Long-term care and assisted living facilities are regulated by both the federal and state governments, though regulations and licensing requirements can vary from state to state.
These sometimes subtle differences contribute to the wide range of senior housing models in different states. But each facility and agency has to meet certain standards, and here’s a look at how different facilities are regulated and by whom:
Home Care Agencies
1. In order for a home care agency to receive Medicare and Medicaid payments, it has to approved by the Centers for Medicare and Medicaid facilities.
2. Most states, but not all, license home care agencies that provide personal care services. Each state’s department of health website can help you see whether all home care agencies are licensed and what requirements must first be met.
3. Non-medical services such as meal preparation, homemaker services and personal care are not regulated by most states.
Assisted Living Facilities
1. The federal government does not set standards for independent living or assisted living facilities.
2. Individual states provide regulations for these facilities, including building and safety codes. Because they do not provide medical services, they are typically not regulated by departments of health. The exception is a specific nursing unit within the facility.
3. A CMS rule in 2014 set standards for state that include assisted living facilities in their Medicaid home and community-based services.
Nursing Homes
1. Subject to federal and state regulation, nursing homes must meet specific requirements about staffing, training, abuse and neglect prevention, reporting incidents, and other standards.
2. State government also regulate nursing homes, and information about individual homes can be found on department of health websites.
3. Each state has a designated Quality Improvement Organization that is responsible for ensuring and improving the quality of care, as well as reviewing/investigating complaints.
4. Long-term care ombudsmen investigate complaints and negotiate solutions to problems in long-term care facilities and nursing homes.
