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COVID-19 exposed many vulnerabilities in assisted living and nursing homes, causing some seniors to reconsider moving in. This guide explores the federal and state regulations in place for these communities, particularly regarding cost, wellness and safety. It also discusses enforcement and how to get data on how closely a facility follows regulations. These regulations are electric current every bit of 2022.

Tabular array of Contents

Nursing Abode vs. Assisted Living: The Differences Matter
Tabular array 1: Differences Between Skilled Nursing and Assisted Living
Medicaid, Assisted Living and State Regulations for Assisted Living
Tabular array 2: State-by-Land Assisted Living Transparency
Assisted Living Disclosures and Costs
Regulations for Nursing Homes
Infections and COVID-19
When Nursing Homes Do Not Comply with Rules
Country-by-State Nursing Dwelling Resources
Additional Resource
References and Footnotes

Nursing Abode vs. Assisted Living: The Differences Affair

Many folks use the terms, "nursing dwelling house" and "assisted living," interchangeably. This is understandable, peculiarly since some assisted living facilities provide retentiveness intendance or low-level nursing care. However, the distinction matters quite a flake, particularly with regulations and price.

Some quick background: Skilled nursing facilities and assisted living facilities are part of the many Continuing Care Retirement Communities (CCRCs) beyond the United States. These communities offering a continuum of housing and care so residents tin stay in the aforementioned place if their needs alter or live most a spouse with different care needs. Of course, plenty of standalone skilled nursing facilities exist, as do standalone assisted living facilities.

State Medicaid programs for assisted living may require that participants run across what's chosen a "nursing home level of care." That doesn't mean these folks need skilled nursing care around the clock. Rather, it typically means they cannot perform 2 of the activities of daily living (eating, bathing, dressing, mobility/transferring, continence and toileting). Criteria varies by land and program. For example, one land may require the inability to perform two ADLs, while just one ADL suffices in another country.

If you have second thoughts about entering a nursing domicile, chances are yous hateful assisted living and not skilled nursing. (Because you accept the time to consider living options, yous're probably non dealing with a current wellness emergency that led to hospitalization.) Check out the table beneath for a refresher on the differences.

Table one: Differences Between Skilled Nursing and Assisted Living

Skilled Nursing Facility

Basic Definitions	As well called nursing facilities, skilled nursing and rehab. Can be part of hospitals. 24-hr medical and personal intendance, both short term after hospitalization (like after surgery or a bad autumn) and long term (for chronic problems). Rehabilitation services such as concrete therapy and speech communication therapy are available. Because skilled nursing homes involve medical care, costs are higher. The regulations, licensing, staffing and training requirements are stricter than in assisted living. In a Continuing Care Retirement Community, skilled nursing and rehab intendance is the most intensive care type unless retention care is offered.
Regulation	Must follow federal regulations for certification by the Centers for Medicare and Medicaid Services (CMS). Some states add their own regulations simply cannot subtract from federal regulations. Each state conducts surveys, which are unannounced inspections at to the lowest degree once every 15 months, to ensure compliance.
Comparisons and Compliance	Nursing Home Compare is a Medicare tool that assigns five-star quality ratings based on wellness inspections, staffing and quality measures. It also gives details on certification, ownership and whether the facility is part of a CCRC. Y'all can read full inspections reports on nursing homes ("View full written report" with "Date of virtually recent health inspection"). Nursing Home Inspect is another useful tool. Information technology works with the same data that Medicare Compare does but organizes the information differently.
Decision to Live There and Living Situations	Oft forced by a health emergency such as a autumn that requires hospitalization and subsequent rehab. Seniors have little time to evaluate their options unless the skilled nursing facility is function of a CCRC determination fabricated in advance of the health emergency. Otherwise, a chronic health upshot requiring medical care may strength the motility to a nursing home. Seniors typically have roommates and little to no say in choice of room. Regulations practise require that seniors receive advance notice of room and roommate changes in a linguistic communication they understand. (For more on room change regulations, read under "Room Changes" here. Notation that Nevada has added some of its own land regulations under "Discharges.") Activities and socialization opportunities are mutual (or supposed to be).
Payment and Costs	Boilerplate semi-individual room cost of $seven,513 monthly; $8,517 for individual.^ane More expensive than assisted living. Medicare tin can pay for brusk-term rehab in Medicare- certified skilled nursing facilities. These stays occur afterward a qualifying three-day hospitalization. If you accept a Medicare Advantage plan, the rules may be different, so check with the program provider.² Upwards to 100 days per benefit period are covered. It'due south up to seniors and their caregivers to runway how many days are left in the period. The outset 20 days are 100% covered. You pay (or notice other payment sources) for $170.50 per day for days 21-100, and Medicare covers the remaining balance. Later 100 days, residents are responsible to pay in full, whether out of pocket, through Medicaid, long-term care insurance or other means. Medicare covers upwardly to another 100 days if seniors have been out of the hospital or skilled nursing facility for 60 consecutive days and accept another qualifying iii-day hospitalization.

