Assisted Living in North Dakota

Agency: Department of Health, Division of Health Facilities for Basic Care Facilities
Phone: (701) 328-2352
Website: http://www.ndhealth.gov/

A basic care facility means a facility licensed by the Department of Health under North Dakota Century Code chapter 23-09.3. The focus of the facility is to provide room and board and health, social, and personal care to assist the residents to attain or maintain their highest level of functioning, consistent with the resident assessment and care plan, for five or more residents not related to the owner or manager by blood or marriage. These services must be provided on a 24-hour basis within the facility, either directly or through contract, and shall include assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs); provision of leisure, recreational, and therapeutic activities; and supervision of nutritional needs and medication administration. An assisted living facility is a facility licensed by the Department of Human Services under North Dakota Century Code 50-32. A license from the Department of Health under North Dakota Century Code 23-09 is required as part of the license process. A licensed assisted living facility means a building or structure containing a series of at least five living units operated as one entity to provide services for five or more individuals who are not related by blood, marriage, or guardianship to the owner or manager of the entity and which is kept, used, maintained, advertised, or held out to the public as a place that provides or coordinates individualized support services to accommodate the individual's needs and abilities to maintain as much independence as possible. An assisted living facility does not include a facility that is a congregate housing facility, licensed as a basic care facility, or licensed under Chapters 23-16 or 25-16 or Section 50-11-01.4

Facility Scope of Care:
A basic care facility may provide assistance with ADLs defined as prompting, encouragement, or minimal hands-on assistance. It must provide personal care services to assist residents to attain and maintain their highest level of functioning consistent with the resident assessments and care plans. In assisted living, tenants choose and pay for only those services needed or desired. An assisted living facility may provide assistance to adults who may have physical or cognitive impairments and who require at least a moderate level of assistance with one or more ADLs and assistance with IADLs.

Move-In/Move-Out Requirements:
A basic care facility may admit or retain only individuals whose condition and abilities are consistent with National Fire Protection Association (NFPA) 101 Life Safety Code requirements and who must be capable of self-preservation. Basic care residents are admitted and retained in the facility in order to receive room and board and health, social, and personal care, and whose condition does not require continuous, 24-hour-aday onsite availability of nursing or medical care. Other admission and discharge criteria are developed by each basic care or assisted living facility dependent upon their ability to meet the needs of the residents and the services available.

Resident Assessment:
In basic care and assisted living facilities, the facilities develop and utilize their own forms.

Medication Management:
In assisted living and in basic care facilities, unlicensed staff may administer medication except for 'as needed' controlled prescription drugs. In Spring 1997, a medication administration bill was passed allowing for the administration of limited medications by unlicensed personnel. This provision requires those personnel to have specific training and be monitored by a registered nurse.

Physical Plant Requirements:
In basic care facilities, private resident units must be a minimum of 100 square feet; semi-private resident units must provide a minimum of 80 square feet per resident; and units for three or more individuals must provide a minimum of 70 square feet per resident. Generally, basic care facilities have semi-private units. Generally, in an assisted living facility, living units are efficiency or one- or two-bedroom apartments. A living unit must contain a sleeping area, an entry door that can be locked, and a private bathroom with a toilet, bath tub or shower, and a sink.

Residents Allowed Per Room:
Not specified for basic care facilities. No more than two people may occupy one bedroom of each living unit of an assisted living facility.

