Assisted Living in New Hampshire

Agency: Department of Health and Human Services, Office of Operations Support, Health Facilities Administration
Phone: (603) 271-4592
Website: www.dhhs.nh.gov

Assisted Living Residence - Supported Residential Health Care (ALR-SRHC) is a community-based long term care residence providing personal assistance. These homes are non-medical and non-institutional and may be publicly or privately owned and operated. They provide shelter, food, and protective oversight to a population of adult, elderly, disabled, special needs, and/or special care residents. ALR-SRHC is designed for adults who may or may not qualify for nursing home care and can no longer manage independent living in their own homes. These residences provide a wide variety of support services based on the specific needs of the residents. Services may include nursing care, personal care, nutrition, homemaker services, and medication management. Assisted Living Residence - Residential Care (ALR-RC) is a nonmedical and non-institutional, publicly or privately owned and operated community-based living arrangement providing shelter, food, and protective oversight to a population of adult, elderly, or disabled individuals residents. ALR-RC facilities are designed for adults who usually do not qualify for nursing home care but either can no longer manage independent living in their own homes or do not want to live alone. These residences provide a wide variety of support services based on the specific needs of residents. Services may include personal care, nutrition, homemaker services, and medication oversight.

Facility Scope of Care:
ALR-SRHC facilities may provide protective services, including supervision of activities of daily living (ADLs), nutrition, medication administration, nursing care, and short-term rehabilitation services. ALR-RC facilities may provide protective services, including supervision of ADLs, nutrition, and medication oversight. Medical and/or nursing or rehabilitative care can be provided in an ALR-RC facility up to 21 visits per incident that requires medical, nursing, or rehabilitative care or services unless the Department authorizes additional visits.

Move-In/Move-Out Requirements:
ALR-SRHC facilities may only admit persons whose needs can be met by the facility and who can evacuate in accordance with the state fire code. ALR-RC facilities may only admit persons whose needs can be met by the facility. Residents must be capable of self-evacuation without assistance and only require assistance with personal care (as defined by National Fire Protection Association (NFPA) 101 - 2003 edition).

Resident Assessment:
There is a standard resident assessment tool that can be obtained by calling (603) 271-3021 or going to the state of New Hampshire web site.

Medication Management:
In ALR-SRHC facilities, residents may self-administer medications with or without staff supervision or self-direct medication administration, or licensed staff may administer medication. Nurse delegation of medications is also allowed.In ALR-RC facilities, residents may self-administer medications with or without staff supervision or self-direct medication administration. Licensed staff may administer medications. Nurse delegation is allowed.

Physical Plant Requirements:
In an ALR-SRHC licensed for 16 or fewer residents, there shall be at least 80 square feet per room with a single bed and 160 square feet per room with two beds, exclusive of space required for closets, wardrobe, and toilet facilities. In an ALR-SRHC licensed for 17 or more residents, there shall be at least 100 square feet for each resident in each private-bedroom and at least 80 square feet for each resident in a semi-private bedroom, exclusive of space required for closets, wardrobes, and toilet facilities. Bedrooms in an ALR-SRHC licensed prior to the effective date of the applicable rule (October 25, 2006) must provide at least 80 square feet per resident in a private room and at least 70 square feet per resident in a semi-private room. The space requirements are exclusive of space required for closets, wardrobes, and bathroom. In an ALR-RC, bedrooms shall have at least 100 square feet for each resident in each private bedroom and at least 80 square feet of space in each semi-private room. ALR-RC facilities licensed prior to April 2008 shall provide at least 80 square feet per resident in a private room and at least 70 square feet in each semi-private room. The space requirements are exclusive of space required for closets, wardrobes, and bathroom.

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

Life Safety:
All new ALR-SRHC facilities must meet the health care chapter of NFPA 101 (2003 edition). Licensed homes doing additions or renovations must construct in compliance with the health care chapter. All other homes will be required to achieve equivalency with the state fire code. Smoke detectors that are hardwired and interconnected are required in every bedroom and on every level. A carbon monoxide monitor and ABC-type fire extinguisher are required on every floor. In ALR-RC facilities, all residents must be able to self-evacuate as defined by NFPA 101 (2003 edition). Homes at this level must comply with the NFPA residential board and care chapter. This includes sprinkler systems for all homes of nine or more residents and smoke detectors that are hardwired and interconnected in every bedroom and on every level. It is anticipated that carbon monoxide monitors will also be required on every level in the new regulations.

Alzheimer's Unit Requirements:
For both levels of licensure, facilities must meet the needs of residents. Locked or secure buildings are prohibited for ALR-RC facilities.

Staff Training for Alzheimer's Care:
Licensees must provide staff with training that meets the needs of residents.

Staffing Requirements:
Facilities must employ a full-time administrator who is responsible for day-to-day operations. Personnel levels are determined by the administrator and based on the services required by residents and the size of the facility. For an ALR-RC facility, full time means at least 35 hours per week, which can include evening and weekend hours. Both ALR-SRHC and ALR-RC licensees shall obtain and review a criminal records check from the New Hampshire Department of Safety for all applicants for employment and household members 18 years of age or older, and verify their qualifications prior to employment. Unless a waiver is granted, licensees shall not offer employment for any position or allow a household member to continue to reside in the residence if the individual: (1) Has been convicted of sexual assault, other violent crime, assault, fraud, abuse, neglect or exploitation; (2) Has been found by the department or any administrative agency in any state for assault, fraud, abuse, neglect or exploitation of any person; or (3) Otherwise poses a threat the health, safety, or well-being of the residents.

Staff Education Training:
Direct-care staff must be at least 18 years of age. All personnel must have orientation and training in the performance of their duties and responsibilities.

Medicaid Policy and Reimbursements:
A Medicaid home and community-based services waiver covers services in assisted living