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Federal and State Regulations in Assisted Living

By Heather Brown
September 07, 2015

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.


2 Replies to “Federal and State Regulations in Assisted Living”

  1. There should be certain rules and regulations for the assisted living facilities, they are charging very high prices. Secondly, the mistake we probably made, we never contact to the senior care specialist before hiring any assisted living facility. This is also one way to save money and pay the right amount for the right facility.

  2. I have had my brother in law in an Assisted Living Home for 9 years. I perform at several assisted living homes and have observed that they are owned by investors, financial groups, and not health companies. Their sole purpose is to make profit from the high fees charged, low paying salaries for the workers, and providing minimum service at cheap cost. The higher priced facilities provide better but still minimum care. Because they are not regulated by the Federal Government they’re policies and procedures are set by the owners. How many people were killed in assisted living homes during COVID epidemic peak. Low paid employees need their salaries and will come to work sick, and initially were not vaccinated. In Santa Rosa when the fire was raging the employees left the assisted living personnel to fend for themselves why they went home to protest their families. Recently Atria assisted gave cleaning chemical to residents thinking it was juice. Most of the assisted living care personnel cannot read English and have difficulty understanding English. Over Assisted Living is a business with unlimited potential to make profit due to the aging baby boomers being placed in assisted living home by their children. It’s a sad life to be in assisted living homes.

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