Assisted Living in Michigan

Agency: Michigan Department of Human Services, Bureau of Children and Adult Licensing
Phone: (517) 373-8580
Website: www.michigan.gov/afchfa

An HFA is a supervised personal care facility, other than a hotel, adult foster care facility, hospital, nursing home, or county medical care facility, that provides room, board, and supervised personal care to 21 or more unrelated, non-transient individuals who are 60 years of age or older. AFC homes are residential settings that provide 24-hour personal care, protection, and supervision for individuals who are developmentally disabled, mentally ill, physically handicapped, or aged who cannot live alone but who do not need continuous nursing care.

Facility Scope of Care:
HFAs are required to provide room, board, protection, supervision, assistance, and supervised personal care consistent with the resident's service plan. AFC homes are required to provide supervision, protection, and personal care in accordance with the individual's written assessment plan and include, but are not limited to, medication administration, social activities, and assistance with activities of daily living.

Move-In/Move-Out Requirements:
HFA: A home may not admit an individual whose needs cannot be adequately and appropriately met within the scope of the home's program statement or who is in need of continuous nursing care. At admission, a written resident admission contract and a resident service plan is required. A service plan is completed by the home in cooperation with the individual or the individual's authorized representative identifying the individual's specific needs for care, maintenance, services, and activities. Evidence of tuberculosis screening within the 12 months before admission and, if the individual is under a physician's care, a written health care statement are required. A resident must be discharged if the resident has harmed self or others, or whose behaviors pose a risk of serious harm to self or others unless the home can effectively manage those behaviors. A resident who needs continuous nursing care may not remain in the home unless the resident's family, physician, and the facility consent to the resident's continued stay and agree to cooperate in providing the needed level of care and the necessary additional services or the resident is receiving services from a licensed hospice program or home health agency. A HFA resident may be transferred or discharged only for medical reasons, for his or her welfare or that of other residents, or for non-payment of his or her stay. A home must provide a resident and his or her authorized representative with a written notice stating the reasons and specifics of the discharge 30 days before discharge. A home may discharge a resident before the 30-day notice if the home has determined and documented that either or both of the following exists: (1) Substantial risk to the resident due to the inability of the home to assure the safety and well-being of the resident, other residents, visitors, or staff of the home. (2) A substantial risk or occurrence of the destruction of property. AFC: A licensee shall not accept, retain, or care for a resident who requires continuous nursing care. This does not preclude the accommodation of a resident who becomes temporarily ill while in the home but who does not require continuous nursing care, or accommodation of a person who is a hospice patient. Prior to move in, the licensee must complete a written assessment of the resident and determine that: a) the amount of personal care, supervision, and protection that is required by the resident is available in the home; b) the kinds of services, skills, and physical accommodations that the resident requires are available in the home; and c) the resident appears to be compatible with other residents and members of the household. A licensee must provide a resident and his or her designated representative with a 30-day written notice, stating the reasons for discharge, before discharge from the home. A licensee may discharge a resident before the 30-day notice when the licensee has determined and documented that any of the following exists: (1) Substantial risk to the resident due to the inability of the home to meet the resident's needs or assure the safety and wellbeing of other residents of the home. (2) Substantial risk, or an occurrence, of self-destructive behavior. (3) Substantial risk, or an occurrence, of serious physical assault. (4) Substantial risk, or an occurrence, of the destruction of property.

Resident Assessment:
Though HFAs and AFCs are required to complete an assessment and service plan at the time of admission, a particular form is not required to be used. Sample forms are available and may be found on the department's Web site. Service plans are to be updated at least annually or if there is a significant change in the resident's condition

Medication Management:
A licensee, with a resident's cooperation, shall follow the instructions and recommendations of a resident's physician or other health care professional with regard to medication. The HFA and AFC rules contain additional requirements governing administration of medications.

Physical Plant Requirements:
HFA: A single resident room must be a minimum of 80 square feet of usable space and 100 square feet for new construction. Multiple-bed resident rooms must provide a minimum of 70 square feet per bed of usable floor space and 80 square feet for new construction. (See HFA administrative rules for additional physical plant requirements.) AFC: A single bedroom must have at least 80 square feet of usable floor space. An AFC multi-bed room must have at least 65 square feet of usable floor space per bed. (See specific AFC administrative rules for additional physical plant requirements.) Note: Fire safety requirements are determined and enforced by the Bureau of Fire Services for HFAs and AFC homes licensed for seven or more residents.