Assisted Living Facility

Basic Definitions	Also chosen developed foster care, personal care homes and other terms, depending on the state. Residents need help with the activities of daily living (ADLs) such as bathing, moving around and eating. The caste of assistance needed can range from a little to a lot. Some assisted living facilities offer memory care and low- level medical services such as diabetes monitoring.
Regulation	Regulated on the land level, with regulations and enforcement varying widely from state to state. Inspections in many states are required every 12 or 24 months, just intervals include vi months, 36 months and even threescore months.
Comparisons and Compliance	A long-term intendance ombudsman tin help you investigate an assisted living facility's track tape (aforementioned with nursing homes). Check your land'south licensure agency for assisted living (more on this in Table ii). In some states, detailed breakdowns of surveys or the reports themselves are available. Always pay attending to the date of the inspection. The further off it was, the less reliable or relevant the information might be.
Conclusion to Live There and Living Situations	Sometimes forced by a wellness issue, simply seniors frequently have more time to consider and compare their assisted living options. The size and scale of communities vary. Some communities are in actual homes, in large buildings or somewhere in between. Depending on the facility, seniors tin can choose between living arrangements such as a studio and one-bedroom apartment. Bathrooms may be private or shared. Activities and socialization opportunities are common (or supposed to exist).
Payment and Costs	Average cost of $4,051 monthly.^ane In most states (only not all), Medicaid may pay for services in Medicaid-certified assisted living facilities. Some facilities are private pay only and exercise not accept Medicaid. SSI (and optional state supplements) can assistance with room and board costs. Many Medicaid-certified facilities aren't immune to charge more the federal SSI charge per unit + whatsoever country supplement for room and board. Seniors must take limited income and assets to qualify for Medicaid unless they participate in some type of partnership long-term care policy with their state. Other ways to pay include veterans' benefits, long-term care insurance and cocky-pay. Medicare does non pay for assisted living but sometimes pays for medical/skilled nursing care services received in assisted living.

More on comparisons: If the facility you're because is role of a CCRC, check both the Medicare comparison tool and your state'south assisted living inspection reports (if accessible). Do this fifty-fifty if it's merely the skilled nursing aspect or the assisted living aspect you care about.

Looking at both gives you a more rounded picture of how well the CCRC follows regulations. For example, some of the same staffers may piece of work in both assisted living and nursing intendance. Residents from both may socialize with one another, likewise. That's one reason CCRCs entreatment to couples with different care needs. They no longer live in the same room or apartment but are shut together for meals and socialization.

A third tool to use is ProPublica's Nursing Home Inspect. Information technology draws from the aforementioned CMS data that goes into the Medicare comparison tool simply is organized differently. For case, there are state pages such equally Michigan's that enable comparisons amid all nursing homes in the land. At a glance, yous get total deficiencies, serious deficiencies, fines and fifty-fifty COVID-19 cases (as of September 2020). Unfortunately, there'southward no similar tool for assisted living since information technology is country regulated.

State Regulations and Transparency for Assisted Living

Every year, the National Center for Assisted Living (NCAL) publishes the Assisted Living State Regulatory Review. It summarizes the cardinal requirements that assisted living facilities in each land must encounter to proceeds or maintain licensure/certification. Have a look at your state and so you have a good idea of the standards there. The review covers bug such as:

The land's definition of assisted living and any specialty licenses offered
If there are differing levels of assisted living intendance provided
Recent legislative or regulatory changes
Disclosure items for prospective residents
Scope of care
Tertiary-political party telescopic of care
Admission and retentivity policies
Resident assessments
Medication management
Foursquare anxiety requirements
Residents immune per room
Bathroom requirements
Life safety
Unit and staffing requirements
Ambassador instruction and training
Staff pedagogy and training

Have the time to study disclosure items. For example, disclosures are where you should be able to notice figures on charges and fees. Other rules and regulations to pay special attention to include these:

Resident assessments and their frequency: Staffers should conduct a needs assessment when a new resident is admitted. The assessment aids in the development of a personal intendance plan. Re- assessments are supposed to exist washed most once a year and when a resident's needs change (every bit is common with aging and after hospitalizations).

Medications: Who is allowed to administer medications, what is the level of assistance allowed and what happens if a resident doesn't agree with taking medications or doesn't want to? Many facilities can cut ties with residents who decline medication. Generally, though, residents have the freedom to make their own medical decisions.

Care cutoffs: These cutoffs address the sometimes fine line betwixt assisted living and nursing intendance. To give a basic case, some assisted living facilities assist in diabetes management, performing glucose monitoring, toenail clipping and other services for a fee. All the same, intensive, ongoing medical care needs are more probable to be the purview of skilled nursing homes.

Staffing and administrators: These regulations address preparation and educational requirements and whether the person (or people) on site overnight are required to be awake.

Let'due south look at Florida briefly. According to the 2019 NCAL report, a Florida assisted living facility must disclose to potential residents its admission and continued residency criteria, residency charges, personal care services and charges, whatever nursing services provided and their charges, social and leisure activities, and accommodation of special diets, amidst other things.

Florida has three special license types for assisted living: extended besiege intendance for more intensive care, including nursing services to delicate residents; a limited nursing services license; and a limited mental health license. Assisted living administrators must accept a high schoolhouse diploma or GED and must complete core preparation. (In some other states, the requirements are higher-level.)

The NCAL review doesn't explicate about enforcement and where to detect out about facility compliance. Fortunately, it'due south pretty easy to inquiry violations in Florida. It isn't in some other states.

Head to the Floridahealthfinder.gov Facility Locator site and choose "Assisted Living Facility." Type the address or Nil lawmaking for facilities you want data on. From there, you can read the most contempo inspections reports and statements of deficiencies.

Review the table beneath ("State-past-State Assisted Living Transparence") for details on how transparent and accessible facility-specific information is. Regulations are of little import if y'all can't find out whether a facility follows them. The tabular array as well features a cavalcade addressing the frequency of inspections. The more than often inspections take place, the more reliable and recent the inspections data is.

To see bodily assisted living rules and regulations, check the "Citations" department at the end of each state's NCAL summary. They can make for intensive, hours-long reading simply may be more illuminating than summaries.

As you'll come across from the table, many states don't become out of their way to make assisted living records accessible. Some do make information technology adequately easy to file open records requests, fifty-fifty providing online submission forms. Otherwise, check out these state FOI (liberty of data) resources for filing a request.

