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A State-by-State Guide to Assisted Living Regulations

A State-by-State Guide to Assisted Living Regulations

Date Updated: June 13, 2024

Reviewed by:

Brindusa Vanta

Dr. Brindusa Vanta is a health care professional, researcher, and an experienced medical writer (2000+ articles published online and several medical ebooks). She received her MD degree from “Iuliu Hatieganu” University of Medicine, Romania, and her HD diploma from OCHM – Toronto, Canada.

If you’re considering assisted living for your loved one, finding a community where they’ll be safe and have access to the highest quality of care is likely a priority. It’s normal to worry about the well-being of an elderly loved one when they’re under someone else’s care, especially as elder abuse is a real problem. However, finding information about assisted living regulations and violations can be challenging. A national website containing audit and licensing information for Medicare-approved nursing homes exists, but there’s no such resource available for assisted living facilities. 

The National Council on Aging reports approximately 1 in 10 Americans aged 60 and older have experienced some form of elder abuse, but only about 1 in 24 of these cases are reported. Knowing how to recognize signs of abuse and report assisted living violations will not only keep your loved one safe but also other potential victims.

This guide covers the types of abuse older adults are exposed to, how to report it and where you can find information about an assisted living facility’s past violations to protect your loved one from harm. 

Who Regulates Assisted Living Facilities?

Assisted living facilities are governed by individual states, not the federal government. Each state has its own agency that regulates ALFs, typically the state health department or social services office. The Centers for Medicare & Medicaid Services (CMS) oversees nursing homes, not assisted living communities, but offers some guidance regarding regulations of Medicaid-certified assisted living facilities. 

Assisted Living Licensing

Assisted living communities must be licensed if they deliver high-level care to residents. Each state has its own licensing requirements, but there are a few common requirements  for these facilities:

  • Daily meals
  • Assistance with daily living activities
  • Trained staff
  • 24-hour emergency call systems and security
  • Social and recreational programs
  • Housekeeping and laundry services
  • Transportation
  • Maintenance services for resident rooms

Assisted Living Inspections

Depending on the state, assisted living inspections are conducted annually, semiannually or as deemed necessary by the regulating agency. Advanced notice doesn’t always have to be given, especially if the inspection is in response to a complaint. When a formal complaint is filed against a facility, the state’s health department or long-term care ombudsman program will likely launch an investigation. The investigators may interview the managers or staff members and inspect safety and security measures to see if the facility is meeting regulations to maintain a healthy environment for its residents. 

Common Assisted Living Violations and Types of Abuse

Many older adults are vulnerable to assisted living abuse, especially if they have a mental impairment, such as memory loss. Elder abuse of any type can cause serious physical and psychological harm, including robbing older adults of their dignity and security or, in severe cases, costing them their lives. There are several common types of elder abuse and assisted living violations to be aware of. 

Types of Assisted Living Abuse

  • Physical abuse: This type of abuse involves inflicting physical harm, such as slapping, pushing, hitting, kicking or improperly using restraints or denying a resident food or drinks. 
  • Emotional or psychological abuse: This includes verbal abuse, harassment, degradation and humiliation. Speaking condescendingly to a resident or giving them the silent treatment for undesired actions also falls under this category. 
  • Sexual abuse: Forcing an assisted living resident to engage in a sexual act, such as touching, fondling or having intercourse when they’re unable or unwilling to consent is sexual abuse
  • Neglect: Failing to provide a resident with life necessities, including food, water, shelter, medical care or clothing, is neglect. This can either be intentional or unintentional, such as a facility being understaffed and not having the capability to adequately care for each resident. 
  • Financial exploitationThis occurs when an older adult is taken advantage of financially by another individual misusing or withholding their money or other assets, usually for their own benefit. 

Common Assisted Living Violations

  • Lack of daily care: A major responsibility of ALF staff is to administer daily care to residents, such as helping them with personal hygiene. Skipping a task or performing it poorly can lead to infections, discomfort and other complications that affect a resident’s overall health and well-being. 
  • Mishandled medications: Failing to dispose of expired medications or refill prescriptions and giving a resident the wrong medication are some of the most common medication administration violations.  
  • Poor food quality: Another common violation is storing or serving food at improper temperatures. A facility can also be cited for deviating from a resident’s dietary plan or failing to provide a scheduled meal altogether. 
  • Inadequate emergency plans: ALFs should have an emergency plan in place for disasters, such as fires, floods, earthquakes or hurricanes. Failing to provide an evacuation plan is against regulations in most states, and facilities may be given a mandated time frame to bring their plan up to code. 
  • Oversight of employee health: Most facilities require employees to have vaccinations for certain conditions, such as the flu and tuberculosis, to protect residents with weakened immune systems. Not keeping tabs on employee health can negatively impact a facility. 