Residents Allowed Per Room:
HFA: For new construction, an HFA bedroom can have no more than four beds. AFC: A maximum of two beds are allowed per bedroom unless the facility has been continuously licensed since April 1994.

Life Safety:
HFA: Design and construction of such facilities shall be in compliance with state fire safety rules for health care facilities. The fire safety rules are administered and enforced by the Michigan Department of Energy, Labor, and Economic Growth's Bureau of Fire Services. AFC: Fire safety for homes licensed for seven or more residents is regulated by the Michigan Department of Energy, Labor, and Economic Growth's Bureau of Fire Services. For new construction, the homes must have sprinklers and a fire alarm system that includes a hard-wired, interconnected smoke detection system. Fire safety for homes of six or fewer residents is regulated by the Michigan Department of Human Services. For new construction, homes must have a hard-wired, interconnected smoke detection system.

Alzheimer's Unit Requirements:
HFA and AFC: If facilities advertise or market themselves as providing specialized Alzheimer's or dementia care, prospective residents, residents, or surrogate decision makers must be provided with a written description of the care and services provided. (See, for HFAs: MCL 333.20178, and for AFCs: MCL 400.726(b).) The written description shall include, but not be limited to, all of the following: (1) The overall philosophy and mission reflecting the needs of patients or residents with Alzheimer's disease or a related condition. (2) The process and criteria for placement in or transfer or discharge from a program for patients or residents with Alzheimer's disease or a related condition. (3) The process used for assessment and establishment of a plan of care and its implementation. (4) Staff training and continuing education practices. (5) The physical environment and design features appropriate to support the function of patients or residents with Alzheimer's disease or a related condition. (6) The frequency and types of activities for patients or residents with Alzheimer's disease or a related condition. (7) Identification of supplemental fees for services provided to patients or residents with Alzheimer's disease or a related condition.

Staff Training for Alzheimer's Care:
Although there are no specific training requirements related to dementia, direct care staff must be trained and competent to meet the needs of all residents in care. (See 325.1931 (1-7) for HFAs and 400.14204 (1-3) for AFCs.)

Staffing Requirements:
In addition to the above staff training requirements, HFAs are required to have adequate and sufficient number of staff who are awake, fully dressed, and capable of providing for resident needs consistent with the resident service plans on duty at all times. The home shall also designate one person on each shift to be supervisor of resident care. The supervisor of resident care shall be on the premises and is to supervise resident care, assure that residents are treated with kindness and respect, protect residents from accidents and injuries, and be responsible for the safety of residents in case of emergency. AFCs are required to have direct care staff on duty at all times for the supervision, personal care, and protection of residents and to provide the services specified in the resident's care agreement and assessment plan, with a minimum staff ratio of one direct care staff to 12 residents and children under the age of 12. AFC and HFA employees are required to have background checks completed including fingerprinting for criminal record clearance.

Staff Education Training:
HFA: In addition to the above training requirements, management must establish and implement a staff training program based on the home's program statement, the residents' service plans, and the needs of employees, such as reporting requirements and documentation, first aid, administration of medication, personal care, supervision, resident rights and responsibilities, safety and fire prevention, containment of infectious disease, and standard precautions. AFC: Direct care staff must be at least 18 years of age and able to complete required reports and follow written and oral instructions related to the care and supervision of residents. All staff must be suitable to meet the physical, emotional, intellectual, and social needs of each resident and be capable of appropriately handling emergency situations. Direct care staff must be competent in the following areas before performing assigned tasks: nutrition, reporting requirements, first aid, CPR, personal care, supervision, protection, resident rights, safety and fire prevention, and prevention and containment of communicable diseases. Staff must be trained in the administration of medication before performing that duty. Additional training is required for facilities that are certified to provide a specialized program for persons with developmental disabilities or mental illness, as required by R 330.1806.

Medicaid Policy and Reimbursements:
In licensed facilities, the Medicaid state plan covers personal care services only. Effective June 1, 2009, the MI Choice Medicaid Waiver program became available to prospective and current HFA and AFC residents. This program supports individuals at risk of nursing home placement or transitioning from a nursing home. In a licensed setting, this program can provide supports and services to an eligible individual that are in addition to the usual and customary care required of a licensed home, but does not provide continuous nursing care