Assisted Living in Tennessee

Agency: Department of Health, Division of Health Care Facilities
Phone: (615) 741-7221
Website: www.state.tn.us/health/HCF/

An Assisted Care Living Facility (ACLF) is a building, establishment, complex, or distinct part thereof that accepts primarily aged persons for domiciliary care and services.

Facility Scope of Care:
The facility may provide medical services and oversight of medical services. The facility shall provide personal services. Medical services include administration of medication, part-time intermittent nursing care, various therapies, podiatry, medical social services, medical supplies, durable medical equipment, and hospice services. Personal services include protective care, safety when in the ACLF, daily awareness of the individual's whereabouts, the ability and readiness to intervene if crises arise, room and board, non-medical living assistance with activities of daily living (ADLs), laundry services, and dietary services.

Move-In/Move-Out Requirements:
A facility shall not admit or permit the continued stay of any resident if he/she: (1) Requires treatment of extensive stage III or IV decubitis ulcer or exfoliative dermatitis; (2) Requires continuous nursing care; (3) Has an active, infectious, and reportable disease in a communicable state that requires contact isolation; (4) Exhibits verbal or physical aggressive behavior which poses an imminent physical threat to self or others, based not on the person's diagnosis, but on the behavior of the person; (5) Requires physical or chemical restraints, not including psychotropic medications prescribed for a manageable mental disorder or condition; or (6) Has needs that cannot be safely and effectively met in the ACLF. An ACLF resident shall be discharged and transferred to another appropriate setting such as home, a hospital, or a nursing home when the resident, the resident's legal representative, ALCF administrator, or the resident's treating physician determine that the ACLF cannot safely and effectively meet the resident's needs, including medical services. The Board for Licensing Health Care Facilities may require that an ACLF resident be discharged or transferred to another level of care if it determines that the resident's needs, including medical services, cannot be safely and effectively met in the ACLF. A facility shall not admit, but may permit the continued stay of residents who require the following treatments on an intermittent basis of up to three 21-day periods: (The resident's treating physician must certify that treatment can be safely and effectively provided by the ACLF for the last two 21-day periods.) (1) Nasopharyngeal or tracheotomy aspiration; (2) Nasogastric feedings; (3) Gastrostomy feedings; or (4) Intravenous therapy or intravenous feedings. The treatments described above can be provided on an ongoing basis if: (1) The resident is receiving hospice services; (2) The resident does not qualify for nursing facility level of care, in which case a waiver may be granted by the Board for Licensing Health Care Facilities, allowing the person to remain in the ACLF; or (3) A person who requires any of the treatments specified above and who is able to self-care for such conditions without the assistance of facility personnel or other appropriately licensed entity will not be subject to the limitations outlined above and may be admitted or permitted to continue as a resident in an ACLF. Any ACLF resident who qualifies for hospice care shall be able to receive hospice services and continue as a resident of the facility as long as the resident's treating physician certifies that hospice care can be appropriately provided at the facility

Resident Assessment:
Facilities are required to assess prospective residents before they move in to make sure they meet the definition of an ACLF resident. The complete written assessment of the resident shall occur within a time-period determined by the ACLF, but no later than 72 hours after admission. Quarterly reviews are to be performed by an interdisciplinary team for residents in a secured unit.

Medication Management:
Medication must be self-administered or administered by a licensed professional. The facility may assist residents with medication, including reading labels, reminders, and observation.

Physical Plant Requirements:
A minimum of 80 square feet of bedroom space must be provided to each resident. Living room and dining areas capable of accommodating all residents shall be provided, with a minimum of 15 square feet per resident per dining area. All new facilities must conform to the 2006 edition of the International Building Code, the 2006 edition of the National Fire Protection Code of the National Fire Protection Association (NFPA), the 2005 edition of the National Electrical Code, and the 1999 edition of the U.S. Public Health Service Food Code as adopted by the Board for Licensing Health Care Facilities. The requirements of the Americans with Disabilities Act, as revised in 2004, and the 1999 edition of the North Carolina Handicap Accessibility Codes with 2004 amendments apply to all new and existing facilities. Where there are conflicts between requirements in local codes and the above listed codes and regulations, the most stringent requirements shall apply.

Residents Allowed Per Room:
No bedroom shall have more than two beds.

Life Safety:
All facilities must be protected throughout by an approved automatic sprinkler system using quick-response or residential sprinklers. All facilities must have electrically operated smoke detectors with battery back-up power operating at all times in at least sleeping rooms, day rooms, corridors, laundry rooms, and any other hazardous areas. In addition to state and federal laws and regulations, Tennessee adheres to NFPA standards

Alzheimer's Unit Requirements:
Facilities are permitted to have secured units and can retain residents into the last stages of Alzheimer's disease, consistent with the above admission/discharge/transfer criteria. Facilities utilizing secured units must provide to survey staff specific information and documentation accumulated during the previous 12 months regarding staffing patterns, care provided, and other health-related issues.

Staff Training for Alzheimer's Care:
Any staff working on a secured unit must have annual in-service training, including at least the following subject areas: (1) Basic facts about the causes, progression, and management of Alzheimer's disease and related disorders; (2) Dealing with dysfunctional behavior and catastrophic reactions in the residents; (3) Identifying and alleviating safety risks to the resident; (4) Providing assistance with ADLs for the resident; and (5) Communication with families and other persons interested in the resident.

Staffing Requirements:
Facilities must employ an administrator, an identified responsible attendant, and a sufficient number of staff to meet the needs, including medical services as prescribed, of the residents. A licensed nurse must be available as needed. An ACLF shall employ a qualified dietician, full time, part time, or on a consultant basis.

Staff Education Training:
The responsible attendant, administrator, and direct care staff must be at least 18 years of age.

Medicaid Policy and Reimbursements:
Tennessee has both a state-only funded and a Medicaid-funded home and community-based (HCB) services program. Medicaid long-term care services, both HCB and nursing facility care, are provided under a managed care program called CHOICES. ACLF services are included in CHOICES with the exception of room and board. ACLFs also can provide respite care to eligible individuals.