Friday Feature: Regulatory Shake-Up – 20 States Revamp Assisted Living Laws in 2022 – 2023

TGIF! Greetings from the great white northland! ‘Tis January and Iowa Caucus time and of course, winter settles in.

In the rapidly evolving landscape of Assisted Living, it is crucial for states to adapt and refine their regulations to ensure the safety and well-being of residents. Between July 2022 and July 2023, a total of 20 states took significant steps in updating their assisted living regulations, according to a report released by the esteemed National Council on Assisted Living (NCAL). While these adjustments primarily focused on updating existing codes, they placed a strong emphasis on three key areas: infection control, disaster planning, and quality management/quality measurement. The report is available here: AL Regulatory Review

The NCAL report sheds light on the current state of assisted living regulations across the nation. Among the noteworthy findings, it is revealed that an overwhelming majority of states, precisely 44 out of 51 (86%), have robust infection control requirements in place. This highlights the industry’s commitment to preventing the spread of infectious diseases within these communities, safeguarding the health of vulnerable residents, particularly post-pandemic.

Furthermore, 45 states (90%) and Washington, DC, have established emergency preparedness requirements, ensuring that assisted living communities are equipped to handle unforeseen disasters and emergencies. This increasingly proactive approach demonstrates the industry’s dedication to ensuring the safety and well-being of residents, even in the face of adversity.

Quality management and measurement are also key priorities for states, with 24 out of 51 (47%) implementing requirements for quality measurement, data collection, or quality management. This focus on quality assurance reflects the industry’s commitment to delivering exceptional care and continuously improving the overall assisted living experience.

The report also delves into the financial aspect of assisted living, revealing that approximately 48% of these communities are Medicaid-certified as home- and community-based services providers. This certification allows residents to access Medicaid funds to cover their daily care expenses, highlighting the vital role that Medicaid plays in supporting individuals in assisted living.

Additionally, the report highlights that nearly 17% of assisted living residents rely on Medicaid to cover their daily care. This statistic underscores the importance of Medicaid as a lifeline for many individuals, enabling them to access the care they need in a safe and supportive environment. Though, as I have written before, Medicaid HCBS remains challenged and slots for Assisted Living residency supports remain limited.

Another interesting finding is that one in every five assisted living providers has a designated unit, wing, or floor specifically tailored to dementia care. This specialized approach caters to the unique needs of individuals living with dementia, ensuring they receive the specialized care and support they require. The breakout, however, is not as distinct for facilities completely dedicated to Memory Care.

The NCAL report offers comprehensive summaries of select state requirements for assisted living licensure and certification. It provides valuable information on the state agencies responsible for licensing assisted living communities, as well as recent legislative and regulatory updates that impact various aspects of assisted living, including scope of care, limitations of service, staffing, training, and more.


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