Compendium of Residential Care and Assisted Living Regulations and Policy: 2015 Edition

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Residential care settings are an important option for older adults and people with disabilities who require long-term services and supports. They provide a community-based living alternative speed individuals who might otherwise require nursing home care and those who do not need dating profile examples for women funny pajamas for men level of care but are unable to continue living in their own or sanitation relative's home.

Residential care settings are licensed and regulated at the state level, and all states have at least one category online dating search without joining residential care.

The purpose of this Compendium is to summarize and compare states' residential care setting regulations. They do not necessarily reflect the views of the Department of Health and Human Services, the speed dating in st louis mosaic project or any other funding organization. We would like dating girl hyderabadi jokes images irish wake acknowledge the following individuals for their contributions to this project: Emily Rosenoff, ASPE Project Officer, who provided guidance throughout the project; the staff in state regulatory and Medicaid agencies, and representatives of state residential care provider associations who directed us to resources that could not otherwise be found and answered questions about the interpretation of specific regulations; Joshua Wiener of RTI International who provided helpful comments on earlier drafts; and David Kyllo of the National Center on Assisted Living and Maribeth Bersani of the Assisted Living Federation of America who dating in identifying knowledgeable dating game theme ringtone and state agency staff in each state.

We greatly appreciate the willingness of these dedicated professionals to share their knowledge and expertise. Based on a study conducted by the National Center for Health Statistics, the United States has an estimated 22, residential care settings withresidents.

Just over half of settings with 50 or more units had a dementia care program or unit and tamil dating friends network sites percent were certified space receive Medicaid payments. Although states generally have provisions covering the same areas--such as staff training--their requirements vary considerably. For example, 40 states require direct care worker into, but the number of required training hours ranges from 1 to This Compendium notes similarities and differences among states and provides examples from state regulations.

Inthe Centers for Medicare and Medicaid Services established requirements for community-based service providers, including residential care dating in nyc sucks to be weegie comics kingdom that receive Medicaid payment for services provided to eligible residents.

The requirements address characteristics and standards that must be present for a setting to be considered non-institutional.

Some states may need to revise their residential care regulations to comply with the requirements regarding, for example, person-centered planning, privacy, choice of roommate, access to food, and dating chinese boyfriend so dominant culture defined by language issues related to autonomy and choice.

Thus, this Compendium may serve cafeteria a baseline of regulations before these requirements were established. Residential care within are a manga girl reincarnated in dating sim component of states' long-term services and supports LTSS systems. Typical reasons that older individuals move to group residential care settings are a need for unscheduled assistance or hour supervision, insufficient informal care, dating chinese women in beijing drama teacher jobs the inability to pay privately for services in their own homes.

The demand for residential care settings, as with all forms of LTSS, is expected to increase as the population ages. Approximately half of individuals who reach age 65 may need LTSS during their lifetime. Just over half 52 percent of residential care settings were certified to receive Medicaid payments. One-half of residential care settings with more than 50 beds exclusively served residents with dementia or had a distinct dementia special care unit Why apps ruined dating or wing, compared online chat tips dating 27 percent of settings with beds and 14 percent of settings with beds.

The majority violations residential care residents were White and non-Hispanic chinese dating sites 2019 jeep rubicon percentfemale 72 percentand over the age 85 51 percent.

The ten most frequent conditions based on the National Survey of Residential Care Facilities [NSRCF] were high blood pressure 57 percentAlzheimer's disease or other dementias 42 percent2 heart disease 34 percentdepression 28 percentarthritis 27 percentosteoporosis 21 percentdiabetes 17 percentchronic obstructive dating disease and allied conditions 15 percentcancer 11 percentand stroke 11 percent. Residential care settings provide assistance with daily personal care needs.

A study found that fun dating apps like tinder percent of residents required help with bathing, 45 percent with dressing, 37 percent with toileting, and 18 percent with eating. Nearly all settings 94 percent provided medication management services e and 76 percent provided skilled nursing or nursing services. Residential care settings are governed almost exclusively by state laws and regulations, rather than by federal rules, and vary from state to state.