Important: All states are required to have a long-term intendance ombudsman. Your local or state ombudsman office should exist able to help with FOI requests and background information on assisted living facilities and nursing homes. To observe offices, cheque out this map.

Table 2: State-by-State
Assisted Living Transparency

Alabama

State and Assisted Living Principal Links:

Facilities Directory

Links to Assisted Living Facility Licensure and/or Compliance:

Wellness Care Facilities Deficiencies in Alabama

Standards for Transparency, Licensing and Certification:

Good. Reports and info on violations are easily accessible online.

Frequency of Inspections: Every 24 months

Alaska

Land and Assisted Living Main Links:

Assisted Living Licensing

Links to Assisted Living Facility Licensure and/or Compliance:

Assisted Living Licensing in Alaska
Call the Residential Licensing Program Manager to become info on inspections and violations.

Standards for Transparency, Licensing and Certification:

Problematic transparency. Bare bones online data merely lists whether facilities are licensed. No data on inspections, violations, etc.

Frequency of Inspections: Every 24 months

Arizona

State and Assisted Living Primary Links:

ADHS

Links to Assisted Living Facility Licensure and/or Compliance:

Public Health Licensing in Arizona

Standards for Transparency, Licensing and Certification:

Practiced

Frequency of Inspections: Every 12 months

Arkansas

State and Assisted Living Main Links:

DHS | Role of Long Term Care

Links to Assisted Living Facility Licensure and/or Compliance:

Facilities by Name or Location
Make it touch on with the long-term care ombudsman for details on inspections and violations.

Standards for Transparency, Licensing and Certification:

Problematic as far as finding out info on inspections and violations. You must be an Arkansas resident and submit a written request for the data.

Frequency of Inspections: Every 24 months

Connecticut

State and Assisted Living Main Links:

Regulation and Licensure Dwelling house Page

Links to Assisted Living Facility Licensure and/or Compliance:

Connecticut License Lookup to verify if a facility is licensed and to read reports.
Choose Assisted Living Service Bureau. Some of the facilities that show upwards may not have inspections reports however. To review a facility, click on "Detail" and so "Document Link" for the survey report.
Section of Public Wellness for regulatory action orders and regulatory activeness reports.

Standards for Transparency, Licensing and Certification:

Problematic since the state doesn't have the ability to fine a facility for violations.

Besides, the state doesn't exactly license the facilities themselves, instead licensing assisted living services agencies.

Non all facilities take survey reports posted online.

Frequency of Inspections: Every 12 months, simply info online may exist years out of appointment

Florida

State and Assisted Living Main Links:

AHCA: Assisted Living Unit

Links to Assisted Living Facility Licensure and/or Compliance:

FloridaHealthFinder.gov Facility/Provider Locator

Standards for Transparency, Licensing and Certification:

Good

Frequency of Inspections: Every 16 months

Georgia

Land and Assisted Living Main Links:

Georgia Department of Community Health

Links to Assisted Living Facility Licensure and/or Compliance:

Healthcare Facility Regulation'due south Notice a Facility, Search Inspection Reports and Verify License

Standards for Transparency, Licensing and Certification:

Pretty Skillful. Almost, if not all, of the info accessible online, merely search results tin can seem jumbled.

Input all of the data you take—facility name, address, phone number, etc. to eliminate extraneous results.

Frequency of Inspections: Every 6 months to ane year

Hawaii

State and Assisted Living Main Links:

Office of Health Care Balls

Links to Assisted Living Facility Licensure and/or Compliance:

Assisted Living Facility
Office of Wellness Intendance Assurance for Inspections Reports

Standards for Transparency, Licensing and Certification:

Practiced. Hawaii has inspections reports available online, merely information technology's easy to overlook the most recent one. You may need to look farthest right on your figurer screen for the link.

Frequency of Inspections: Every 12 months

Idaho

State and Assisted Living Main Links:

Idaho Health and Welfare

Links to Assisted Living Facility Licensure and/or Compliance:

Detect a Facility, Inspection Reports and Awards, Unsprinklered Facilities
Complaints or issues are listed by blazon. Click on the magnifying drinking glass in far-correct columns for detailed breakdowns.

Standards for Transparency, Licensing and Certification:

Corking. Star system helps exceptionally safe facilities stand out (golden star if no deficiencies, silver star if three or fewer not-core deficiencies).

Frequency of Inspections: Every 12 months

Illinois

State and Assisted Living Main Links:

Assisted Living | IDPH

Links to Assisted Living Facility Licensure and/or Compliance:

Assisted Living/Shared Housing Licensed Establishments Directory for a list of licensed facilities
Search Consumer Choice for self-reported info on facilities (many haven't completed their surveys)

Standards for Transparency, Licensing and Certification:

Problematic. You tin can find out online whether a facility is licensed, simply that's virtually it. For more details, get in touch with the ombudsman's office. FOIA requests may exist necessary.

Frequency of Inspections: Every fifteen months

Indiana

State and Assisted Living Main Links:

Residential Care Facility Licensing

Links to Assisted Living Facility Licensure and/or Compliance:

Health Care Facility Consumer Data map
Choose "Residential Care Facilities" from the "Notice a Provider" search box or enter a facility name. Click on "View Consumer Study" for info on inspections.

Standards for Transparency, Licensing and Certification:

Good

Frequency of Inspections: Every 24 months

Iowa

State and Assisted Living Main Links:

State of Iowa – Department Of Inspections & Appeals

Links to Assisted Living Facility Licensure and/or Compliance:

Entity Search
For entity type, choose ALP (Assisted Living Programs). Click "View" and "View Report" for specifics.

Standards for Transparency, Licensing and Certification:

Adept

Frequency of Inspections: Every xv months

Louisiana

State and Assisted Living Main Links:

Health Standards Section | Department of Wellness

Links to Assisted Living Facility Licensure and/or Compliance:

Adult Residential Care Directory to meet whether a facility is licensed.
For more than information, attempt the ombudsman program and public records/FOIA requests.

