General Approach

The Department of Health, Protective Health Services, Long-term Care Services, licenses assisted living centers and residential care homes (RCHs). A subchapter of the RCH rules includes provisions for facilities that serve three or fewer residents; this profile includes provisions for assisted living centers and RCHs for four or more residents.

The state does not have a licensure category for adult foster care. Homes that serve two or more residents may be licensed as assisted living centers or RCHs.

This profile includes summaries of selected regulatory provisions for assisted living centers and RCHs. The complete regulations can be viewed online using the links provided at the end.

Definitions

Assisted living center means a home or establishment coordinating or providing services to two or more persons who by choice or because of functional impairment need assistance with personal care or nursing supervision, and may need intermittent or unscheduled nursing care, medication assistance, and assistance with transfer and/or ambulation.

Residential care home means a facility that provides accommodations and supportive assistance. Residents must be ambulatory and essentially capable of managing their own affairs and may not routinely require skilled nursing care or intermediate care.

Admission and Retention Policy

Assisted living centers may not admit or retain individuals whose need for care or services exceeds what the facility can provide; who require physical or chemical restraints as determined by a physician; who pose a threat to self or others; or if the facility is unable to meet their needs for privacy and dignity.

If a resident develops a disability or a condition consistent with the facility’s discharge criteria, the resident’s physician, facility staff, and the resident or his/her representative must determine through consensus any reasonable and necessary accommodations and additional services required to permit the resident to remain in the facility. All accommodations or additional services must be described in a written plan that is reviewed at least quarterly by a licensed health care professional. If the parties fail to reach a consensus on a plan of accommodation, the facility may terminate residency.

Residential care homes may not admit or retain individuals who need services provided in a licensed nursing facility or who are not ambulatory and essentially capable of managing their own affairs. A home may not involuntary transfer or discharge a resident except for medical reasons or for the resident’s or other residents’ safety.

Medication Provisions

Assisted living centers must provide medication administration, which may only be administered on a physician’s order. The employee responsible for administering medications prepares the dose, observes the swallowing of oral medications, and records the medication. Unlicensed personnel administering medications must complete a training program approved by the relevant state entity. Medications must be reviewed monthly by a registered nurse (RN) or pharmacist, and quarterly by a pharmacist.

The provisions include very detailed provisions regarding the administration of bulk medications, including staff who may dispense from bulk medication containers (e.g., licensed nurse, physician, pharmacist, certified medication aide, or medication aide technician); storage (e.g., maximum container size); and permitted types of bulk medications (e.g., oral analgesics, antacids, and laxatives).

Residential care homes may administer medications and assist with self- administration of medications. Self-administration of all medications–prescription and over-the-counter–is permitted only after the resident has been monitored and documentation shows the resident capable of self-administration of medications. Only persons who have completed an approved course in medication administration may administer or monitor medications. Monitoring includes observation of the resident taking the proper medication, in the proper dosage, at the correct time; documenting medication taken; and storing the medication in a safe manner. The RCH staff must conduct at least a monthly documented review of a resident’s self-administration program.

Food Service and Dietary Provisions

Assisted living centersprovide three daily meals and must use a licensed dietician or qualified nutritionist to develop the center’s diet plan and address the needs of residents who require special diets. Staff who prepare food must complete a food service training program offered or approved by the Department.

Assisted living centers must provide three nutritionally adequate meals per day.
Homes with residents requiring special diets prescribed by a physician must contract with a consulting licensed/registered dietician, who must approve all special diet menus.