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. The myriad of complex laws that apply to the different levels of senior housing often makes an already difficult decision even more challenging.

There are federal guidelines in place for long-term care facilities that are certified by Medicare, licensing standards and Medicaid regulations enacted on the state level, and unique in-house rules that individual communities elect to follow (these are usually detailed in a facility’s contract or admission agreement). These policies and procedures are used to calculate costs for services, set staffing ratios, determine when care plans must be updated, define the level of care a facility can provide and much more.

Because assisted living is an intermediate level of long-term care that varies widely by state, gaining even a cursory understanding of some of the unique rules these providers must follow will be invaluable when making care decisions for an aging loved one.

  1. The Band-Aid application ban: Most assisted living facilities (ALFs) are only able to provide “limited health care services,” which are carefully regulated. For example, ALFs in the state of Rhode Island are not allowed to provide even basic wound care, such as the application of a Band-Aid, unless it has been ordered by a physician and it must be applied by a qualified, licensed staff member. While this regulation may seem frivolous, it helps control what level of care an assisted living community can legally provide. Compared to a skilled nursing facility, which offers around-the-clock medical care, ALFs follow less strict staffing, licensing and training requirements. It’s important to educate yourself on what medical care services a particular community can provide, especially when accounting for future changes in your loved one’s condition, before making the decision to move them there.
  2. The care plan command: Many states require assisted living staff to conduct a comprehensive needs assessment of each resident upon admission to develop a personalized care plan. In Georgia, this must be done within 14 days of an elder’s admission, and the plan must be reevaluated at least once a year (or every three months for those residing in memory care units) and 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.
    It’s important to inquire about prospective facilities’ care plan policies. You should be able to receive a written copy of the current plan at any time and request care team meetings to discuss any issues and potential changes.
  3. The medication adherence mandate: Residents have the right to control their receipt of medical services based on informed decision making, including the refusal of medications. However, ALF residents in Idaho must take their medications as prescribed by their doctor or risk being discharged. A reputable facility will document the refusal and contact the resident’s physician and authorized family members to work on a solution, but these facilities are not obligated to retain residents who endanger their own health.
    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 allowed to help a resident with their medications, how much assistance they can legally provide and how related issues are handled. This will enable you to determine whether a prospective facility can provide adequate assistance to ensure your loved one’s regimen is followed.
  4. 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 they need around-the-clock skilled nursing care. Assisted living communities may be able to offer residents increased help with certain medical tasks, such as medication management, insulin administration and blood glucose testing, at an increased cost. However, even those facilities that employ certified nursing personnel are not allowed to admit residents who require full-time medical care. If your loved one needs 24/7 care, you may want to consider hiring home health care or placement in a skilled nursing facility.
  5. The leisure activities requirement: Assisted living communities in Georgia require their residents to be capable of participating in the social and leisure activities they provide. Obviously, staff members cannot demand that your loved one actually engage in these events, but it’s often advisable to encourage an elder to pursue an active social life when moving to senior living.
  6. The toe nail care condition: In Idaho, there are restrictions on which staff members can clip a diabetic resident’s nails. Only licensed medical professionals may assist with this personal care task because individuals with diabetes tend to heal slowly and experience limited sensation in their extremities. Even a minor cut or abrasion can become dangerously infected. This is one example of how a loved one’s unique needs directly influence your search for a long-term care provider.
  7. The dementia training directive: States typically require anyone working in an assisted living community to undergo formal training in how to interact with residents who have dementia. In some cases, this mandate may extend beyond the obvious medical staff and personal care aides to encompass all employees who have regular contact with residents, including kitchen, housekeeping and maintenance staff. If you’re caring for a loved one who has Alzheimer’s disease or another form of dementia, be sure to ask all prospective communities what type of initial and ongoing dementia training is mandated for their employees. This can have a big impact on a resident’s safety and the overall quality of care they receive.
  8. The ineffective CPR exemption: In the event that an ALF resident in Georgia becomes unresponsive and it is apparent that any effort to revive them would be futile (i.e. their body is stiff, their skin is blue/grey and cool to the touch, etc.), staff members do not have to perform cardiopulmonary resuscitation (CPR). There is a great deal of controversy surrounding the effectiveness and advisability of CPR on seniors. For example, an independent living facility in California 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 your 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.

Of course, only a few of these sample regulations may apply to an aging loved one who is looking to move into an assisted living community. However, being aware of the varied and complex policies that govern this type of residential care will assist you in your research and help you determine which questions to ask when evaluating potential providers.