Life Safety:
Basic care facilities: In general, in basic care facilities, automatic sprinkler systems are required to protect construction types that may be unprotected or of combustible materials. NFPA 13D, NFPA 13R, or NFPA 13 automatic sprinkler systems may be used. Smoke detectors are required in resident rooms, corridors, and common areas. There are exceptions where these requirements may not apply. Basic care facilities must comply with the NFPA safety code, 1988 edition, chapter 21, residential board and care occupancy, slow evacuation capability, or a greater level of fire safety. Fire drills must be held monthly with a minimum of 12 per year, alternating with all work shifts. Residents and staff, as a group, shall either evacuate the building or relocate to an assembly point identified in the fire evacuation plan. At least once a year, a fire drill must be conducted during which all staff and residents evacuate the building. Fire evacuation plans must be posted in a conspicuous place in the facility. Written records of fire drills must be maintained. These records must include dates, times, duration, names of staff and residents participating and those absent and why, and a brief description of the drill including the escape path used and evidence of simulation of a call to the fire department. Each resident shall receive an individual fire drill walk-through within five days of admission. Any variation to compliance with the fire safety requirements must be approved in writing by the department. Residents of facilities meeting a greater level of fire safety must meet the fire drill requirements of that occupancy classification. Assisted living facilities: Operators of assisted living facilities must certify that facilities are in compliance with all applicable federal, state, and local laws, and upon request make available to the department copies of current certifications, licenses, permits, and other similar documents providing evidence of compliance with such laws. Each assisted living facility must install smoke detection devices or other approved alarm systems of a type and number approved by the department, in cooperation with the state fire marshal. Assisted living facilities must meet exiting requirements. Access to fire escapes must be kept free and clear at all times of all obstructions of any nature. The proprietor of the assisted living facility must provide for adequate exit lighting and exit signs as defined in the state building code. Each assisted living facility must be provided with fire extinguishers as defined by the NFPA standard number 10 in quantities defined by the state building code and the state fire code. Standpipe and sprinkler systems must be installed as required by the state building code and state fire code. Fire extinguishers, sprinkler systems, and standpipe systems must conform with rules adopted by the state fire marshal. A contract for sale or a sale of a fire extinguisher installation in a public building is not enforceable, if the fire extinguisher or extinguishing system is of a type not approved by the state fire marshal for such installation. No fire extinguisher of a type not approved by the state fire marshal may be sold or offered for sale within the state. Assisted living facilities must meet smoke detector regulations as stated in North Dakota Administrative Code 33-33-05. These regulations require every sleeping room, passageway, and hallway to be equipped with a smoke detection device. In addition, at least one sleeping room in an assisted living facility shall be equipped with a listed smoke detection device for the hearing impaired. At least 10 percent of battery-operated smoke detectors must be tested weekly and at least 10 percent of hardwired detectors must be tested monthly on a systematic basis. Records of those tests need to be kept for two years.

Alzheimer's Unit Requirements:
Alzheimer's units are available in basic care facilities. They are not available in assisted living facilities.

Staff Training for Alzheimer's Care:
None specified. However, all staff in basic care facilities are required to receive annual training on the mental and physical health needs of the residents, including behavior problems

Staffing Requirements:
In assisted living, staff must be available 24 hours a day to meet the needs of the residents, not necessarily on site. Basic care facilities must provide 24-hour staffing.

Staff Education Training:
All employees in basic care facilities must have in-service training annually on: a) fire and accident prevention and safety; b) mental and physical health needs of the residents, including behavior problems; c) prevention and control of infections, including universal precautions; and d) resident rights. In basic care facilities, the staff responsible for food preparation are required to attend a minimum of two dietary educational programs per year and staff responsible for activity services are required to attend a minimum of two activity-related programs per year. All employees of assisted living facilities must receive annual training on : a) resident rights; b) fire and accident prevention and training; c) mental and physical health needs of tenants; d) behavior problems and preventions; and e) control of infection, including universal precautions.

Medicaid Policy and Reimbursements:
A personal care option pays for services in a basic care facility. The individual must be Medicaid eligible to qualify for the personal care option. Personal funds or state general funds pay for room and board. Individuals in assisted living facilities may be eligible for services funded by state resources, Medicaid, or Medicaid waiver services. Generally, low-income individuals have limited access to assisted living because funds are not available for rental assistance (except through the U.S. Department of Housing and Urban Development in limited situations)