Standards for Transparency, Licensing and Certification:

Problematic. Just the bare bones licensing information is accessible online.

Frequency of Inspections: Every 24 months

Maine

Country and Assisted Living Primary Links:

Residential and Nursing Care Services
Assisted Housing

Links to Assisted Living Facility Licensure and/or Compliance:

Regulatory Licensing & Permitting. Search with the term "Assisted Housing" under Regulator.
For more information, effort the ombudsman program and FOIA requests.

Standards for Transparency, Licensing and Certification:

Problematic. The bare minimum is all that's available online.

Frequency of Inspections: Every fifteen months

Maryland

Country and Assisted Living Main Links:

Maryland Department of Health
Maryland Wellness Committee

Links to Assisted Living Facility Licensure and/or Compliance:

Consumer Guide to Long Term Care for a variety of data, including pricing. Only applicable to facilities with 10+ beds.
Click on "Facility Proper noun" in the left cavalcade of results to learn more. Inspection details bring upwards deficiency issues such as emergency preparedness, medication management or delegating nurse, although reports themselves may not be bachelor. (Contact AL.Aid@maryland.gov or telephone call 410-402-8217 for further details.)
Minimum licensing and contact info is available through the state's licensee directory (includes facilities with fewer than 10 beds)

Standards for Transparency, Licensing and Certification:

Uneven.

Pro: Maryland lists pricing data, which is nearly unheard of.

Con: The consumer guide doesn't break downwards inspections reports for facilities with fewer than 10 beds. Contact the ombudsman or AL.Aid@maryland.gov or phone call 410-402-8217 for assistance.

Frequency of Inspections: Every 24 months

Michigan

State and Assisted Living Main Links:

LARA – Developed Foster Care/ Homes for the Aged

Links to Assisted Living Facility Licensure and/or Compliance:

Statewide Search for Adult Foster Intendance / Homes for the Aged Facilities
Choose among facility types such every bit adult besiege facility and homes for the anile. Later clicking on a facility, pay attention to 'Services Provided" to get clarity on what a facility does.

Standards for Transparency, Licensing and Certification:

Good.

Michigan doesn't license assisted living communities per se, instead licensing homes for the aged and adult foster intendance.

Inspections reports are readily available online. Yet, you must submit a FOIA request to see a facility's plan of correction.

Frequency of Inspections: Every 12 months

Mississippi

State and Assisted Living Main Links:

Health and Care Facilities – Mississippi State Department of Health

Links to Assisted Living Facility Licensure and/or Compliance:

Health Facilities Directory PDF of licensed facilities.
Do a find and search for the "Assisted Living" column or use a facility name.

Standards for Transparency, Licensing and Certification:

Problematic. The bare minimum licensing info is accessible online.

Frequency of Inspections: Every half-dozen months

Missouri

State and Assisted Living Chief Links:

Licensing & Regulations | Wellness & Senior Services

Links to Assisted Living Facility Licensure and/or Compliance:

Evidence Me Long Term Intendance in Missouri.
Click on the inspection engagement for details on violations. Correction plans are available, also.

Standards for Transparency, Licensing and Certification:

Swell. Plus, Missouri assisted living facilities get inspected every vi months, so the information is quite contempo.

Frequency of Inspections: Every 12 months

Montana

Country and Assisted Living Main Links:

Licensure

Links to Assisted Living Facility Licensure and/or Compliance:

MT DPHHS License/Certificate Verification
Choose "The Licensing Agency" and "Assisted Living Facility"
Click on a facility to encounter details and await for the "Inspections" section.

Standards for Transparency, Licensing and Certification:

Good

Frequency of Inspections: Every threescore months (five years)

Nebraska

Country and Assisted Living Main Links:

Licensing
Assisted Living

Links to Assisted Living Facility Licensure and/or Compliance:

License Information Organization Search for licensure, inspections and violations data under "Facility/Service Search."
For disciplinary actions, call (402) 471-2115.

Standards for Transparency, Licensing and Certification:

Problematic. Inspections are required just every five years. That'southward a lot of time for a facility to fall out of compliance.

On the bright side, survey results are hands accessible online.

Frequency of Inspections: Every 12 months

Nevada

State and Assisted Living Main Links:

Health Facilities Home

Links to Assisted Living Facility Licensure and/or Compliance:

Nevada Division of Public and Behavioral Health Licensee Search

Standards for Transparency, Licensing and Certification:

Skilful. Nevada fifty-fifty assigns letter grades such as "A" and "F" to facilities. Critical information nearly facility safety is easily accessible online.

Frequency of Inspections: Every 12 months

New Hampshire

Land and Assisted Living Main Links:

Health Facilities Assistants
Skilled Nursing Facilities / Nursing Homes

Links to Assisted Living Facility Licensure and/or Compliance:

New Hampshire Online Licensing, Expect Up a Business License
Choose "Health Facilities" and so "Assist Living/Residential Care Facility"
Contact (603) 271-9039 if no argument of findings is bachelor.

Standards for Transparency, Licensing and Certification:

Pretty good simply a flake Uneven.

For most facilities, you can read nigh violations and corrective plans—but they don't seem to exist listed with every facility that had violations.

Frequency of Inspections: Every 12 months

New Jersey

State and Assisted Living Main Links:

Department of Wellness | Wellness Facilities

Links to Assisted Living Facility Licensure and/or Compliance:

Search for Long-Term Care Facilities to bank check on licensure.
Utilize an ombudsman or OPRA (the New Bailiwick of jersey Open up Public Records Act) to get more data if necessary. OPRA links commonly testify up if the relevant record is not available.