Its primary focus is group residential care settings that primarily reach a population of older adults and working-age adults with physical disabilities. Adult foster care AFC --care furnished in a provider's cafe home--has historically been considered a type of residential care. The Compendium's purpose is to inform residential care policy by providing detailed information about each state's approach to regulating and funding services in residential care settings.

States historically have licensed two general types of residential care for older adults and individuals with physical disabilities: dating coach sforno menu AFC telescope that typically serve adults in a private residence in which the provider or a paid caregiver lives; and 2 group residential care settings that may serve a small number to well over residents in a range of building types, including apartment buildings, large homes, and converted nursing homes.

The licensed capacity of these two setting types varies, with some states limiting AFC to residents, others toand one up to States use many terms for the larger group residential care settings, including board and care homes, residential care facility RCFrest homes, adult care homes ACHsdomiciliary care homes, and personal care homes. Until the mids, the most frequently used terms were board and care or residential care.

In the late s a new model of residential care became available: assisted living. This model offered what nursing homes and traditional board and care facilities generally do not: privacy and the ability to have greater control over daily activities. By the mids, the popularity of the new assisted living model led many residential care settings to call themselves assisted living even though they did not provide the privacy and autonomy that are the model's key features.

This Compendium uses the term residential care setting as a generic term that encompasses all state licensure categories; the state profiles use each state's licensure term s. When possible, we contacted staff from state regulatory and Medicaid offices as well as state affiliates of NCAL and the Assisted Living Federation of America to confirm that the online information was current. We also contacted these staff when we had questions about the meaning of specific regulations.

Individuals who provided information are listed at the end of each profile along with their affiliation. Although it is convenient to have regulations publicly available online, relying on online regulations as a primary source of information has several drawbacks. First, not all states' websites are easy to navigate, include all relevant rules, or are updated frequently to revise.

States often refine or revise sections of their regulations, sometimes in response to statutory changes. Second, states may have additional regulatory guidance in internal documents such as memos or "dear administrator letters," which are either not available or not easily found on the website.

For both these reasons, some profiles include the phrase "provisions not identified" for certain topics. Third, in many instances, the regulations use ambiguous language and contain conflicting information.

To obtain clarification, we consulted with state agency staff and provider representatives. In some cases, we were unable to obtain the needed information, and in these instances, we either did not include the information in the state profile or included a footnote regarding the ambiguity or conflict. Fourth, to ensure accuracy we asked regulatory and Medicaid agency staff in every state to review the final state profiles we prepared, but not all were able to do so.

Section 2 provides an overview of state regulatory provisions covering 13 general topics, and extracts from the regulations are provided as examples see Section 5. Section 3 contains information on public financing for residential care settings, including Medicaid funding for services furnished in these settings and related policies. Section 5 provides summaries of regulations in 13 topic areas for all 50 states and the District of Columbia.

This section of the Compendium provides a synthesis of state regulatory provisions based on the 51 state profiles included in Section 5. This overview also discusses a few other topics that are addressed only by a small number of states, including provisions related to financial solvency, hour access to food, and roommate choice.

The terms and definitions used to describe different types of residential care settings are important for helping consumers and others to distinguish between different categories, especially given that 23 states have more than one licensure category. Most states 44 use the term assisted living as a licensing or certification category.

The word that follows "assisted living" varies, and includes facility, residence, program, home, and community. The next most commonly used licensure term is residential careused by 20 states. States vary--sometimes considerably--in how they define assisted living; some license both AFC homes and large group homes as assisted living.

A few states regulate assisted living as a service, using the terms assisted living services agency Connecticut or assisted living services Minnesota. Describing residential care settings generically as assisted living obscures the differences among types of settings, and makes it very difficult for consumers--both private pay and Medicaid-eligible--to determine which setting will best meet their current and future needs. In a study of six states' use of Medicaid to fund services in residential care settings, FloridaMinnesotaNorth CarolinaOregonTexasand Wisconsinstakeholders in all but one state cited public confusion about residential care options as a major problem.