Recognizing Signs of Potential Assisted Living Abuse and How to Spot Elder Abuse

Since there are so many types of abuse that can occur, it can be difficult to know what to look for to help your elderly relative stay safe. If you’re worried about a loved one’s condition, here are a few common signs of potential assisted living abuse:

  • Unexplained bruises, broken bones, pressure marks or burns
  • Poor hygiene or unsanitary living conditions
  • Increased fear or anxiety
  • Withdrawal from normal activities
  • Unusual changes in behavior or sleep patterns
  • Unusual changes in spending habits or financial documents
  • Unpaid bills
  • Isolation from friends or family

Spotting Elder Abuse

Assisted living abuse can go unrecognized for a long time because victims may keep details to themselves out of fear, shame or embarrassment. They may be unable to report the abuse due to a disability or lack of phone access. One of the best ways to keep a loved one safe is to visit them often. If their health or well-being is declining and unrelated to any physical or mental health conditions, or they consistently have poor hygiene and unsanitary living conditions, they may be a victim of elder abuse. 

Talking to a trained caregiver or nurse at the facility who routinely checks in on your loved one may help you determine the cause of your relative’s declining health and bring attention to their status. You can also focus on how your loved one reacts when being around certain staff members. If they seem fearful or anxious, this may be a sign they’re being mistreated. 

How to Find Information About an Assisted Living Facility’s Past Violations

The process for finding information about an assisted living facility’s violation history varies by state, since each state has different regulations and laws. However, your state’s Department of Health website should be able to help. Once you get to the site, search for assisted living or adult care facilities. Depending on the site, this should bring up a facility directory or search form you can filter based on facility name or location. 

After choosing a specific facility, you should be able to access its past inspection reports. Any previous citations or violations should be included with these reports, along with other important information detailing the safety and security of the facility. If this information isn’t readily available or your state’s Department of Health website isn’t user-friendly, you can try calling the department directly and asking how you can access a copy of past inspection or violation reports. 

How to Report Violations of Assisted Living Regulations

If you notice any signs of abuse or regulation violations when visiting a loved one at an ALF, it’s important to report it right away. Filing a complaint with the facility may be enough to resolve the issue, but in severe cases, you may need to file an official report with your state’s long-term care ombudsman program. 

How to Prepare a Report

When preparing an abuse or violation report, be as specific as possible about what happened. The more details you can provide of the incident, the more effectively it can be investigated. However, if you’re unsure of some details, don’t be deterred. Reporting the information you have is better than not reporting at all. To make your report as informative as possible, try to include these details:

  • General statement describing what happened
  • Who it happened to
  • When it happened
  • Where it happened
  • The perpetrator of the abuse or violation
  • Names of any witnesses

Providing these details can help your local long-term care ombudsman thoroughly prepare for the investigation and know exactly who to speak with at the facility. 

Where to Report Assisted Living Violations and Abuse in Each State

Each state has a long-term care ombudsman program to resolve problems regarding the health, safety and rights of individuals living in long-term care facilities, including assisted living communities and nursing homes. These programs are meant to promote policies that protect residents and ensure they have access to high-quality services and support at residential facilities. 

Whenever a resident or family member files an official abuse or violation complaint, it’s the state ombudsman program’s job to conduct an investigation and resolve the issue in the best interest of the affected resident. Depending on the state, ombudsmen may be paid staff and/or local volunteers. 

You can use the following table to identify the contact information for your state’s ombudsman program.

