Assisted living communities in Alabama are bound by state regulations that dictate everything from the paperwork signed upon admission to the quality and quantity of residents' daily meals. Here are some of the most important rules by which these assisted living operations must abide:

Assisted Living Service Plan Requirements

Prior to admission, residents must be examined by a physician to determine their needs. The results of that exam are then used to develop a comprehensive plan of care. Service planning includes not just the physician but also the resident and, if the resident chooses, a third-party representative.

Assisted Living Admission Requirements

Assisted living facilities in Alabama may not admit or retain residents who:

• Require restraints
• Are unable to understand the in-house medication system
• Require complex medical care or daily monitoring for chronic health conditions
• Need assistance beyond care for typical activities of daily living
• Have been diagnosed with severe cognitive impairment

Some exceptions may be made for residents who require additional care for 90 days or less or if that resident is under hospice care for a non-cognitive condition.

Assisted Living Scope of Care

Assisted living facilities in Alabama must provide services, including general health supervision, regular assistance with the activities of daily living, medication assistance, housekeeping, laundry, transportation to medical appointments and coordination of social activities. Activities of daily living include but are not limited to:

• Bathing
• Oral hygiene
• Hair
• Manicure/pedicure
• Shaving
• Food service
• Personal safety
• Making and keeping appointments

Some services may be provided by an outside home health agency or hospice organization contracted by the assisted living facility.

Assisted Living Medicaid Policy

Medicaid may cover some assisted living costs for eligible residents, but not all facilities accept Medicaid or related programs as a form of payment. The Alabama Medicaid Elderly and Disabled Waiver helps seniors with demonstrated financial need avoid nursing home placement in favor of other appropriate care alternatives.

Individuals interested in using Medicaid benefits to pay for assisted living care in Wyoming should ask whether their preferred assisted living facility accepts Medicaid or the Elderly and Disabled Waiver program as payment.

Assisted Living Facility Requirements

According to state law, assisted living properties in Alabama may have single- or double-occupancy unites. Apartment-style living is not required. These units may share bathrooms and bathing facilities, but there must be a minimum of one sink and toilet per every six residents and a minimum of one shower or bathtub per every eight residents.

Medication Management Regulations

Residents who understand their medical conditions and who are judged to be capable and competent may store and administer their own medication or ask for assistance from both licensed and unlicensed staff members.

Staff at the assisted living community may only store and administer medication that is packaged in single-dose units. Staff may help residents with medication reminders, opening medications and offering liquids to help residents take oral medications, but staff cannot actually administer medication, give injections or prepare any other medications in any way. This includes:

• Administering eye drops, inhalers, enemas or suppositories
• Telling a patient to take an as-needed (PRN) medication
• Crushing, splitting or otherwise altering medications
• Loading medications into a feeding tube
• Combining medications with a resident's food or beverage

All medications given to a resident must be recorded in the resident's medication administration record.

Staffing Requirements

Alabama has no minimum staff-to-resident ratios in place for assisted living facilities. Instead, staffing must be “adequate to meet residents' needs.” All assisted living communities must have an administrator to oversee operations and the personal care staff in charge of general resident care. Any community that intends to administer medication to residents must also have a registered nurse (RN) or licensed practical nurse (LPN) on staff.

Each community must have an automated external defibrillator (AED) and be continuously staffed by at least one employee who is certified in AED use by the American Red Cross or American Heart Association and at least one employee who is certified in cardiopulmonary resuscitation (CPR).

Staff Training Requirements

Staff at assisted living facilities in Alabama must be trained both upon hire and on a continual basis on subjects including:

• All federal, state and facility-specific laws and policies
• Guidelines for recognizing and reporting abuse, neglect and exploitation of residents
• Needs of elderly, infirm and mentally disabled residents
• First aid
• Advanced directives
• Resident privacy and overall confidentiality
• Basic nutrition as it pertains to the elderly
• Fire safety
• Environmental safety
• Signs of dementia

Administrators of assisted living facilities must complete at least six hours of continuing education annually.

Background Checks for Assisted Living Staff in Alabama

Anyone classified as a worker at an adult care facility in Alabama (including contract employees, volunteers and applicants for those positions) must be fingerprinted and undergo a background check. Anyone who appears on the Alabama Department of Public Health Nurse Aide Abuse Registry may not be employed by a long-term care facility.

Requirements for Reporting Abuse

Caregivers in Alabama are legally required to report suspected abuse, neglect or exploitation of seniors as well as any other person who is physically or mentally impaired. This mandate also applies to Alabama’s Long Term Care Ombudsman. Reportable situations include infliction of pain or injury, willful deprivation of care, failure to provide essential services and needs such as food and shelter, exploitation of an individual or their resources, reckless infliction of anguish and other definitions as outlined by the State Code of Alabama.

Instances of abuse or expected abuse should be reported to local law enforcement or by calling the Abuse Hotline at (800) 458-7214.