Assisted Living in Massachusetts

Agency: Executive Office of Elder Affairs
Phone: (617) 727-7750
Website: www.state.ma.us/elder

An assisted living residence is any entity that provides room and board and personal care services for three or more adults and collects payments from or on behalf of residents for the provision of assistance with activities of daily living (ADLs).

Facility Scope of Care:
The facility must provide for the supervision of and assistance with ADLs and instrumental activities of daily living; selfadministered medication management for all residents whose service plans so specify; timely assistance to residents and response to urgent/emergency needs; and up to three regularly scheduled meals daily (at a minimum, one meal).

Move-In/Move-Out Requirements:
An assisted living residence shall not provide, admit, or retain any resident in need of skilled nursing care unless (1) the care will be provided by a certified provider of ancillary health services or by a licensed hospice; and (2) the certified provider of ancillary health services does not train the assisted living residence staff to provide the skilled nursing care. (Note: The state attorney general has stated that this section of the statute violates the Americans with Disabilities Act and, therefore, Elder Affairs does not enforce this.)

Resident Assessment:
The resident record must include a resident assessment, including the resident's diagnoses, current medications (including dosage, route, and frequency), allergies, dietary needs, need for assistance in emergency situations, history of psychosocial issues, level of personal care needs, and ability to manage medication. Elder Affairs does not require a standardized form to be utilized for the assessment. Every facility must have a quality improvement and assurance program

Medication Management:
Self-administered medication management is permitted. Limited medication administration may only be provided by a family member, a practitioner as defined in state law, or a nurse registered or licensed under the provisions of state law. Nurses employed by the assisted living residence may administer noninjectible medications prescribed or ordered by an authorized prescriber to residents by oral or other routes (e.g. topical, inhalers, eye and ear drops, medicated patches, as necessary oxygen, or suppositories).

Physical Plant Requirements:
Facilities must provide either single or double occupancy units with lockable doors on the entry door of each unit and either a kitchenette or access to cooking facilities.

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

Life Safety:
Massachusetts does not have any specific life safety code requirements for Assisted Living Residences. Rather, the regulations state that they must "meet the requirements of all applicable federal and state laws and regulations including, but not limited to, the state sanitary codes, state building and fire safety codes, and laws and regulations governing use and access by persons with disabilities."

Alzheimer's Unit Requirements:
A residence may designate a distinct part or the entire facility as a Special Care Residence to address the specialized needs of individuals, including those who may need assistance in directing their own care due to cognitive or other impairments. There are additional requirements, including policies and procedures and staff training, necessary for certification as a Special Care Residence.

Staff Training for Alzheimer's Care:
All staff must receive at least two hours of training on the topic of dementia/cognitive impairment, including a basic overview of the disease process, communication skills, and behavioral management as part of the general orientation. The manager and service coordinator shall receive an additional two hours of training (at least four hours total) on these topics. In addition, as part of the ongoing in-service training, all staff must receive at least two hours per year of training on dementia/cognitive impairment topics.

Staffing Requirements:
The facility must have a manager and service plan coordinator on staff. A staff person must be on the premises 24 hours per day.

Staff Education Training:
Personal care staff must be licensed nurses, certified nursing assistants, certified home health aides, qualified personal care homemakers, or complete a 54-hour training course. The service coordinator must be qualified by training and experience. All staff and contracted providers who will have direct contact with residents and all food service personnel must receive a sevenhour orientation prior to active employment.

Medicaid Policy and Reimbursements:
The Medicaid state plan covers personal care services.