State Ombudsman Program

Contact: Phone Contact: Email

Alabama Office of the State Long-Term Care Ombudsman Program

(334) 242-5743

ageline@adss.alabama.gov

Alaska Office of Long Term Care Ombudsman

(907) 334-4480

akoltco@alaska.gov 

Arizona Long-Term Care Ombudsman

(602) 542-6454

ltcop@azdes.gov

Arkansas Long-Term Care Ombudsman Program

(501) 508-8857

charlotte.bishop@dhs.arkansas.gov

California Department of Aging Long-Term Care Ombudsman

(800) 231-4024 (24/7 CRISISline)


(916) 419-7510

Colorado Long-Term Care Ombudsman

Contact your local Area Agency on Aging to reach the ombudsman serving your region

Connecticut Long-Term Care Ombudsman Program

(866) 388-1888

ltcop@ct.gov

Delaware Long-Term Care Ombudsman Program

(855) 773-1002

DHSS_OSEC_Ombudsman@Delaware.gov

District of Columbia Office of the Long-Term Care Ombudsman

(202)434-2190 

DCOmbuds@aarp.org

Florida Long-Term Care Ombudsman Program

(850) 414-2323

LTCOPInformer@elderaffairs.org

Georgia Long Term Care Ombudsman Program

Complete the contact form or use the online map to find the ombudsman serving your county

Hawaii Long-Term Care Ombudsman

(888) 229-2231

info@hi-ltc-ombudsman.org

Idaho Commission on Aging Ombudsman

(208) 334-3833

icoa@aging.idaho.gov

Illinois Long Term Care Ombudsman

(800) 252-8966

Aging.SLTCOProgram@illinois.gov

Indiana Long-Term Care Ombudsman

(800) 622-4484

LongTermCareOmbudsman@ombudsman.IN.gov

Iowa Office of the State Long-Term Care Ombudsman

(515) 725-3308

Kansas Long-Term Care Ombudsman

(877) 662-8362

Camille.Russell@ks.gov

Kentucky Long-Term Care Ombudsman

(800) 372-2991

sherryculp@ombuddy.org

Louisiana Ombudsman Program

(866) 632-0922

StateOmbudsman@la.gov

Maine Long-Term Care Ombudsman Program

(800) 499-0229

MLTCOP@MaineOmbudsman.org

Maryland Department of Aging Ombudsman Program

Contact the ombudsman serving your county.