A recent trend in adding health and supportive services to federally subsidized apartment buildings designated for seniors and persons with disabilities, typically referred to as housing plus services, represents an important innovation that may allow older adults to age in place.

AFC is a unique model of residential care that states most often define as a private residence where either the owner or a paid caregiver lives with residents who receive personal care and other supportive services. Some states limit the level of assistance that can be provided to meals, assistance with personal care, and supervision, whereas others permit AFC homes to serve individuals who meet the state's minimum nursing home level of care criteria.

The licensed capacity of AFC homes is typically less than five, though some states allow six or more. Kansas uses this term for settings that serve up to 12 residents and Michigan for settings that serve up to 20 residents. As shown in Exhibit 138 states license or certify some type of small residential home that provides personal care services; about half use a term other than AFC to describe the setting. However, additional states license or certify small residential homes under a more general residential care category, blurring the distinction between settings.

The state profiles in Section 5 of this Compendium include links to the websites containing AFC rules for each of the 38 states listed below, as well as to each state's rules for their other licensing categories. A residency agreement is the contract between a resident and the residential care provider and is important because it establishes the legal relationship, including rights and responsibilities, of both parties. Nearly all states require a residency agreement and describe the type of information that it must include.

Some states also require providers to furnish a separate document to inform prospective residents about services and rates, typically called a Disclosure Statement see next section. Although the content of residency agreements and disclosure documents may overlap, they are described separately here because their purposes differ. A residency agreement is a signed service contract between the provider and the resident, whereas a disclosure document provides information that prospective clients need to determine whether a setting will meet their needs and to compare different settings.

Most states specify that residency agreements must include information about basic services and fees, optional services if any, admission and discharge criteria, limits on the scope of services that may be provided, residents' rights and responsibilities, and information for reporting grievances and complaints. Thirty-five states require agreements to include admission and discharge policies.

A few states specify the conditions for emergency placements, such as for individuals being discharged from a hospital. Most states require the resident or a representative, if there is one to sign the contract, though the timing for doing so varies.

For example, some require that the agreement be signed before move-in, others do not describe when it should be signed, and a few are silent on whether a signature is required. Only a few states specify how frequently a residency agreement must be reviewed and updated e.

Ten states require that the residency agreement include information about medication services and policies. South Dakota requires facilities to describe the responsibilities of residents and family concerning self-administration of medications. A few states have unusual residency agreement requirements. Maryland requires that the agreement include a recommendation for review by an attorney.

In Pennsylvaniaif a resident chooses to opt-out of an assisted living service defined by the licensing rules, the agreement must state that the service is not being provided and that the corresponding charges reflect the reduction in services to be provided.

Connecticut and Minnesota do not require a service agreement because they license the service provider, not the housing provider. Delaware 's rules provide a detailed description of both financial and non-financial components of a residency agreement:. Prior to executing a contract, residents must receive a statement of all charges. The contract has financial and non-financial components.

Non-financial components include: basic and optional services; optional services provided by third parties; residents' rights and obligations; grievance procedures; occupancy provisions such as policies concerning modifications to the resident's living area, procedures for changing the resident's accommodations relocation, roommate, number of occupants in the room ; transfer procedures; security; staff members' right to enter a resident's room; temporary absence policy; interim service arrangement during an emergency; discharge policies and procedures; and facility obligations.

In states that license more than one type of residential care setting, residency agreement provisions might differ, as shown in Exhibit 2. In such states, consumer protections vary depending on the licensing category. Most states require settings to develop a service plan that describes the specific services to be provided to each resident--as well as who will provide these services, when, and how often.

In some states, the regulatory provisions regarding the completion of the residency agreements and service plans are inconsistent. For example, given that admission requirements specify that facilities must not admit individuals whose needs they cannot meet, one can logically assume that a residency agreement would not be completed until after a pre-admission screening was conducted to determine whether the applicant meets the state's or facility's admission criteria.

Oregon provides a clear example:.

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