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Interesting Rules to Be Aware of In Assisted Living

The regulatory world of senior living can be complicated without the proper training and necessary support.

Welcome to the world of senior living, where regulations have regulations. All jokes aside, it’s really not so bad, but interesting for many to discover the degree to which governments, both federal and state, go to protect the elderly.

We agree that keeping seniors safe and thriving must be our chief concern. Although many of the rules to follow aren’t mandated from the federal level, there are general guiding principles that cover most locales. In addition, as you begin to make your plans to build your own residential assisted living business, there are regulations specific to your state and city that you will want to know.

Some regulations may seem odd for the uninitiated, but with the proper help, support, and guidance, a new investor or owner can navigate the oddities of senior living without any major setbacks.

Nonetheless, oddities included, as we cannot eliminate them, applied knowledge is powerful. Become knowledgeable today by obtaining the education, training, guidance and consultation of the Residential Assisted Living Academy.

Your ability to navigate the multifaceted world of senior living regulations will be vital to your success and ability to deliver quality care to seniors.


The regulatory environment for senior living is largely driven by the primary payor of such services, Medicare.

Federal guidelines provide the type of guidance that makes state regulations easy to create and enforce. It is wise for residential assisted living homes to have policies and procedures in place for optimal operation, but alignment with Medicare regulations is essential to ensure overall compliance.

Also, depending upon the level of care administered in your residential assisted living home, certain guidelines must be followed to ensure the safety of both the resident and the care provider. Adherence also prevents or thwarts unmerited lawsuits and citations from regulatory agencies.

For the most part, residential assisted living is an intermediate level long-term care housing option. Therefore, regulations vary state by state. That’s right, although federal regulations are in place, state regulators are the lead compliance arm for senior living.

Since residential assisted living homes are intermediate, there is no symmetry between one state and another as to how and what is regulated.


1. The Band-Aid Application Ban:
Any assisted living facility is meant to be exactly what the name suggests, assisted living. These facilities are not Skilled Nursing Facilities, however, in many states they function as such because residents refuse to relocate. The idea of the residential assisted living home is to provide limited care for elderly patients who are otherwise healthy, active, and desirous of an independent life. In some states, basic wound care is prohibited. Therefore, one must be knowledgeable to the extent of care permissible in a specific state and gear policy and procedures to meet but not exceed those limits. Again, assisting with living, not maintaining life is the idea.

2. The Care Plan Command:
Most states require residential assisted living homes to conduct a complete assessment of needs prior to admission. The purpose is to gather information that is necessary to determine compliance with state regulations about who can live in a residential assisted living home, or any assisted living facility for that matter. Some states require the needs assessment be done a week or two prior to admission, while others require 30 days prior to admission. This assessment also contributes to the resident’s comprehensive care plan, which must be documented, on file, and enacted daily. Changes will occur over time, but the baseline assessment and plan must be in place or compliance will be a major issue.

3. The Medication Adherence Mandate:
In the assisted living space, seniors can refuse medical services including medication. There is a catch, though. In many states, if medication is refused eviction can occur. That’s right! If a resident says, “Meds No,” the RAL homeowner can say, “You’ve got to Go.” That’s powerful. Now, the administration of medications in a residential assisted living home can be a little hairy. Only certain staff members are permitted to administer, handle or dispense medication. In most states, medically certified staff persons can handle medications, but in other states it is more selective. Be sure to know who can do what with medication.

4. The Continuous Medical Care Cut-off:
When medical care becomes a 24 hour a day responsibility, in most states, that resident should or must be placed in a Skilled Nursing Facility. Regardless of family requests, that level of medical attention is to be administered in a nursing home, where the majority of the staff is certified to render that level of care. Assisted living facilities can assist with medical care but are not ideally created to deliver said care. I know it sounds like semantics. However, it is not. When a resident’s care is unable to be led by the resident, the resident has experienced a significant reduction in activities of daily living, both executive and basic. Therefore, that resident should be relocated; however, this varies from one state to another. So, once again, know your state.

5. Leisure Activities Requirement:
Residents in a residential assisted living facility should have no problem at all participating in social and leisure activities provided in the home. Some states even have exercise requirements that residents should be able to perform to some degree. When residents lose the ability to participate in activities, that resident may be declining to the point of needing to relocate to a more nursing based facility. However, the activity requirement is one that varies state by state; therefore, be clear on the regulation in your state.

6. The Toe-Nail Care Condition:
I know it may sound, well unseemly, but toenail care is a big issue. It is directly tied to the overall health of a resident, especially a diabetic one. In some states, the clipping of toenails of a diabetic patient must be done by certified medical professionals, while in others states anyone is permitted. The challenge with clipping the toenails of diabetic patients is infection, which can quickly develop into a major infection that can cause death. Therefore, it is imperative that you know what your state requires in terms of footcare for all residents, but especially diabetic patients.

7. The Dementia Directive Training:
States normally require specialized training to be provided pertaining to assisted living community employment. This training covers much of the general information relative to caring for the elderly, but also combs through key regulations which can result in liability of the residential assisted living home and the employee. Of specific importance is the training for dementia. The most common dementia, Alzheimer’s Disease, is a disease of which the majority of seniors moving into a residential assisted living home possess several risk factors. Other forms of dementia, specifically Vascular, are associated with cardiovascular complications or challenges of which many seniors are under chronic medical management. Therefore, employees are trained to be able to identify, mitigate and report changes in behavior, balance and the like to prevent these diseases from intensifying unknowingly. The safety challenges that accompany dementia are sure to be a problem if employees are unaware of the prevalence and warning signs for dementia.

8. The Ineffective CPR Exemption:
Believe it or not, CPR can be a problem in senior living. The effectiveness of CPR is under scrutiny, as some residents end up hospitalized for broken ribs, punctured lungs and other challenges. Also, some residents have a DNR in place, which is a Do Not Resuscitate order. It is a legally binding document, but in some states not as enforceable as in others. Some residential assisted living homes may be cited, fined, or sued by family for performing CPR on their loved one who had a DNR in place. So, once again, know your state regulations. They become your only protection in these circumstances. Also, be sure to have all medical and legal documents relating to the care of each resident filed in a location easily accessible to your RAL home’s management staff.


As a new assisted living homeowner, you will need the support and guidance of our professionals at the Residential Assisted Living Academy, who have seen and experienced it all in this industry. It will be vital to navigate the unique oddities of the regulatory environment in your state.

Know Your State:

  • Have you seen the regulation manual for your state? It’s usually thicker than the bible.
  • Do you understand both medical and legal jargon conflated into one cohesively written anthology, or do you have someone in your corner who can explain it to you and your staff?
  • Lastly, are you able to interpret the regulations and draft policies that comply seamlessly?

Yes, these are loaded questions but so is the regulatory environment. Do not attempt to do this alone. The survival of your residential assisted living home is contingent upon this being done right, the first time.

Contact the Residential Assisted Living Academy, immediately.

An experienced team of nationwide experts will help you understand the federal guidelines, decipher your state’s requirements, and how best to implement policies and procedures that are effective.

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