The world of elder care is fraught with countless rules, regulations and guidelines—it's enough to make even an experienced caregiver's head spin.
Adding to the confusion, are the myriad of complex (and often confusing) laws that apply to the different categories of senior housing. Each state has the ability to enact legislation governing everything from what kinds of care a particular housing facility can provide, to what services an elderly resident can be billed for and what a community can do about unruly or uncooperative residents.
Find an Assisted Living Facility »
Here are 8 examples of assisted living rules you may not be aware of:
- The Band-Aid application ban: Men and women working for assisted living communities in the state of Rhode Island are not allowed to place Band-Aids on an elderly resident, even if they are a registered nurse. This regulation, while frivolous on the surface, has its roots in controlling what level of care an assisted living community can legally provide. It may seem erroneous that a nurse should be prohibited from putting a Band-Aid on an elder, however, the existence of such a rule highlights the necessity to educate yourself and your loved one on what medical care services a particular community can provide before making the decision to move there.
- The care plan command: Many states require assisted living community staff members to develop a comprehensive care plan for each of their residents. In Georgia, this must be done within 14 days of an elder's admission, with the plan being re-evaluated at least once a year (or every six months for those residing in memory care units), or whenever an elder's care needs change. In California, an aging adult's care plan must also include an assessment of their likes and dislikes, as well as suggestions for appropriate community-run social activities for them to engage in. If your loved one has resided in a community for more than two weeks and a formal care plan has not been drawn up, you may want to inquire about why this integral step hasn't occurred.
- The medication adherence mandate: In Idaho, residents in assisted living communities must take their medications as prescribed by their doctor, or risk being expelled from the community. Rules regarding who can dispense and administer medications in assisted living communities can be especially tricky. The key is to determine which staff members are and are not allowed to help a resident with their medications. It will then be easier for you to come up with a strategy for ensuring that your elderly loved one has the enough assistance to keep their prescription regimen in check.
- The continuous medical care cut-off: In most states, the cut-off point for an individual to be able to reside in an assisted living community is whether or not they need round-the-clock medical or nursing care. Assisted living communities may be able to offer residents help with certain medical tasks, including: medication management, insulin administration and blood glucose testing. However, even those facilities that employ certified nursing personnel are not allowed to admit elderly residents who require full-time medical care. If your loved one is in need of 24/7 care, you may want to consider hiring an in-home caregiver, or placing them in a nursing home.
- The leisure activities requirement: Assisted living communities in Georgia require their residents to be capable of participating in social activities. Obviously, these facilities cannot demand that your loved one actually engage in these events, but it's often advisable to encourage an elder to have an active social life when moving into senior living.
- The toe nail care condition: In Idaho, not just any assisted living staff member can clip the nails of someone with diabetes. Only licensed medical personnel may assist diabetic residents with this personal care task. Because of this, and other similar distinctions, the best way to begin your search for suitable senior housing is by listing out your loved one's care needs and determining which communities can meet those needs.
- The dementia training directive: States typically require anyone working in an assisted living community to undergo formal training in how to interact with people who have dementia. In some cases, this mandate may extend beyond professional care aides, to encompass all staff members who have regular contact with residents, including cooks and maintenance workers. If you're caring for a loved one who is living with Alzheimer's, or another form of dementia, be sure to ask your list of prospective communities what type of dementia training program they give to their staff, as this can have a big impact on the safety and overall quality of care your loved one receives.
- The ineffective CPR exemption: In the event that an assisted living resident in Georgia experiences a cardiovascular event and it becomes apparent that any effort to revive them would be in vain (i.e. their body is stiff or their skin is blue or grey and cool to the touch), staff does not have to perform CPR. There is a great deal of controversy surrounding the effectiveness and advisability of CPR on elders who have collapsed. Recently, an independent living facility came under intense scrutiny when a nurse refused to give a dying woman CPR. When it comes to emergency resuscitation efforts, the best way to avoid confusion is to encourage you loved one to fill out an advance care directive. Also, be sure that you fully understand the policies and procedures a particular community has regarding CPR and Do-Not-Resuscitate (DNR) orders.
Not all of these regulations will directly impact every elder who enters an assisted living community. But the existence of such varied and complex policies underscore the need for caregivers and their elderly loved ones to engage in sufficient research before determining whether or not to make the move to assisted living.
Before deciding where a loved one should live, be sure to not only consider your state's regulations, but also the rules governing each individual community you're considering. You may want to try out a temporary stay at an assisted living facility to help you find the right fit for your loved one.