A State-by-State Guide to Assisted Living Regulations

Assisted living is meant to be a safe place for senior citizens where they can receive help with activities of daily living (ADLs), socialize with their peers and thrive in a secure environment. Unfortunately, some seniors may face abuse, neglect or mistreatment at the hands of a caregiver, leading seniors and their families to feel concern and mistrust when transitioning into assisted living or other types of senior care.

Elder abuse affects hundreds of thousands of adults living at home and in senior living communities across the United States each year. According to data published by the Centers for Disease Control, 10% of people aged 60 and older have experienced abuse. That abuse can occur in various forms, ranging from physical abuse and neglect to financial abuse.

Finding information about assisted living regulations can be difficult. While seniors and their families can access the audit and licensing history of Medicare-approved nursing homes online, this information isn’t readily available for assisted living facilities. Instead, assisted living is governed at the state level, which can make it more of a challenge to find information about a facility’s history and gain the peace of mind necessary to feel safe in assisted living.

This guide includes a comprehensive list of state agencies responsible for overseeing assisted living facilities and reporting violations or abuse, as well as detailed information on assisted living inspections, regulations, and common violations.

Assisted Living Regulations: What You Need To Know

Assisted living facilities are regulated at the state level instead of the federal level. In every state, a different government branch is responsible for creating and enforcing assisted living regulations. These regulations, and the particular branch in charge of enforcement, varies depending on the state.

Assisted Living Licensing

While the laws and regulations that assisted living facilities must follow vary in each state, there are high-level licensing requirements that are covered by these regulations across the country. While the exact rules facilities must follow may differ, each state’s regulations cover the following:

• Staff-to-resident ratios
• Meal services
• Room requirements
• Required social activities
• Medication management and/or administration
• Caregiver qualifications and training
• Care planning
• Criminal background checks for caregivers and staff

Assisted Living Inspections

To ensure compliance with state regulations, the department in charge of assisted living in each state is also in charge of conducting thorough inspections on a regular basis. The frequency of these inspections is determined by each state’s assisted living regulations but in most cases, they occur once every one to two years.

When a complaint is filed, the state or county’s long-term care ombudsman will determine appropriate steps. That typically includes following up with the complainant or the senior in question and the facility to gather more information and when necessary, a full investigation may be launched to determine whether abuse or violations have occurred.

Types of Assisted Living Violations

Assisted living violations can range from small deviances from state regulations to more severe problems, such as abuse and neglect. It’s important for seniors and their families to understand the types of violations that might occur and how to recognize them.

Types of Assisted Living Abuse

Abuse in assisted living facilities may be physical, emotional or sexual, or it may be in the form of neglect or exploitation.

• Physical abuse: Physical abuse is any act that causes a senior physical harm. It can include hitting, kicking, pushing or unwarranted restraining. It can also occur when an assisted living resident is forcibly fed, starved or denied water.
• Emotional abuse: Emotional abuse is any act that causes emotional distress. It can be in the form of verbal assault and name-calling, harassment or degradation.
• Sexual abuse: Sexual abuse occurs when a caregiver or staff member engages in sexual touching or intercourse with an assisted living resident against their will.
• Neglect: Neglect occurs in assisted living when a resident doesn’t receive the care they require. This can include lacking adequate food or water, help with ADLs such as bathing and grooming or providing housekeeping.
• Financial exploitation: Exploitation can include theft of possessions or unlawful use of a resident’s money.

Common Assisted Living Violations

While abuse is the most severe issue faced by residents of assisted living, other violations can have a substantial negative effect on seniors’ quality of life. Some of the most common violations include:

• Poor nutrition or dietary care: Missed meals or meals that don’t comply with dietary restrictions
• Improper food handling procedures: Food that isn’t stored at the proper temperatures or served after the expiry date
• Poor medication handling: Providing expired medication or failing to refill a resident’s prescriptions
• Care plan violations: Deviations from a resident’s care plan or failure to provide adequate care planning
• Neglectful caregiving: Failure to provide personal care services such as bathing or grooming to a resident each day
• Lack of emergency preparedness: Maintaining poor emergency and evacuation procedures
• Poor employee illness procedures: Employees providing care while sick or unvaccinated

Recognizing Signs of Potential Elder Abuse in Assisted Living

Elder abuse can happen to anyone, and it’s important for families to watch for signs that it might be occurring. It’s not uncommon for seniors who experience abuse to feel shame or embarrassment, and as a result, they may avoid seeing friends or family members who may catch on. Families of seniors in assisted living should check on loved ones routinely and be aware of the signs of elder abuse. These include:

• Depression or confusion
• Isolation from peers, friends or family members
• Unexplained injuries, bruises or scars
• Poor hygiene
• Appearing underfed, dehydrated or over/under-medicated
• Changes in spending

Spotting Elder Abuse

For each type of elder abuse, there are different signs families should watch for.

• Physical abuse: Common signs of physical abuse include broken bones, bruises, welts, cuts, scrapes and pressure marks.
• Emotional abuse: Hesitation or nervousness when speaking with family members, isolation or withdrawal from loved ones, and anxiety or depression could all be signs of emotional abuse.
• Sexual abuse: Signs that a senior is being sexually abused include an unexplained STD, pain or irritation on the genitals, inappropriate relationships with a caregiver or bruising on thighs or genitals.
• Neglect: Neglect is a common form of abuse in senior care with signs that include extended periods of time without care, bedsores, missing medical equipment and a lack of food, hygiene or hydration.
• Financial abuse: Seniors who are being abused or exploited financially may have unusual withdrawals or purchases on bank statements, limited or no access to financial records or large sums of cash missing.

If a friend or family member suspects elder abuse has happened, asking the senior some of the following questions may provide clarity and help determine if a report or further investigation is needed.

• Are you afraid of anyone?
• Have you been hit, kicked, restrained or confined?
• Have you been touched without permission?
• Have you been force-fed?
• Do your caregivers ever give you the silent treatment or otherwise deprive your emotional needs?
• What happens when you disagree with your caregiver?
• Do you require medical equipment that you’re not granted access to?
• Have you been left alone for long periods of time?
• How do you get help when you need it?
• Does your caregiver depend on you for financial support?
• Have you ever had money go missing or stolen from you?

How to Find Information About an Assisted Living Facility’s Past Violations

Every state has a different system in place to track and monitor assisted living regulations and violations. To find information about an assisted living facility and its past violations, it’s best to contact the department in charge of assisted living in one’s state directly.

How to Report Violations of Assisted Living Regulations

Complaints about senior care are directed to each state’s long-term care ombudsman. In the event any signs of abuse or violations of state regulations are noticed, it’s important to file a report to the facility or caregiver as quickly as possible to ensure the safety of seniors under their care.

How to Prepare to Make a Report

Before contacting the long-term care ombudsman, reporters should be prepared to provide as much detail as possible. They’ll be expected to make a general statement about what happened or why they suspect an issue has occurred, as well as to provide the following details:

• Victim’s name
• Caregiver/staff member’s name(s)
• Place the event occurred
• Date and time the event occurred

In the event all details can’t be provided, it’s important for loved ones to still go ahead with reporting any time elder abuse is suspected.

Where To Report Assisted Living Violations and Abuse in Each State

In every U.S. State, the long-term care ombudsman’s office gathers and investigates complaints about assisted living abuse and violations of regulations. Ombudsmen may be government employees or volunteers working at the state or county level. Their sole purpose is to collect and investigate complaints about long-term care and to follow up on reports of abuse or violation to ensure the safety and wellbeing of seniors.

Ombudsman Department

Contact: Phone

Contact: Email