Assisted Living in Vermont

Agency: Vermont Department of Disabilities, Aging, and Independent Living, Division of Licensing & Protection
Phone: (802) 241-2345
Website: http://www.dail.vermont.gov/

An assisted living residence is a program that combines housing, health, and supportive services to support resident independence and aging in place. Within a homelike setting, the residence must offer a minimum of a private bedroom, private bath, living space, kitchen capacity, and a lockable door. Assisted living must promote resident self-direction and active participation in decision making while emphasizing individuality, privacy, and dignity.

Facility Scope of Care:
The facility must provide services such as, but not limited to: (1) 24-hour staff supervision to meet emergencies, and scheduled and unscheduled needs; (2) Assistance with all personal care activities and instrumental activities of daily living; (3) Nursing assessment, health monitoring, routine nursing tasks, and intermittent skilled nursing services; (4) Appropriate supervision and services for residents with dementia or related issues requiring ongoing staff support and supervision; and (5) Medication management, administration, and assistance. A resident needing skilled nursing care may arrange for that care to be provided in the facility by a licensed nurse as long as it does not interfere with other residents.

Move-In/Move-Out Requirements:
Assessment must be done by a registered nurse (RN) within 14 days of move-in. Residents may be discharged if they pose an immediate threat to themselves that cannot be managed through a negotiated risk agreement or to others, or if their needs cannot be met with available support services and arranged supplemental services. However, if a facility is able to, it may retain residents who need: (1) 24-hour on-site nursing care; (2) Are dependent in four or more activities of daily living; (3) Have severe cognitive decline; (4) Have stage III or IV pressure sores; or (5) Have a medically unstable condition.

Resident Assessment:
There is a required assessment form: Vermont Residential Care Home/Assisted Living Residence Assessment Tool. This tool is available online.

Medication Management:
If residents are unable to self-administer medications, they may receive assistance with administration of medications from trained facility staff. Staff may be trained to administer medications by delegation from an RN in accordance with regulations and Vermont's Nurse Practice Act.

Physical Plant Requirements:
Private resident units must be a minimum of 225 square feet (160 in pre-existing structures), excluding bathrooms and closets. Each resident unit shall include a private bedroom, private bathroom, living space, kitchen capacity, adequate space for storage, and a lockable door. The licensing agency may grant variances for pre-existing structures in specified instances.

Residents Allowed Per Room:
All resident units must be private occupancy unless a resident voluntarily chooses to share the unit.

Life Safety:
Vermont uses the 2006 edition of the National Fire Protection Association Life Safety Code as the basis for fire safety standards for assisted living facilities. The Department of Public Safety administers life safety rules published at http://www.dps.state.vt.us/fire/06firecodeADOPTEDjune15092.pd f. Requirements vary based on building type. Smoke detector and sprinkler system requirements apply to most facilities. The highest requirements apply to new construction. Effective October 2007, required carbon monoxide detectors must be hardwired (versus battery-powered).

Alzheimer's Unit Requirements:
Special care units must meet requirements of the Residential Care Home Licensing Regulations at 5.6 (incorporated by reference into the Assisted Living Licensing Regulations). A residence must obtain approval from the licensing agency prior to establishing and operating a special care unit. Approval is based on demonstration that the unit will provide specialized services to a specific population. A request for approval must include all of the following: (1) A statement outlining the philosophy, purpose, and scope of services to be provided; (2) A definition of the categories of residents to be served; (3) A description of the organizational structure of the unit consistent with the unit's philosophy, purpose, and scope of services; (4) A description and identification of the physical environment; (5) The criteria for admission, continued stay, and discharge; and (6) A description of unit staffing, including staff qualifications; orientation; in-service education and specialized training; and medical management and credentialing as necessary.

Staff Training for Alzheimer's Care:
Staff who have any direct care responsibility shall have training in communication skills specific to persons with Alzheimer's disease and other types of dementia.

Staffing Requirements:
Staff must have access to the administrator and/or designee at all times. At least one personal care assistant must be on site and available 24-hours per day to meet residents' scheduled and unscheduled needs. On-site trained staff must be available in sufficient number to meet the needs of each resident. An RN or licensed practical nurse must be on site as necessary to oversee service plans.

Staff Education Training:
All staff providing personal care must be at least 18 years of age. All staff must be oriented to the principles and philosophy of assisted living and receive training on an annual basis regarding the provision of services in accordance with the resident-driven values of assisted living. All staff providing personal care must receive training in the provision of personal care activities (e.g., transferring, toileting, infection control, Alzheimer's, and medication assistance and administration). Staff who have any direct care responsibility must have training in communications skills specific to persons with Alzheimer's disease and other types of dementia.

Medicaid Policy and Reimbursements:
Two programs cover assisted living services: The Assistive Community Care Services Program is a Medicaid state plan service that pays for services below nursing home level of care. Any resident who qualifies for the setting and is enrolled in Medicaid is eligible. The Choices for Care 1115 Program includes an enhanced residential care service that provides funding for services to persons at the "highest" classification of need as an entitlement, and to as many persons at the "high" need classification as funds permit. The program began in October 2005. All participating individuals have needs that meet Vermont's nursing home level of care guideline and meet long-term care Medicaid requirements.