A vital role of the Assisted Living Federation of America (ALFA) is to advocate on behalf  of senior living and the residents served by senior living companies.  ALFA works with its state affiliates and chapters, along with legislators, regulators and  advocacy groups to ensure that senior living laws and regulations serve the best interests  of senior living providers, their residents and family members. ALFA supports meaningful  and appropriate oversight of assisted living in each state.

ALFA’s Public Policy Positions, promulgated and approved by the ALFA Board of  Directors, are used to guide ALFA’s efforts in shaping public policy. These Public Policy  Positions encourage consumer choice, quality care and accessibility for all Americans  needing assistance with long-term services and support. In addition, please feel free to learn about ALFA's Core Principles.

ALFA 2012 Public Policy Positions

Assisted Living is regulated in all 50 states and ALFA supports the continuation of regulatory oversight at the state level. ALFA does not recommend one singular approach to regulatory oversight but rather supports sufficient flexibility to allow adaptation to state needs. However ALFA does support certain public policy principles that we believe should be included in every state’s assisted living legislative or regulatory framework.

Senior Living Philosophy

The philosophy of senior living is unique and sets it apart from institutional settings. This philosophy provides seniors with a home and community based option that is consumer driven. Seniors are integrated into the community at large, and the community is integrated into the senior living environment. ALFA’s senior living provider members are professionally managed and appropriately licensed as required by state law.  The philosophy of senior living supports ALFA’s core principles of choice, independence, dignity, accessibility and quality of life for all seniors.

Informed Choice

The decision of when to move in or out of a senior living community is a personal decision that takes thoughtful planning. Unfortunately and too frequently, the decision of when a resident has to leave a senior living community is made not by the resident or family, but by state regulations.  ALFA supports the concept of informed choice whereby senior living providers disclose information to consumers to allow them the opportunity to make an informed decision about where to live.

ALFA supports the need for every community to provide a consumer friendly disclosure document that is distributed to prospective residents and families. The disclosure statement should include information about services, costs, limitations on care delivery and move in and move out processes.     

ALFA supports a residency agreement that is provided in addition to the consumer disclosure document, to supplement but not duplicate the necessary information.

ALFA supports provider commitment to fulfill written obligations made to consumers.

ALFA supports a decision-making process that involves the provider, resident/resident’s family and physician to make the decision.

ALFA supports the right of residents to receive hospice services upon move in and remain in senior living if they so choose, if the provider, family/resident and physician all agree.
 

Resident Rights

Residents of senior living do not “check their rights” at the front door upon moving into a community. To assume that someone cannot continue to have the same rights to privacy, independence, and decision making, no matter where they live, is discriminatory.

ALFA supports residents’ rights to continue to make the same decisions they would make in their own home.

ALFA supports a resident’s right to make decisions about their care and quality of life and also supports the use of Negotiated Risk Agreements to support these decisions.   

ALFA supports participation of a guardian or responsible party to ensure that the rights of cognitively impaired residents are preserved.

ALFA supports the development of Individualized Service Plans for residents who need care. This plan shall reflect the personalized needs and desires of each resident. Resident assessments should be completed prior to moving into a community, and every six months thereafter, as well as upon any significant change in condition. The assessment should be completed by a trained staff member, and prepared in conjunction with the resident, family and staff.
 

Quality Staffing

 

Senior Living communities provide a wide range of services and amenities to seniors with different needs and desires. Senior living communities must hire qualified staff with a servant heart to care for seniors.

ALFA supports hiring staff with qualifications to meet the needs of each particular position. Experience in assisted living, educational background and a positive attitude towards seniors are important elements to be considered       

ALFA supports criminal background checks on every employee prior to start date to ensure that staff that have a criminal history and could potentially endanger residents are excluded from employment. Background checks that utilize direct care worker registries or predator registries are also supported. Criminal background checks must be cost efficient and provide the results in a timely manner. Providers should have the flexibility to use an outside service or state law enforcement agency. Tuberculosis Testing is another requirement that is necessary to protect the health of the residents.

ALFA supports the prohibition of hiring staff who have been convicted of a crime that indicates that the applicant may present a danger to residents.    

ALFA supports tuberculosis testing on every employee prior to start date.         

ALFA supports staffing requirements that allow assisted living communities to hire staff in sufficient numbers to adequately meet the needs and preferences of the resident population. 

ALFA supports awake staff available 24 hours a day.

ALFA supports that if the needs of the resident population require the skills of licensed or registered nurses, their skills should be applied to promote quality care on an as needed basis.    

ALFA supports training requirements that reflect the responsibilities of each particular position. Specialized training in dementia must be provided for staff caring for residents with these needs. CPR and First Aid training is encouraged for all staff, and at a minimum one CPR/ First Aid trained person must be available in each community at all times.

ALFA supports the use of specially trained staff to administer or assist with administration of medications.
 

Appropriate Infrastructure

Maintaining a residential building that is also safe is a major concern for senior living residents. There are a number of safety measures that can be incorporated into the physical plant to help ensure the safety of the residents. Because fire safety is regulated by state and local building codes, it is imperative that there be a coordinated and consistent fire safety plan.

ALFA supports fire sprinklers in senior living communities. Older buildings without sprinklers should be retrofitted within a reasonable time.    

ALFA supports smoke detectors in resident rooms and common areas.    

ALFA supports the coordination of local and state fire codes with state regulations.    

ALFA supports the development of disaster contingency plans and implementation of staff training by senior living communities in anticipation of potential disasters and communication of disaster policies with families, residents and staff.
 

Appropriate Oversight

All 50 states regulate assisted living.  Independent living must also comply with various fire safety and food service requirements. Adequate oversight and enforcement of state and local regulations is critical to ensure provider compliance with state laws and regulations.

ALFA supports state licensure of assisted living communities. 

ALFA supports annual unannounced survey inspections by state licensing agencies to determine regulatory compliance with the option for communities that have demonstrated consistent compliance to have a longer survey cycle or abbreviated survey visit. 

ALFA supports the Informal Dispute Resolution (IDR) process which is the method by which assisted living communities are offered an opportunity to resolve disagreements surrounding survey deficiencies. 

ALFA supports fines, closure, and other sanctions for communities that are in serious violation of state regulations and who endanger the health, safety and welfare of residents, provided there is appropriate due process. 

ALFA supports consumer option to live in independent living and receive long term services and supports as needed.

Zero Tolerance for Abuse

A responsibility of caring for seniors is to make sure they are protected from financial and physical abuse, neglect, and exploitation.

ALFA supports educating family members, residents and staff about elder abuse annually.

ALFA supports policies and procedures that include dismissal of staff involved in abuse.