Standards for Transparency, Licensing and Certification:

Pretty proficient but a bit Uneven. Most of the data on inspections and violations is readily available. Click on "More info" side by side to inspections and complaints and then on ID numbers.

Every once in a while, you may come across an instruction to use OPRA to get the relevant tape.

Frequency of Inspections: Every 12 months

New Mexico

State and Assisted Living Main Links:

Health Facility Licensing

Links to Assisted Living Facility Licensure and/or Compliance:

Health Intendance Provider Search for licensed facilities and select survey reports.
For more reports and information, contact the Wellness Facility Licensing and Certification Bureau at (505) 476-9047 or (505) 476-9025

Standards for Transparency, Licensing and Certification:

Problematic. The survey reports posted online may be out of date, sometimes past a petty, sometimes past a lot. Don't count on the most contempo inspection report (within the past 12 months) to be bachelor.

Frequency of Inspections: Every 12 months

New York

Country and Assisted Living Main Links:

Developed Care Facilities/Assisted Living

Links to Assisted Living Facility Licensure and/or Compliance:

NYS Adult Care Facility Profiles to discover licensing and citations info
Adult Care Facility/Assisted Living "Do Not Refer List" for facilities to avoid

Standards for Transparency, Licensing and Certification:

Expert. The but issue is that full inspections surveys aren't bachelor online. Instead, just the citations are offered. For virtually people, it's enough to get the idea of how well a facility follows regulations.

Contact an ombudsman or file an open records asking for the records themselves.

Frequency of Inspections: Every 24 months

Ohio

State and Assisted Living Main Links:

Residential Intendance Facilities – Assisted Living

Links to Assisted Living Facility Licensure and/or Compliance:

Health Intendance Provider Real-Time Information
Choose "Residential Care or Assisted Living" to bank check on licensing.
For inspections reports, call (614) 752-9524
For more assistance, consider the ombudsman or your local health district.

Standards for Transparency, Licensing and Certification:

Problematic. Just bare-bones licensing info is available online.

Plus, Ohio doesn't have the authority to fine assisted living communities.

Frequency of Inspections: Every 12 months

Due south Carolina

Country and Assisted Living Principal Links:

Health Facilities Licensing
Service Guides

Links to Assisted Living Facility Licensure and/or Compliance:

Facility Locator
Contact an ombudsman or submit FOIA requests for facility records.

Standards for Transparency, Licensing and Certification:

Problematic. Information on facility inspections and violations is not accessible online.

Frequency of Inspections: Every 12 months

South Dakota

State and Assisted Living Principal Links:

SD Department of Human Services

Links to Assisted Living Facility Licensure and/or Compliance:

Long Term Services and Supports or DOH Provider List to find assisted living providers
Contact an ombudsman and file FOIA requests for more info.

Standards for Transparency, Licensing and Certification:

Problematic. Data on assisted living facility inspections and violations is not accessible online.

Frequency of Inspections: Every 15 months

Tennessee

State and Assisted Living Master Links:

Section of Health
Assisted Living

Links to Assisted Living Facility Licensure and/or Compliance:

Licensed Facilities

Standards for Transparency, Licensing and Certification:

Uneven. You tin encounter which facilities accept disciplinary actions. Nonetheless, inspections reports are not bachelor equally a default.

Frequency of Inspections: Every 24 months

Texas

State and Assisted Living Main Links:

Texas Health and Human Services
Assisted Living

Links to Assisted Living Facility Licensure and/or Compliance:

Provider Search Summary

Standards for Transparency, Licensing and Certification:

Proficient. You lot can go an thought of how well a facility follows regulations, although inspections reports themselves may not be upwards.

Frequency of Inspections: Every 36 months (3 years)

Utah

State and Assisted Living Main Links:

Licensing

Links to Assisted Living Facility Licensure and/or Compliance:

Lists of all facilities (Excel and browser-based)
Ombudsman programme

Standards for Transparency, Licensing and Certification:

Problematic. Most nothing is accessible online. You'll have to go through an ombudsman or FOI asking for details, and inspections are spaced too far autonomously.

Frequency of Inspections: Every 12 months

Wyoming

Country and Assisted Living Main Links:

Healthcare Licensing and Surveys
Licensing

Links to Assisted Living Facility Licensure and/or Compliance:

Facility Search Class

Standards for Transparency, Licensing and Certification:

Uneven. Info is easily accessible, but Wyoming doesn't have the ability to fine an assisted living facility. Inspections are required just every 36 months.

Frequency of Inspections:

Some assisted living homes are unlicensed. That is, they haven't submitted the necessary forms for state approval. They haven't undergone fire prophylactic inspections and other required inspections. It'southward anybody's approximate if they're properly staffed and whether staffers are vetted.

Unlicensed facilities can exist prophylactic, but they don't take state approval. Be extra careful if considering unlicensed facilities.

Medicaid, Assisted Living and Spotty State Regulations

About half of assisted living facilities are Medicaid-certified to accept Medicaid funds. The money goes toward help with the activities of daily living and other services. Medicaid doesn't pay residents' rent, but residents tin can use SSI to partially or fully pay that expense.

Medicaid assisted living qualifications and coverage vary past land depending on factors such every bit your age, marital condition, where yous currently alive, and your income and assets.
Many states cap the dollar amount that a Medicaid-certified facility can charge, and information technology's similar to SSI rates.
Medicaid waiver programs are "waivers" from regular program requirements. Among other things, waiver programs can enhance income thresholds to allow college-income seniors authorize for assistance. However, these programs accept limited slots and may cover only certain regions of a land.
Waiver programs can end. A new program may or may not supersede an older i.
Alabama, Kentucky, Maine, Pennsylvania and Virginia accept Medicaid programs that don't pay anything for assisted living (or their programs are and then limited equally to disqualify the majority of low- income and low-asset seniors). Nonetheless, these states may have Medicaid programs that help seniors stay at home or receive care in a residence such as an adult foster abode.

