Senior living residents are protected by numerous state requirements. For example, assisted living is regulated by every state in the country, and the exact regulations and licensure requirements vary from state to state. The sometimes subtle differences in regulations contribute to the wide range of senior housing models available. State regulations are consumer-based and seek to maximize independence and choice, enabling senior living providers to focus on innovative solutions to meet their particular markets. Rather than implement uniform regulations that would result in cookie-cutter communities, states have explored unique approaches, borrowing from the successes of other states and avoiding the mistakes of others.

In your state or in the state where you’re seeking a senior living residence, you may find that some properties may be licensed, others may be unlicensed, some may accept Medicaid payments for services, and others may be limited to private pay. While this variety can be confusing, it has allowed senior housing to evolve and change to meet the variety of different markets and consumer preferences within those markets.

You should be aware that some lobbying groups have pushed for federal oversight of assisted living. Such federal-level control would saddle assisted living with prescriptive, institutionalized regulations that have been the hallmark of the nursing home industry. State-level regulations are working. Residents are regularly reviewed and citations are issued when state regulators uncover problems. Forcing federal regulations on assisted living would remove the focus on choice and independence that defines the industry.

Assisted Living State Regulations and Licensing

The most progressive state regulations take cues from consumers and focus on protecting consumers in a way that provides the most choice and independence possible. The Assisted Living Federation of America supports certain core principles that should be included in every state's assisted living legislative or regulatory framework.

State regulations generally address the mandatory services a senior living residence must provide. For example, mandatory services in an assisted living residence generally include assistance with activities of daily living (help with dressing, eating, etc.), meals, housekeeping, and resident assessments. Some regulations include a list of optional services, such as money management, shopping services, and medical appointment management. Regulations also may outline services senior living residences can’t provide. For example, states often prohibit assisted living residences from providing continuous skilled nursing care.

Assisted Living Regulations in Your State

Many states’ regulations also include language about resolving resident grievances. The regulations may require a residence to develop a policy for addressing resident grievances or they may require the grievance process be disclosed as part of the lease or residency agreement. When visiting communities, ask for the residence’s complaint policy as well as who is responsible for addressing grievances.

Click here to view assisted living regulations in your state and be prepared to ask meaningful questions about your rights when you visit potential residences.

Other Resources

Long-Term Ombudsman Care program for seniors in long-term care.