Assisted Living in New York

Agency: Department of Health
Phone: (518) 408-1600
Website: www.health.state.ny.us

Adult homes provide long term residential care, room, board, housekeeping, personal care, and supervision to five or more adults. Enriched housing programs provide long term residential care to five or more adults (generally 65 years of age or older) in community-integrated settings resembling independent housing units and must provide or arrange for room, board, housekeeping, personal care, and supervision. Residences for adults generally serve a younger population than that served by adult homes and enriched housing programs. Services that must be provided by the operator include room, meals, housekeeping, supervision and case management. Assisted living and an assisted living residence means an entity that provides or arranges for housing, on-site monitoring, and personal care and/or home care services, either directly or indirectly, in a homelike setting for five or more adults unrelated to the assisted living provider. An approved assisted living residence must also provide daily food service, 24-hour on-site monitoring, case management services, and the development of an individualized service plan for each resident. An assisted living operator must provide each resident with considerate and respectful care and promote the resident's dignity, autonomy,independence, and privacy in the least restrictive and most homelike setting consistent with the resident's preferences and physical and mental status. Enhanced assisted living is a certification issued by the Department of Health and may be obtained for either a portion of or an entire residence. The certification authorizes an assisted living residence to provide "aging in place" by retaining residents who desire to continue to live in that residence and who: (1) Are chronically chairfast and unable to transfer, or chronically require the physical assistance of another person to transfer; (2) Chronically require the physical assistance of another person in order to walk; (3) Chronically require the physical assistance of another person to climb or descend stairs; (4) Are dependent on medical equipment and require more than intermittent or occasional assistance from medical personnel; or (5) Have chronic unmanaged urinary or bowel incontinence. Special needs assisted living is a certification that allows a facility to serve individuals with special needs. One such designation is persons with cognitive impairment. A facility must apply to the Department of Health and submit a special needs plan demonstrating how the special needs of the residents will be safely and appropriately met. The Department of Health has developed guidance specifically to ensure adequate staffing and training. Separate from the assisted living residence (ALR) classification created in 2004 is the assisted living program, which was established in 1991 to serve private pay and Medicaid eligible individuals who are medically eligible for nursing home placement, but who are not in need of the highly structured, medical environment of a nursing facility and whose needs could be met in a less restrictive and lower cost residential setting. Assisted living programs (ALPs) are responsible for providing residents with long term residential care, room, board, housekeeping, personal care, supervision, and providing or arranging for home health services. ALPs are required to hold dual licenses/certification as an adult home or enriched housing program and as a licensed home care services agency (LHCSA), long term home health care program, or certified home health agency (CHHA). If the ALP is licensed as a LHCSA, it must contract with a CHHA for provision of skilled services to ALP residents. ALPs may receive Medicaid reimbursement for the health care services provided, whereas an ALR may not.

Facility Scope of Care:
Adult homes and enriched housing programs can provide supervision, personal care, housekeeping, case management, activities, food service, and assistance with medication. A certified enhanced assisted living residence may allow residents to age in place when the provider, the resident's physician, and, if necessary, the resident's licensed or certified home care agency agree that the additional needs of the resident can be safely met.

Move-In/Move-Out Requirements:
In adult homes and enriched housing, residents who have stable medical conditions and are capable of self-preservation with assistance may be admitted. Persons may not be admitted who need continuous nursing care; are chronically bedfast or chairfast; or are cognitively, physically, or mentally impaired to the point that the resident's safety or safety of others is compromised. In certified enhanced assisted living residences, a resident in need of 24-hour skilled nursing care or medical care may continue residency when all of the following conditions are met: (1) The resident in need of 24-hour skilled care hires appropriate nursing, medical, or hospice staff to meet his or her needs. (2) The resident's physician and home care services agency determine and document that the resident can be safely cared for in the residence. (3) The assisted living provider agrees to retain the resident and coordinate the care for all providers. (4) The resident is otherwise eligible to reside at the residence.

Resident Assessment:
Each assisted living resident will have an individualized service plan (ISP) developed when they move into a residence. The ISP is developed jointly by the resident, the resident's representative if applicable, the assisted living operator, a home care agency (as determined by the resident's physician), and in consultation with the resident's physician. The ISP must address the medical, nutritional, rehabilitation, functional, cognitive, and other needs of the resident. The ISP must be reviewed and revised at least every six months or when required by the resident's changing care needs.

Medication Management:
Assistance with self-administration of medication is permitted in facilities. This includes prompting, identifying the medication for the resident, bringing the medication to the resident, opening containers, positioning the resident, disposing of used supplies, and storing the medication.

Physical Plant Requirements:
Enriched housing programs must provide single-occupancy units, unless residents want to share. Adult Homes may provide either single- or double-occupancy resident units.

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

Life Safety:
For ACFs: For Adult Homes and Residences for Adults: (1) Regulations require an automatic sprinkler system throughout in buildings housing 25 or more residents; (2) The Building Code of New York State (modeled after the International Building Code) requires an automatic sprinkler system in accordance with the applicable occupancy group designated for the ACF; (3) Regulations require a supervised smoke detection system installed throughout the building; and (4) Regulations require all fire protection systems required to be directly connected to the local fire department or to a 24/7- attended central station. For Enriched Housing Programs, the state building code requires the installation of automatic sprinkler systems, detection systems, and fire alarm and early warning systems in accordance with the applicable occupancy group designated for the ACF. Proposed regulations for all assisted living residences would require: (1) An automatic sprinkler system installed throughout the building with no bed capacity limitations; (2) A supervised smoke detection system installed throughout the building; and (3) All fire protection systems to be directly connected to the local fire department or to a 24/7-attended central station.

Alzheimer's Unit Requirements:
Special requirements exist for dementia units.

Staff Training for Alzheimer's Care:
Any ACF with approved dementia units is required to provide staff training in characteristics and needs of persons with dementia, including behavioral symptoms, and mental and emotional changes. The training should include methods for meeting the residents' needs on an individual basis. Further, in order to obtain approval for a special needs assisted living residence (SNALR), the 2004 statute requires an operator to submit a plan to the Department which must include not only proposed staffing levels, but also staff education, training, work experience, and professional affiliations or special characteristics relevant to the population the SNALR is intending to serve (including Alzheimer's or other dementias)

Staffing Requirements:
Adult care facilities must have a case manager and staffing sufficient to provide the care needed by residents. The regulations list specific staffing ratios.

Staff Education Training:
Enriched housing programs and adult homes must provide an orientation and in-service training in the characteristics and needs of the population served, resident rights, program rules and regulations, duties and responsibilities of all staff, general and specific responsibilities of the individual being trained, and emergency procedures.

Medicaid Policy and Reimbursements:
Medicaid reimbursement is available for home care services under the Assisted Living Program with a capacity of 4,200 beds statewide. Medicaid reimbursement will not be available for people in assisted living residences