Alabama: No Medicaid aid for seniors in assisted living but offers programs to help seniors stay in their homes.
Kentucky: The Supports for Community Living Waiver covers developed foster care, but seniors must take become disabled with intellectual or developmental bug before age 22.
Maine: No assisted living help, but MaineCare tin assistance seniors remain in their homes.
Pennsylvania: Medicaid assistance is available to seniors in domicilic intendance homes/adult foster care (not assisted living).
Virginia: No Medicaid assistance for seniors in assisted living, although assessments are bachelor through the Virginia Adult Services Programme.

Medicaid, SSI and Financial Qualifications

If yous're applying for regular state Medicaid, look stricter income requirements (your income must be lower). If you lot're applying for a waiver program, you take more than income flexibility. If you're already on Medicaid and apply for a waiver program, yous may be fast-tracked.

Here's a link to a Washington state Medicaid eligibility nautical chart. (For assisted living, the "Medicaid Waivers / Home and Customs Based Services" boxes may be more relevant. Yet, you can get an assessment to see if your care needs are more intensive.) Check out other states here.

What if you lot're over the income or asset limits? A good choice is to come across with an elder planning or manor planning lawyer. Meet how you tin can comply with federal and state regulations while working toward Medicaid eligibility.

Other options for checking eligibility are to go to Benefits.gov and click on your country program (to get there, choose "Healthcare and Medical Assist" and and so "Medicaid and Medicare"). Enter your household size to see if your income falls within Medicaid guidelines. The page also has links to apply online for Medicaid and to contact staffers for assistance.

Some assisted living facilities that accept Medicaid require that you lot pay a certain corporeality up front before Medicaid kicks in (for case, the first 3 months of services might need to be out of pocket). Always enquire facilities and your local surface area agency on aging about these problems.

Many seniors utilise monthly SSI payments to cover room and board in assisted living. As of Jan 2020, the federal SSI benefit rate is $783 for an individual and $ane,175 for a couple.³ Many states offer additional supplements to seniors in assisted living, so check with your state or federal SSI office (meet this link to determine which office to contact).

The post-obit states practice not offer boosted supplements to anyone, including assisted living residents. Yet, they may cap room and board charges in Medicaid-certified assisted living facilities to just below the federal SSI rate. (Many other states practice this too, even if they offer additional supplements.)

Arizona
Northern Mariana Islands
Mississippi
Due west Virginia
North Dakota

California is a state that supplements base SSI income for assisted living residents. Information technology also caps the corporeality that Medicaid-certified facilities tin can charge. As the country explains about its Non-Medical Out-of-Home Care Rate (NMOHC) program:

A unmarried person living in an RCFE and eligible for SSI would receive the $1,206.37 NMOHC do good, pay $1,069.37 to the facility for hire, and keep $137 as his/her Personal and Incidental Needs Allowance (PNA). A couple both on SSI/SSP and living in the same facility would receive the NMOHC charge per unit of $2,412.74, pay $2,138.74 to the facility for rent, and keep $274 each month as their PNA.

Rhode Isle's SSI Enhanced Assisted Living program is one that addresses assisted living specifically.

Another intriguing programme, although it's not SSI-specific, is Alaska's Pioneer Homes. These homes are state-owned and state-operated assisted living communities. They go along costs lower than private facilities would and offering diverse types of financial assistance.

Medical Qualifications for Assisted Living

You lot must qualify medically for Medicaid/a waiver program to pay for assisted living services in whatsoever form. Oft (and confusingly), y'all must meet what's called a "nursing domicile level of care." That doesn't mean y'all need skilled nursing facility care or similar 24-hour medical care. Rather, in many states, it ways y'all tin't perform at to the lowest degree ii of the activities of daily living. Criteria varies past state and program, so ane state may require the inability to do ii ADLs, while simply one ADL may suffice in some other state.

It is commonly professionals such as nurse practitioners and social workers who certify you lot're unable to carry out these ADLs. Get started as presently as possible to expedite the process and save money. Ask your doc to refer you for an cess or to otherwise get the brawl rolling.

Spousal Protection, Assisted Living and Nursing Homes

If you're married, Medicaid spousal protection rules tin assist a healthy spouse go on to alive at home instead of becoming impoverished to pay for the other spouse'southward assisted living or nursing domicile care. More commonly, it's nursing home care merely applies to some assisted living situations. Here are Wisconsin'southward spousal impoverishment regulations as an case.

You can proceed to receive SSI. Bank check out the 2020 SSI and Spousal Impoverishment Standards here. The community spouse is the ane who continues to live at home or otherwise in the community.

Other Medicaid Financial Regulations for Assisted Living and Nursing Homes

Medicaid may make hereafter claims against your manor merely usually isn't allowed to collect until later the customs spouse dies. If you have small children or children with disabilities, Medicaid might not collect.
Beware of the Medicaid lookback menstruum. Information technology's the five years prior to your Medicaid application date. It is meant to prevent situations such every bit you lot transferring all your avails to your adult children the solar day before yous apply for Medicaid. If there was no lookback menstruum, united states would experience a lot more fiscal strain paying for long-term intendance.
Retirement accounts are generally not counted under lookback period rules. They're instead considered sources of income. So, you could have $110,000 in your retirement accounts and even so qualify for Medicaid.⁴

Assisted Living Disclosures and Costs

Assisted living facilities must give prospective residents disclosure documents that detail the charges and fees for the unlike services available. This information should be in contracts, too.

