Assisted Living in Alabama

Agency: Department of Public Health, Bureau of Health Provider Standard
Phone: (334) 206-5575
Website: www.adph.org

An assisted living facility provides or offers to provide a residence and personal care to individuals who are in need of assistance with activities of daily living (ADLs). A specialty care assisted living facility meets the definition of an assisted living facility and is specially licensed and staffed to permit residents with a degree of cognitive impairment that would ordinarily make them ineligible for admission or continued stay in an assisted living facility. Both assisted living and specialty care assisted living are sub-classified according to the number of residents: 'Family assisted living facility' means a facility authorized to care for two or three adults. 'Group assisted living facility' means a facility authorized to care for four to 16 adults. 'Congregate assisted living facility' means a facility authorized to care for 17 or more adults.

Facility Scope of Care:
Assistance with ADLs such as bathing, oral hygiene, and grooming may be provided. A facility must provide general observation and health supervision of each resident to develop awareness of changes in health condition and physical abilities and awareness of the need for medical attention or nursing services

Move-In/Move-Out Requirements:
To be admitted to an assisted living facility, residents may not require restraints or confinement; require limitations on egress from the facility; be unable, because of dementia, to understand the unit dose medication system in use by the facility; or have chronic health conditions requiring extensive nursing care, daily professional observation, or the exercise of professional judgment from facility staff. A resident who requires medical care, skilled nursing care, is severely cognitively impaired, or requires any care beyond assistance with ADLs must be discharged. Despite these requirements, a resident who requires medical care, administration of oral medications, or skilled nursing care for no longer than 90 days, or if a resident has been admitted to a certified and licensed hospice program because of a condition other than dementia, may remain in the facility by arrangement of such care to be delivered by properly licensed individuals. In these instances the facility is responsible for the delivery of the appropriate care.

Resident Assessment:
Each resident must have a medical examination prior to entering an assisted living facility and a plan of care developed by the facility in cooperation with the resident and, if appropriate, the sponsor. There is certain information that must be included in the plan of care, but there is no required standard form. Two assessments on required forms must be completed for individuals who move into a specialty care assisted living facility: a Physical Self Maintenance Scale and a Behavior Screening Form. Each resident must have a specified score on the Physical Self Maintenance Scale to be able to live in the specialty care assisted living facility

Medication Management:
A resident may either manage, keep, and self-administer his or her own medications or receive assistance with the selfadministration of medication by any staff member. Medications managed and kept under the custody and control of the facility shall be unit-dose packaged. In specialty care assisted living facilities that care for residents with dementia, medication must be administered by a registered nurse (RN), licensed practical nurse, or an individual licensed to practice medicine or osteopathy by the Medical Licensure Commission of Alabama

Physical Plant Requirements:
Private resident units must be a minimum of 80 square feet, and double occupancy resident units must be a minimum of 130 square feet.

Residents Allowed Per Room:
A maximum of two residents is allowed per resident unit.

Life Safety:
The state of Alabama has two types of licensed assisted living facilities for the elderly: standard assisted living facilities and specialty care assisted living facilities for residents with dementia or Alzheimer's symptoms. Each of these is divided into the three categories of Family (three residents or less), Group (4- 16 residents), and Congregate (17 or more residents). A Family facility is usually set up in an individual's home. The home is reviewed and modified as necessary for compliance with the National Fire Protection Association (NFPA) 101 chapter for One and Two Family Dwellings. By rules, both Group and Congregate facilities are required to comply with the NFPA 101 chapter on Residential Board and Care with residents classified as "impractical to evacuate." Under this evacuation requirement, the Life Safety Code requires each facility to have both a sprinkler system and a supervised fire alarm system. In the Residential Board and Care chapter, a Group facility is required to comply with Small Facility standards. A Congregate facility is referred under Large Facility to the requirements of Limited Care found in the NFPA 101 chapter for Health Care Occupancies.

Alzheimer's Unit Requirements:
Facilities that are not licensed as specialty care facilities may neither admit nor retain residents with severe cognitive impairments and may not advertise themselves as a "Dementia Care Facility," an "Alzheimer's Care Facility," or as specializing in or being competent to care for individuals with dementia or Alzheimer's disease. Residents must be screened and approved to move into the specialty care facility. The screening must include a clinical history, a mental status examination including an aphasia screening, a geriatric depression screen, a physical functioning screen, and a behavior screen. Additionally, the Physical Self Maintenance Scale and the Behavior Screening Form must be completed and the state has required scores that must be achieved on the Physical Self Maintenance Scale in order for a resident to move in and continue to reside in the facility.

Staff Training for Alzheimer's Care:
All staff having contact with residents in assisted living facilities and specialty care dementia units must receive training on specific topics prior to having any resident contact and must have at least six hours of continuing education annually.

Staffing Requirements:
There must be an administrator and personal care staff as needed to provide adequate care and promote orderly operation of the facility. Specialty care assisted living must have an administrator, a medical director, at least one RN, and a unit coordinator. Specialty care assisted living must have at least two staff members on duty 24 hours-a-day, seven days a week, and must, at a minimum, meet the staffing ratios specified in regulation.

Staff Education Training:
In an assisted living facility, staff having contact with residents including the administrator must have required initial training and refresher training as needed. In a specialty care assisted living facility, each staff member must have initial training in the basics and complete the Dementia Education and Training Series on dealing with dementia and complete at least six hours of continuing education per year

Medicaid Policy and Reimbursements:
There is no Medicaid waiver program at this time.