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3 Tips to Keep Up with Increasing Regulations in Assisted Living

August 21, 2023

Because assisted living facilities are regulated by the states where they operate, there’s no one set of guidelines to follow. But there is one thing that’s consistent across the country: regulations are increasing. In fact, according to the National Center for Assisted Living (NCAL), between 2020 and 2022, 33 states reported regulatory or legislative changes that affect assisted living communities. These changes include new requirements for licensure, staff training, infection control, and resident rights, that can impact everything from the care you deliver to community structures. What trends should you be aware of so you can best prepare? In a review of all 50 states and the District of Columbia, NCAL identified the most prominent trends:

  • 46 states and the District of Columbia now require a consumer disclosure, agreement, and/or bill of rights for assisted living residents.
  • All 50 states and the District of Columbia require resident assessment and that the facility assist with activities of daily living (ADL) for residents.
  • 49 states and the District of Columbia allow and regulate providing medication management to residents.
  • 45 states and the District of Columbia now have minimum educational and training requirements for administrators.

Understanding the regulations in your state and keeping up with change are critical to avoiding liability. It’s also critical that staff understand the regulations that affect them and receive guidance on how they should interact with and care for residents. Here are some tips that can help you avoid issues.

  1. Stay informed of changes and understand how they affect your facility. Varying regulations, frequent changes, and the involvement of multiple agencies can make keeping up challenging but there are resources that can help. The NCAL website,, provides the Assisted Living State Regulatory Review, a yearly report on changes in each state along with an overview of trends nationwide. The site also provides an AL Regulatory Summary for each state and the District of Columbia. It’s also important to ensure that the facility’s own policies and procedures don’t conflict with state regulations and that updates are made as appropriate. To help you stay informed and on top of any changes that affect you and your staff, consider joining an organization like the American Assisted Living Nurses Association (AALNA). AALNA provides its members with educational resources, support, and access to a nationwide network of assisted living nurses.
  2. Keep staff in the know. Make sure staff members know what they are required to do, as well as what they are prohibited from doing. There should be procedures in place to cascade relevant information to staff members, particularly those who have daily contact with residents.
  3. Keep families and residents informed. Certain regulations may affect the care residents can receive from staff or may even determine whether they’re eligible to remain in the facility or community. For example, some states prohibit assisted living facilities from providing even basic wound care unless they obtain a special license or don’t require staff to perform CPR in certain circumstances. Medication management rules also vary and can have a significant effect on residents. In Idaho, for example, residents have the right to control their medications but must take them as prescribed or risk discharge. Residents and their families should be aware of any regulations that affects the kind of care they can receive at the facility as well as what’s prohibited.

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