Massachusetts Long-Term Care Ombudsman Program 

(617) 727-7750 

Michigan Long Term Care Ombudsman Program

(866) 485-9393

Use the online contact form to email the ombudsman

Minnesota Office of Ombudsman for Long-Term Care

(800) 657-3591

MBA.OOLTC@state.mn.us

Mississippi State Long-Term Care Ombudsman Program

(888) 844-0041

Missouri Long-Term Care Ombudsman

(800) 309-3282

LTCOmbudsman@health.mo.gov

Montana Long Term Care Ombudsman Program

(800) 332-2272

Nebraska Long-Term Care Ombudsman

(800) 942-7830

DHHS.LTCOmbudsman@nebraska.gov

Nevada Long Term Care Ombudsman Program

(888) 282-1155

New Hampshire Long-Term Care Ombudsman

(603) 271-4375

OLTCO@dhhs.nh.gov

New Jersey Long-Term Care Ombudsman

(877) 582-6995

ombudsman@ltco.nj.gov 

New Mexico Long-Term Care Ombudsman Program

(866) 451-2901

New York Long Term Care Ombudsman Program

(855) 582-6769

ombudsman@aging.ny.gov

North Carolina Long Term Care Ombudsman

(919) 855-3400 

Contact the ombudsman serving your region

North Dakota Long-Term Care Ombudsman Program

(855) 462-5465

dhsagingombud@nd.gov

Ohio Long-Term Care Ombudsman

(800) 282-1206

OhioOmbudsman@age.ohio.gov

Oklahoma Long-Term Care Ombudsman

(405) 521-2281

Ombudsman.intake.line@okdhs.org

Oregon Office of the Long-Term Care Ombudsman

(800) 522-2602

ltco.info@rights.oregon.gov

Pennsylvania Long-Term Care Ombudsman Program

(717) 783-8975

LTC-ombudsman@pa.gov

Rhode Island Office of Healthy Aging Ombudsman Program

(401) 785-3340

South Carolina Long Term Care Ombudsman Program

(800) 868-9095

South Dakota Long-Term Care Ombudsman Program

(866) 854-5465

LTCO@state.sd.us

Tennessee Long-Term Care Ombudsman

(615) 925-1552

teresa.teeple@tn.gov

Texas Office of the Long-Term Care Ombudsman

(800) 252-2412

ltc.ombudsman@hhs.texas.gov

Utah Long-Term Care Ombudsman

(385) 222-1273

asipes@utah.gov

Vermont State Long-Term Care Ombudsman Program

(800) 889-2047

Virginia Office of the State Long-Term Care Ombudsman

(800) 552-5019

Washington State Long-Term Care Ombudsman Program

(800) 562-6028

ltcop@mschelps.org

West Virginia Long-Term Care Ombudsman Program

(800) 834-0598

Wisconsin Long-Term Care Ombudsman

(800) 815-0015

BOALTC@wisconsin.gov

Wyoming Long-Term Care Ombudsman Program

(307) 777-2885

How to Find Assisted Living Regulations in Each State

Below, you’ll find the websites where you can learn more about the assisted living governing departments and regulatory information in each state. Click on the state name for an overview of assisted living laws and regulations in that state. 

State

Assisted Living Governing Department

Assisted Living Regulation Information

Alabama

Public Health Bureau of Health Provider Standards

Facilities Rules

Alaska

Health Division of Health Care Services

Statutes and Regulations

Arizona

Health Services Public Health Licensing

Residential Facilities Licensing

Arkansas

Human Services Office of Long-Term Care

Regulations

California

Social Services

Laws and Regulations

Colorado

Public Health & Environment

Regulations

Connecticut

Public Health Facility Licensing and Investigations

Regulations and Statutes

District of Columbia

Health Regulation and Licensing Administration

Regulations

Delaware

Health and Social Services Division of Health Care Quality

Regulations

Florida

Bureau of Health Facility Regulation

Regulations

Georgia

Community Health Health Care Facility Regulation Division

Laws and Regulations

Hawaii

Office of Health Care Assurance

Administrative Rules

Idaho

Health and Welfare

Regulations

Illinois

Public Health

Laws and Rules

Indiana

Health Division of Long-Term Care

Laws and Regulations

Iowa

Inspections and Appeals

Regulations

Kansas

Aging and Disability Services

Statutes and Regulations

Kentucky

Aging and Independent Living

Regulations

Louisiana

Office of Aging and Adult Services

Health standards

Maine

Health and Human Services

Regulations

Maryland

Office of Health Care Quality

Regulations

Massachusetts

Executive Office of Elder Affairs

Regulations

Michigan

Health & Human Services

Rules and Statutes

Minnesota

Department of Health

Regulations

Mississippi

Division of Health Facilities Licensure and Certification

Health Facilities Regulations

Missouri

Health and Senior Services

Laws, Regulations & Manuals

Montana

Public Health and Human Services

Regulations

Nebraska

Health and Human Services

Regulations

Nevada

Bureau of Health Care Quality and Compliance

Laws and Regulations

New Hampshire

Bureau of Health Facilities Administration

Administrative Rules

New Jersey

Department of Health

Statutes and Rules

New Mexico

Division of Health Improvement

Health Facility Regulations

New York

Department of Health

Regulations

North Carolina

Division of Health Service Regulation

Regulations

North Dakota

Health Response and Licensure

Regulations

Ohio

Bureau of Regulatory Operations

Regulations

Oklahoma

Department of Health

Rules, Regulations and Statutes

Oregon

Human Services Office of Safety, Oversight and Quality

Laws, Rules and Policies

Pennsylvania

Human Services

Regulations

Rhode Island

Department of Health

Regulations

South Carolina

Health and Environmental Control

Regulations and laws

South Dakota

Department of Health

Administrative Rules

Tennessee

Office of Health Care Facilities

Rules and Regulations

Texas

Health and Human Services

Regulations

Utah

Health & Human Services Division of Licensing and Background Checks

Licensing Rules

Vermont

Division of Licensing and Protection

Facility regulations

Virginia

Social Services

Regulations

Washington

Social and Health Services

Facility Rules

West Virginia

Office of Health Facility Licensure & Certification

Rules & Regulations

Wisconsin

Health Services Bureau of Assisted Living

Rules and regulations

Wyoming

Healthcare Licensing & Surveys

Regulations

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Caring.com is a leading online destination for caregivers seeking information and support as they care for aging parents, spouses, and other loved ones. We offer thousands of original articles, helpful tools, advice from more than 50 leading experts, a community of caregivers, and a comprehensive directory of caregiving services.

 

The material on this site is for informational purposes only and is not a substitute for legal, financial, professional, or medical advice or diagnosis or treatment. By using our website, you agree to the Terms of Use and Privacy Policy

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