U.S. Department of Health and Human Services

Residential Care and Assisted Living Compendium: 2007

Robert Mollica and Kristin Sims-Kastelein
National Academy for State Health Policy

Janet O'Keeffe
RTI International

November 30, 2007

This report was prepared under contract #HHS-100-03-0025 between the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Term Care Policy and Research Triangle Institute. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the ASPE Project Officers, Gavin Kennedy and Emily Rosenoff, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. Their e-mails address are: Gavin.Kennedy@hhs.gov and Emily.Rosenoff@hhs.gov

The opinions and views expressed in this report are those of the authors. They do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organization.

Below are the sections and tables associated with Residential Care and Assisted Living Compendium: 2007. Each section is a separate file (available in both PDF and HTML), as well as each state's Section 3 summary is available as a separate PDF file. To view the material, simply clink on the PDF or HTML link beside it.

NOTE: A Portable Document Format (PDF) file requires Acrobat Reader [http://www.adobe.com/products/acrobat/readstep2.html] in order to view it.

TABLE OF CONTENTS

REPORT INTRODUCTION [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcom.pdf]

Table of Contents [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom.htm#ToC]

Acknowledgments [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom.htm#acknow]

Acronyms [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom.htm#acronym]

SECTION 1: OVERVIEW OF RESIDENTIAL CARE AND ASSISTED LIVING POLICY [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.pdf] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm]

Introduction to the Current Edition [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#intro]

Overview of Policy Developments Since 2004 [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#overview]

Increased State Use of Websites to Provide Information [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#increase]

Defining Assisted Living [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#define]

Assisted Living Philosophy [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#philosophy]

Occupancy Requirements and Privacy [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#occupy]

Disclosure Requirements and Residency Agreements [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#disclose]

Admission and Retention Criteria [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#admit]

Services [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#service]

Quality Assurance and Monitoring [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#quality]

Training Requirements [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#train]

Provisions for Residents with Alzheimer’s Disease and Dementia [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#dementia]

Public Financing of Services [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#public]

SECTION 1 Boxes, Figures and Tables

BOX 1-1. State Licensing and Regulatory Approaches [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#box1-1]

BOX 1-2. Examples of Definitions of Assisted Living [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#box1-2]

FIGURE 1-1. Supply Changes [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#figure1-1]

TABLE 1-1. Information Provided on States’ Websites [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#table1-1]

TABLE 1-2. Summary of Major Activities in Residential Care Policy Since 2004 [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#table1-2]

TABLE 1-3. States with Regulations that Include an Assisted Living Philosophy [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#table1-3]

TABLE 1-4. Residency Agreement Provisions [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#table1-4]

TABLE 1-5. Disclosure Requirements for Facilities Serving Residents with Dementia [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#table1-5]

TABLE 1-6. Medicaid Long-Term Care Spending [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#table1-6]

TABLE 1-7. Nursing Home Supply and Occupancy Rates and Residential Care Supply, 2003 [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#table1-7]

TABLE 1-8. States Using Medicaid to Cover Services in Residential Care Facilities [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#table1-8]

TABLE 1-9. Sources of Public Funding for Services in Residential Care Settings [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#table1-9]

TABLE 1-10. Differences Between State Plan and Waiver Services [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#table1-10]

TABLE 1-11. States That Limit Room and Board Charges [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#table1-11]

TABLE 1-12. Family Supplementation Policy [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#table1-12]

TABLE 1-13. State Rate Setting Approaches [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#table1-13]

TABLE 1-14. New Jersey Rate Schedule [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#table1-14]

TABLE 1-15. Oregon Service Priority Categories and Monthly Payment Rates: Assisted Living [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#table1-15]

TABLE 1-16. Texas Daily Reimbursement Rates Effective September 1, 2007 [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm#table1-16]

SECTION 2: COMPARISON OF STATE POLICIES [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcom2.pdf] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom2.htm]

SECTION 2 Tables

TABLE 2-1. Comparison of State Residential and Assisted Living Regulations: Supply [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom2.htm#table2-1]

TABLE 2-2. Comparison of State Residential and Assisted Living Regulations: Characteristics [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom2.htm#table2-2]

TABLE 2-3. Requirements for Facilities Serving Residents with Dementia [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom2.htm#table2-3]

TABLE 2-4. Requirements for Resident Agreements [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom2.htm#table2-4]

TABLE 2-5. Staff Training Requirements [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom2.htm#table2-5]

TABLE 2-6. Comparison of State Reimbursement Policy [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom2.htm#table2-6]

SECTION 3: STATE SUMMARIES [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.pdf, complete section] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm]

Notes on State Summaries [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#statenotes]

Alabama [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomAL.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#AL]

Alaska [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomAK.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#AK]

Arizona [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomAZ.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#AZ]

Arkansas [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomAR.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#AR]

California [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomCA.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#CA]

Colorado [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomCO.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#CO]

Connecticut [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomCT.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#CT]

Delaware [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomDE.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#DE]

District of Columbia [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomDC.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#DC]

Florida [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomFL.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#FL]

Georgia [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomGA.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#GA]

Hawaii [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomHI.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#HI]

Idaho [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomID.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#ID]

Illinois [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomIL.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#IL]

Indiana [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomIN.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#IN]

Iowa [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomIA.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#IA]

Kansas [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomKS.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#KS]

Kentucky [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomKY.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#KY]

Louisiana [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomLA.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#LA]

Maine [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomME.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#ME]

Maryland [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomMD.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#MD]

Massachusetts [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomMA.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#MA]

Michigan [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomMI.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#MI]

Minnesota [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomMN.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#MN]

Mississippi [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomMS.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#MS]

Missouri [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomMO.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#MO]

Montana [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomMT.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#MT]

Nebraska [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomNE.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#NE]

Nevada [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomNV.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#NV]

New Hampshire [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomNH.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#NH]

New Jersey [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomNJ.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#NJ]

New Mexico [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomNM.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#NM]

New York [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomNY.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#NY]

North Carolina [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomNC.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#NC]

North Dakota [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomND.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#ND]

Ohio [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomOH.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#OH]

Oklahoma [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomOK.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#OK]

Oregon [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomOR.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#OR]

Pennsylvania [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomPA.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#PA]

Rhode Island [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomRI.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#RI]

South Carolina [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomSC.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#SC]

South Dakota [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomSD.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#SD]

Tennessee [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomTN.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#TN]

Texas [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomTX.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#TX]

Utah [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomUT.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#UT]

Vermont [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomVT.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#VT]

Virginia [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomVA.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#VA]

Washington [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomWA.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#WA]

West Virginia [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomWV.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#WV]

Wisconsin [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomWI.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#WI]

Wyoming [PDF: http://aspe.hhs.gov/daltcp/reports/2007/07alcomWY.pdf, this state only] [HTML: http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm#WY]

ACKNOWLEDGMENTS

We would like to acknowledge the following for their contributions to this project: the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services for its financial support; and the many people in state agencies throughout the country who answered questions and provided copies of the statutes, regulations, and reports needed to update this compendium. We greatly appreciate the willingness of these dedicated professionals to share their knowledge and expertise.

ACRONYMS