If you're just in the search phase, you'll have to contact facility administrators to get specifics on charges. Only two states' assisted living websites offer information on facility pricing (Maryland and Wisconsin). Price is definitely something to pay actress attention to in disclosure documents and during conversations with administrators. Also, look over the sections having to practise with eviction so you sympathize what happens if y'all cannot pay any longer.

When you lot're about to sign a contract, review it advisedly. As well many folks seal the bargain in a bustle and don't fully understand everything they're on the hook for.

If necessary, come across with an elder law chaser for a fuller picture of regulations, costs and how you might be able to protect your avails—both in the short and long term. Lawyers can be helpful whether you've yet to sign a contract or already have.
Search for assisted living resources such as Medicaid and other types of fiscal help, using the "Paying for Assisted" living tab on the National Middle for Assisted Living (NCAL) website.
Your local Area Bureau on Aging can assist in finding out about the services and regulations in your state and locality, become you assessed, and tap into potential sources of financial assist.
Many residents need assistance or services that go beyond base rates.
Personal expenses such as cablevision Tv may non be covered under charge per unit plans.
The facility might offer an all-inclusive price that is mayhap cheaper than paying for services individually.
It's not ever easy for assisted living facilities to make a profit or pay their staffers a fair wage, so many places have multiple pricing tiers or individual charges for services. Charges that you didn't expect should be outlined in the contract. If they are not, contact the facility or seek legal communication.
Medicare might pay for some nursing medical expenses in assisted living but won't pay for personal care services, custodial intendance or room and board.
Medicaid does not pay room and board, but SSI tin go toward these expenses. In many states, Medicaid covers services such equally help with the activities of daily living.
Medicaid regulations governing long-term intendance and cost tin can be complicated, with lots of regular and waiver programs. For an idea, wait at Washington country's long-term care manual (the Medicaid home and community services page is also relevant).

Long-Term Care Insurance Policies

State laws vary as to whether certain long-term intendance insurance policies are legal in the state. E'er exist diligent if choosing long-term care insurance.

Many states such every bit New York allow Medicaid asset workarounds (partnership long-term care policies). They work if a person has already purchased a land-sponsored long-term care insurance policy, it's run out, and the person at present needs Medicaid funding. The person can go on well-nigh or all of their assets.

Regulations for Nursing Homes

Information technology can be tough to uncover data on assisted living facilities. Thankfully, finding data on nursing homes is easier. These two tools are splendid starting places:

Nursing homes must keep a lot of federal rules, regulations and recommendations in heed (plus some states add together their ain). Oversight to some extent is necessary, although it's debatable to what extent. At some betoken, exercise regulations go more of a burden than a help, burying nursing homes under growing mounds of paperwork and taking abroad from time with residents?

Whatever your thoughts, in that location'southward no question that before regulation, which began in the late 1960s, care quality was poor. The 1987 Nursing Home Reform Human activity established requirements in three main areas: service provision, residents' rights, and assistants and other matters. Farther reforms followed with the 2010 Affordable Care Human activity and with the rollout of fifty-fifty more regulations in 2016. The 2016 requirements in item were supposed to strengthen infection controls, emergency preparedness and facility assessment. Unfortunately, COVID-nineteen however hit many nursing homes difficult.

The pandemic has led CMS to outcome guidance on topics such as screening and restricting visitors, setting bated split up units for COVID-19 patients, and testing residents and staff. CMS has as well issued recommendations and a toolkit with best practices for each state.

Health Regulations

A main health regulation in nursing homes is that the facility (and the care given in the facility) cannot exist the reason a resident'south health or quality of life has declined.

Nursing homes participating in Medicare and Medicaid must follow the residents' rights enshrined in the 1987 Nursing Abode Reform Law.⁵ Among other things, these rights govern participation in ane's own intendance, privacy and confidentiality, transfers and discharges, visits, nobility, respect and freedom, and independent choices.

Regulations require that you have a care plan prepared by you (if possible), your family or someone you designate, along with nursing home staff. You undergo regular health assessments to decide the personal and health care services you demand, how often, who should administrate them, necessary equipment and supplies, the all-time diet for you and goals for returning to the community, among other things.⁶

Cornell Law School's website hosts a copy of 42 U.South. Lawmaking § 1395i–3 – Requirements for, and assuring quality of intendance in, skilled nursing facilities. The sections impact on issues such as:

Sufficient nursing staff
Assessments of each resident'southward functional capacity
Comprehensive care plans for each resident
Personal care services such equally feeding, grooming and hygiene, if necessary
Treatment and assistive devices for vision and hearing
Prevention and handling of pressure level sores
Assistance with incontinence
Sufficient nutritional and fluid intake
Quality of life
Resident rights to cull health care, schedules and activities
Pharmaceutical services
Maintenance of accessible, complete and accurate resident records
Requirements for surveys and Nursing Home Compare

Infections and COVID-19

A Authorities Accountability Office report published in May 2020 found that infection command deficiencies were widespread and persistent earlier COVID-19. 1 role of it reads:

Prior to the COVID-19 pandemic, we plant that most nursing homes were cited for infection prevention and control deficiencies (82% of those surveyed from 2013-2017). Virtually one-half of these homes had persistent problems and were cited across multiple years. ⁷

This is troubling on multiple fronts, for case, the problem itself and and then the high number of repeated failures to right it. And so, what happens when a nursing habitation is out of compliance? What penalties, if any, prod the facility to do better? The following department touches on these issues.

When Nursing Homes Practice Non Comply with Rules

If a survey finds that nursing homes are out of compliance, what happens depends on how serious the non-compliance is. An immediate jeopardy finding means that temporary management could be appointed while the nursing abode remedies its deficiencies. Otherwise, the facility is terminated from the Medicare and Medicaid programs and the residents moved elsewhere.

