Nebraska has a comprehensive set of rules in place that regulate operations in the state’s assisted living facilities. The following entries encompass some of the most important provisions and policies from the state code:

Assisted Living Service Plan Requirements

Upon admittance, each resident must receive an assessment and a corresponding service plan (a resident services agreement) that address which services will be provided, who will deliver those services, and how and when those services will take place. Service plans must be regularly updated to reflect any changes in the resident’s needs.

Assisted Living Admission Requirements

Admission to an ALF and ongoing retention is at the discretion of the facility’s administrator, who has a lot of leeway. However, that administrator’s decision must reflect the Assisted-Living Facility Act. Generally, applicants are expected to both need and want ongoing shelter, food and help with personal care and both medical and daily living activities.

Those who display violent or otherwise disruptive behavior are typically not admitted in an assisted living facility.

Assisted Living Scope of Care

Assisted living facilities in Nebraska are permitted to provide a wide range of services, including the following:

• Help with personal care
• Assistance with the activities of daily living
• Health maintenance activities
• Transportation
• Laundry and housekeeping
• Financial management
• Case management
• Behavioral management
• Shopping
• Spiritual services
• Personal beauty and salon services

Assisted Living Medicaid Policy

Medicaid subsidies may be an option for low-income seniors in Nebraska looking for help paying for assisted living, but not all facilities accept these subsidies. To find out if a specific ALF accepts Medicaid programs such as SSI and the Aged & Disabled Waiver, ask them about their Medicaid policy.

Assisted Living Facility Requirements

Residential units in Nebraska's assisted living facilities may be either individual bedrooms or apartment style, but apartment-style accommodations are not required. ALFs who choose to offer apartments must ensure those units have a sleeping area as well as a kitchen area and private bathroom.

Other facility requirements depend on the age of the facility.

Facilities built before April 3, 2007, must have:

• No more than four residents per unit
• A toilet and sink for every six beds
• At least one bathing area for every 16 residents

Facilities built after April 3, 2007, must have:

• No more than two residents per unit
• A toilet and sink for every four beds
• At least one bathing area for every 8 residents
• A toilet room attached to every bedroom

Medication Management Regulations

All medication policies at assisted living facilities in Nebraska must be overseen by a registered nurse (RN) who will review those policies, oversee aide/administration training and document findings on an annual basis at a minimum.

There are three ways assisted living residents can receive their medications:

• Self-administration, with or without the supervision of on-site staff
• Administered by a licensed health care professional
• Administered by a trained, competent and professional directed medication aide

In general, medication administration in ALFs follows the Medication Aide Act and aides must be trained in the following:

• How to handle, store and provide medications to residents
• How to properly document medications
• Directions for managers/supervisors monitoring medication aides
• Directions for providing medications according to the needs of the existing resident population

Staffing Requirements

Each ALF must have an administrator tasked with not just overseeing operations but also ensuring that the proper planning and organization of service takes place. That administrator must also empower a second in command who can take over managerial duties if the administrator is absent from the facility.

Nebraska has no law detailing minimum staff-to-resident ratios. However ALFs must have sufficient staff on site to meet all resident needs. In addition, there must at all times be at least one staff who is on duty, awake and ready to assist residents.

Staff Training Requirements

All assisted living facility staff who have direct interactions with residents must complete an orientation upon hire as well as ongoing training that covers general job duties as well as topics specific to the needs of the current resident population. Continuing education must total at least 12 hours per year.

Within six months of assuming his or her position, every assisted living facility administrator must complete training to include 30 hours on the following topics:

• Administration
• Gerontology
• General resident care and services
• Social services
• Financial management
• Overarching rules and regulations pertaining to ALFs

Administrators must also commit to continuing education totaling at least 12 hours of training per year.

Administrators with an active nursing home or hospital administrator's license are exempt from both types of training detailed above.

Background Checks for ALR Staff in Nebraska

Every staff member who will have direct contact with residents must undergo a criminal background check and be run through the sex offender registry, the adult central registry for abuse and neglect, the child central registry of abuse and neglect and the nurse aide registry to determine suitability for employment.

Requirements for Reporting Abuse

Physicians, nurses, physician and nursing assistants, mental health professionals, human service professionals and AFL owners, operators and employees are just some of the individuals who are mandated by law to report suspected or witnessed elder abuse to the proper authorities. Anyone who suspects elder abuse should contact local law enforcement or call the elder abuse hotline at (800) 652-1999 with the following information:

• Basic information on the vulnerable adult
• Basic information on the caregiver
• Details regarding the expected abuse
• Any evidence of previous abuse
• Any other pertinent information