, and staff. A sample of resident records is also reviewed. Residents are asked if they are satisfied with the facility, the services, and food. If they are not satisfied, they are asked for details that may be explored with the manager. The team reviews their findings and completes the survey report. Survey reports may be posted at the facility or requested from the Department.

Communicating with Consumers

The DADS home page has a "find services" button with a drop-down menu that has a link to "find and compare long-term care facilities." The searchable database has information on four types of assisted living facilities. Users can search by facility name, county, ZIP code, area code, or State-wide. Search results list the name of the facility, address, owner, and number of licensed beds, as well as the number of complaints investigated and substantiated in 2003, 2004, and 2005, a listing of deficiencies cited during recent inspections, and recent events such as a change in ownership.

The business link on the home page leads to the long-term care policy and a link to forms. This page has links to disclosure forms for assisted living facilities and Alzheimer's assisted living facilities. It also contains links for providers to a general checklist used by surveyors, a checklist for life safety code requirements for different types of facilities, a list of providers of courses for assisted living managers, and several monitoring forms. 

Top of Page

Utah

Approach

The Department of Health, Bureau of Health Facility Licensing, Certification, and Resident Assessment surveys facilities annually and issues a license for a 2-year period. The Department's Web site includes a report card that lists the name of the facility and the number of class I and II violations in 2001, 2002, and 2003. Details about the violations are not posted. A database of facilities by county or city includes the name, address, phone, type of facility, the date the license was issued, and the number of beds. A monthly census summary is also posted. Forms available on the Web site include interpretive guidelines, general forms for service plans, incident reports, negotiated risk contracts, resident assessment, and criminal background checks. A summary of the levels of care is also available.

Communicating with Consumers

The Health Facility Licensing Web site contains a list of facilities by county and alphabetically and a comparison of the level of care criteria for assisted living, nursing homes, home health agencies, hospice, and hospitals. Interpretive guidelines are posted that list the standard contained in the licensing regulations and guidelines used by surveyors to determine whether the facility complies with the standard. An assisted living report lists the number of class I and class II violations by facility for 2001-2003. The licensing regulations are posted on the Department's Web site. 

Top of Page

Vermont

Approach

The Department of Disabilities, Aging, and Independent Living licenses assisted living residences and residential care facilities and conducts annual surveys. Facilities that receive deficiencies must submit and implement corrective action plans.

The Department works with facilities to help them comply with the regulations. The State investigates complaints that merit investigation. Assisted living residences must have a quality improvement process that includes an internal committee comprising the director, an RN, a staff member, and a resident. The committee must meet at least quarterly. Resident satisfaction surveys must be conducted annually and be used by the committee.

Communicating with Consumers

The Department's home page has a link to "Licensing and Protection." On the left side of the page there are links to State regulations for assisted living residences and residential care homes and a list of all residential care and assisted living facilities. The list includes the name of the facility, level of care, address, phone number, contact person, and capacity. 

Top of Page

Virginia

Approach

The Department of Social Services may issue 1-, 2-, and 3-year licenses to assisted living facilities. New legislation requires that administrators of assisted living facilities be licensed by the Board of Long-term Care Administrators.

Surveyors enter information on a personal computer that has the standards and the previous history of compliance for the facility being inspected. Survey findings and corrective action plans are printed during the exit interview. Surveys are posted on the Department's Web site. Licensing officials are working to expand the system's capacity to generate management reports that would allow them to compare facilities owned by one company, to compare compliance history with other companies, and examine citation patterns of individual surveyors or regional offices.

Communicating with Consumers

The Department's Web site includes a database with the name of the facility, address, phone number, administrator, expiration date for the license, and information about inspections. The database includes inspection dates, whether the inspection was complaint related, and whether or not there were violations. Clicking the inspection date loads the areas reviewed, action from previous violation reports, technical assistance provided, and comments by the surveyor. The report also lists the standards violated, a description of the violation, and the corrective action that will be taken by the facility.

The Web site also has tools for providers, including a level of care worksheet, uniform assessment instrument and care plan, application for licensing and renewal, medication administration record, record of on-site health care oversight, record of staff training, model resident agreement, and other forms.

To find information about assisted living on the Department's home page, click services, topics, and assisted living. The assisted living link describes what the term assisted living means in Virginia and suggests clicking the link to the ombudsman program for questions about specific facilities. Click on publications and long-term care for a provider directory and a consumer guide that has a section on assisted living. The section explains what assisted living is and is not in Virginia, levels of services, meals, social activities, amenities, the admission assessment, staffing, and resident rights and responsibilities.

Page last reviewed September 2006
Internet Citation: Section III: State Summaries (continued, 2): Residential Care and Assisted Living. September 2006. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/residentcare/rescare8.html