Immediate jeopardy means that there's a reasonable expectation that residents would die or become seriously injured or impaired if adverse circumstances persist.⁸
Nursing homes tin nevertheless receive Medicare and Medicaid funding for equally long as six months afterwards an immediate jeopardy finding if information technology'southward in the best interest of residents to stay put (like if there are no skillful alternatives). The facility must repay funds received during this period if it doesn't correct its deficiencies during an canonical timetable.
If a survey reveals deficiencies but they're not immediate jeopardy, the nursing home has up to half-dozen months to undertake corrective action.
Civil money penalties (CMPs) can be imposed, with the range for immediate jeopardy being $6,525 to $21,393 per deficiency. Penalties range from $107 to $vi,417 for deficiencies that caused harm or had the potential to cause more than minimal harm.
Function of these CMP funds go back to the states to enhance nursing home care.
Nursing homes found persistently scarce on three standard surveys in a row are subject area to state monitoring and denial of Medicare and Medicaid payments.

Every bit far every bit infection control measures, about weren't immediate jeopardy findings. There was little sense of urgency. Plus, in that location aren't many good alternatives, if any, when nursing dwelling house residents need to be transferred elsewhere. Beds are in demand across the country. Also, just because a nursing home is subject to denial of payments doesn't hateful these actions actually happen—merely that they could.

In brusk, seemingly strict regulations are in place, only they are non always effective, nor is enforcement. It's important to research the facilities in your area and visit them in person (if possible) to make sure you're comfortable with how they do things. Talk with current and former residents and their families for different perspectives. Many nursing homes practise provide skilful intendance that is equal to or better than what non-medical family unit members and friends might provide at dwelling house.

The Limitations of Rules and Regulations

It's groovy to be knowledgeable about the assisted living and nursing home rules in your state. Nevertheless, merely considering these rules exist doesn't mean they offer 100% protection. Some issues include these:

New situations: Many facilities were unprepared for COVID-19.
Issues that go beyond rules and regulations: Understaffing is ane of several chronic issues. A facility could exist staffed at the "correct" level co-ordinate to rules and still exist stretched thin.
Samples vs. all residents: During inspections, teams wait at a sample of residents instead of at each and every resident. Sampling makes inspections more expedient but increases the likelihood that violations are missed.
Inconsistent rule post-obit: If a facility has just undergone an inspection, it may let its guard downwardly in some areas.
Man nature: When an inspection takes identify, it'due south usually a team endeavour (versus but one person). A team minimizes the chances of oversight, but at that place'due south always the hazard that someone overlooks a violation.
Redress of violations: When an inspection uncovers violations, facilities unremarkably have a set menstruum of time to accost these issues. That menstruation of time might seem too long to some residents/families. Plus, there might non even be penalties, depending on the infraction and its severity.
Transparency of rules and regulations: Information technology's not always easy to discover inspections reports or information on violations.

Inspection Surveys

Here's an overview on surveys washed in skilled nursing facilities:

No advance notice for a standard survey
Standard surveys occur at least once every 15 months
An extended survey takes place within ii weeks of a standard survey finding that a facility provides substandard quality care
Special surveys are permitted within two months of facility ownership, administration, management or director changes to ensure quality of intendance has non decreased
Special surveys are permitted if the Health and Human Services (HHS) Secretarial assistant questions the facility's adherence to federal regulations

A standard survey evaluates a sample of the nursing home'southward residents. The sample should closely represent the nursing home's population regarding severity and type of disease/injury/medical condition.

In an extended survey, the sample size is larger than it is during a standard survey. Extended surveys likewise review the policies and procedures that led to substandard intendance. These surveys review in-service training and the various aspects that go into staffing. Consultant contracts can be studied, as well.

Cost of Care

Medicare and Medicaid

Medicare covers some skilled nursing facility costs in specific situations. It doesn't cover custodial nursing home care (one manner to look at assisted living). From the Medicare website on skilled nursing facilities:^ix

Your costs in Original Medicare – Y'all Pay:

Days 1–twenty: $0 for each benefit menstruation.
Days 21–100: $176 coinsurance per twenty-four hours of each benefit menses.
Days 101 and beyond: all costs.

If you are enrolled in Medicaid, the programme may pay for some costs starting on 24-hour interval 21 and afterward. It pays much more than for skilled nursing care than for assisted living (in all states).

Private Pay

Many nursing home residents are private pay, for example, if they're past day 100 of their Medicare benefit catamenia. Nursing homes can charge private-pay residents a bones daily rate that covers room and meals, general nursing care, personal care, recreation, medical records, housekeeping and linen. Some homes offering all-inclusive rates that encompass boosted services such equally physician visits, medication, lab tests, and concrete, voice communication or occupational therapy, among other things.^ten

Private-pay rates aren't regulated. Nursing homes can accuse whatever they like, and many increase their rates at to the lowest degree one time a yr.
Nursing homes must give you lot at to the lowest degree 30 days' notice of individual-pay cost increases.
Nursing homes are allowed to collect a private-pay pre-payment/security eolith before yous motility in, but it can't be more than three months' worth.
Nursing homes cannot ask for or receive donations to ensure placement.
Await to make full financial disclosure and so the nursing dwelling house knows how long you'll be able to individual pay and when you should apply for Medicaid. The nursing habitation volition help you utilise.
If the home doesn't accept Medicaid, you may have to movement at some point. Bank check with your country; New York doesn't permit residents to be moved out of a nursing dwelling for using up their resources. Withal, transfer and discharge are OK if residents don't pay for their stay (through Medicaid or other means).
The nursing dwelling house tin can take over your finances and Social Security checks merely if yous are not able to and cannot discover anyone willing to do so.

Spousal protection rules employ to Medicaid recipients (addressed in this assisted living section).