Assisted Living in Iowa

Agency: Department of Inspections and Appeals, Adult Services Bureau
Phone: (515) 281-6325
Website: www.dia-hfd.iowa.gov/DIA_HFD/Home.do

Facility Scope of Care:
Assisted living" means provision of housing with services which may include (but are not limited to) health-related care, personal care, and assistance with instrumental activities of daily living (IADLs) to three or more tenants in a physical structure that provides a homelike environment. Assisted living also includes encouragement of family involvement, tenant self-direction, and tenant participation in decisions that emphasize choice, dignity, privacy, individuality, shared risk, and independence. Assisted living includes the provision of housing and assistance with IADLs only if personal care or health-related care is also included. Assisted living includes 24 hours per day response staff to meet scheduled and unscheduled or unpredictable needs in a manner that promotes maximum dignity and independence and provides supervision, safety, and security.

Move-In/Move-Out Requirements:
Programs may provide assistance with up to four activities of daily living (ADLs), and IADLs. In addition, health-related care (by an RN or LPN) may be provided on a part-time or intermittent basis only, not to exceed 28 hours per week.

Resident Assessment:
A program may not knowingly admit or retain a tenant who requires more than part-time or intermittent health-related care; is bed-bound; is under the age of 18; requires routine two-person assistance to stand, transfer, or evacuate; on a routine basis, has unmanageable incontinence; is dangerous to self or others; is in an acute stage of alcoholism, drug addiction, or mental illness; is medically unstable; or requires maximal assistance with ADLs. "Part-time or intermittent" means licensed nursing services and professional therapies that are provided no more than five days per week; or licensed nursing services and professional therapies that are provided six or seven days per week for temporary periods of time with a predictable end within 21 days; or licensed nursing services and professional therapies in combination with nurse-delegated assistance with medication or ADLs that do not exceed 28 hours per week. The state may grant a waiver of the occupancy and retention criteria for an individual tenant on a time-limited basis when it's the choice of the tenant, the program is able to provide staff necessary to meet the tenant's service needs, and it will not jeopardize the health safety, security, or welfare of the tenant, staff, and other tenants.

Medication Management:
There are no specific forms required, but the selected forms must be submitted with the application for certification. The assessment must cover functional, cognitive, and health status at specified intervals and upon significant change in condition. Programs must develop individualized service plans at specified intervals.

Physical Plant Requirements:
Tenants self-administer medications or the tenant may delegate the administration to the program. The regulations defer to the Iowa Nurse Practice Act, which allows nurses to delegate medication administration to unlicensed staff. A program that administers prescription medications or provides health care professional-directed or health-related care must provide for a registered nurse to monitor, at least every 90 days or after a significant change in condition, each tenant receiving program-administered prescription medications for adverse reactions and ensure that the medication orders are current and the medications are administered consistent with those orders.

Residents Allowed Per Room:
Private tenant single occupancy units must be a minimum of 240 square feet for new construction or a minimum of 190 square feet for a structure being converted or rehabilitated for assisted living. Double occupancy tenant units must be a minimum of 340 square feet for new construction and a minimum of 290 square feet for a structure being converted or rehabilitated for assisted living.

Life Safety:
Each tenant unit must have a bathroom, including a toilet, sink, and bathing facilities.

Alzheimer's Unit Requirements:
All new facilities must be sprinklered. Smoke detection is required. Smoke alarms and smoke detection systems shall comply with National Fire Protection Association (NFPA) 101, 2003 Edition, Chapter 32 (New Board & Care) or Chapter 33 (Existing Board and Care) and NFPA 72, National Fire Alarm Code. Approved smoke alarms shall be installed inside every sleeping room, outside every sleeping area in the immediate vicinity of the bedrooms, and on all levels of the resident unit. Corridors and spaces open to corridors shall be provided with smoke detectors, arranged to initiate an alarm that is audible in all sleeping areas. Sprinkler systems must comply with NFPA 13 or 13R standards. Building type may determine which type of sprinkler system should be installed. The type of smoke detection required varies depending on whether a facility is new, existing, sprinkled or not. When the assisted living facility is attached to a health care facility that is certified for Medicaid and Medicare patients, the facility must comply with either Chapter 32 or Chapter 33 of the NFPA 2000 edition of the Life Safety Code

Staff Training for Alzheimer's Care:
A program must be designed to meet the needs of tenants with dementia. Service plans must include planned and spontaneous activities based on the tenant's abilities and personal interests. An operating alarm system shall be connected to each exit door in a dementia-specific program. A program serving a person with a cognitive disorder or dementia, whether in a general or dementia-specific setting, shall have written procedures regarding alarm systems and appropriate staff response if a tenant with dementia is missing. A program serving persons with cognitive impairment or dementia must have the means to disable or remove the lock on an entrance door and must do so if the presence of the lock presents a danger to the health and safety of the tenant. Dementia-specific programs are exempt from some of the structural requirements for general assisted living programs. (Exemptions include that self-closing doors are not required for individual dwelling units or bathrooms; dementia-specific programs may choose not to provide bathing facilities in the living units; and square footage requirements for tenant rooms are reduced.)

Staffing Requirements:
All personnel employed by or contracting with a dementiaspecific program shall receive a minimum of eight hours of dementia-specific education and training within 30 days of either employment or the beginning date of the contract. All personnel employed by or contracting with a dementia-specific program shall receive a minimum of two hours of dementia -specific continuing education annually. Direct-contact personnel shall receive a minimum of eight hours of dementia-specific continuing education annually. Specific topic areas must be covered in the training.

Staff Education Training:
Sufficiently trained staff must be available at all times to fully meet tenants' scheduled and unscheduled or unpredictable needs in a manner that promotes maximum dignity and independence and provides supervision, safety, and security. All Assisted Living Programs must be overseen by an RN. A Dementiaspecific Assisted Living Program must have one or more staff on duty 24 hours a day in the proximate area.

Medicaid Policy and Reimbursements:
g All personnel must be able to implement the program's accident, fire safety, and emergency procedures, and assigned tasks.