Assisted Living Service Plan Requirements

Care plans are documents that outline the specific needs and services required by an individual resident. They spell out how those needs are addressed, who provides the services and when those services are given.

ALFs are not required to perform an assessment or complete a care plan; however, ALFs must evaluate prospective residents to ensure residency criteria are met. ALFs must also maintain records of given services for all residents.

BCFs are held to different standards. Within 14 days of entering a facility, new residents receive an assessment to help staff members and administrators create an individual care plan.

Assessments involve gathering information relating to a resident’s current needs:

• Health and psychosocial needs
• Functionality
• Ability to perform self-preservation
• Nutritional and personal care needs
• Social and recreational interests

Assisted Living Admission Requirements

North Dakota's admission and retention policies are less restrictive than many other states.

Determining residency criteria is left to individual ALFs, and BCFs may do the same. BCFs must, however, adhere to these guidelines:

• Residents must be capable of self-preservation
• Residents cannot have a condition that calls for 24-hour nursing or health care

Assisted Living Scope of Care

The scope of care defines the services and care that a facility is licensed, or required, to provide.

In North Dakota, ALFs must provide support services for each resident, including assistance with ADLs. Services are not packaged; residents pay for each service individually. Some ALFs may provide health services.

BCF's scope of care goes a step further:

• Assistance with ADLs and iADLs
• Health care arrangements
• Transportation and transfer arrangements
• Monitoring and recording of behavioral or physical changes
• Medication services
• Social and recreational services
• Nursing availability

Residents at BCFs may purchase service packages.

Assisted Living Medicaid Policy

Medicaid does not offer financial benefits for ALF residents; however, those living in BCFs may qualify for the HCBS waiver or BCAP program detailed above. The state caps fees that facilities can charge waiver participants for room and board to $683.

North Dakota does permit family supplementation which means that family members may assist with living expenses without affecting a senior's Medicaid eligibility, provided it's done in an approved manner.

Please note: Not all facilities accept Medicaid as a form of payment. Contact your local communities to learn about their policies.

Assisted Living Facility Requirements

North Dakota sets guidelines concerning bathing and toilet facilities as well as room occupancy and accessibility.

ALFs are not mandated to provide apartments, though many are similar. Living units can be single or double occupancy. All units must include the following:

• Sleeping area
• Lockable entry door
• Private bathroom with sink, toilet and tub or shower

BCF rooms can be designated as single-occupancy or multi-resident rooms for three or more people. There must be one toilet and sink for every four residents and a tub or shower for every 15.

Medication Management Regulations

In both ALFs and BCFs, staff members may assist with medications. Assistance typically includes reading labels, opening containers and giving reminders.

All facilities must adhere to state regulations for medication administration, including those described in the Nurse Practice Act. To administer medication, a staff member must be certified as a level I, II or III medication assistant and operate under the supervision of a registered nurse.

BCFs must also have all residents' medication regimen reviewed by a health professional or pharmacist at least once per year or as needed.

Staffing Requirements

Neither ALFs nor BCFs is mandated to meet specific staffing ratios; instead, adequate staff must be present 24 hours a day to perform expected and unexpected services for residents.

ALFs must employ a manager and direct care staff, and the manager may be the licensee. For ALFs that administer medication, an RN must be available to perform administration or supervise certified medication assistants.

BCFs must staff an administrator as well as a licensed nurse, either through direct employment or contract, to administer medication, provide nursing services and supervise medication assistants. Direct care staff are required to provide personal care and services as needed.

BCFs must have at least one awake staff member on duty at all times.

Staff Training Requirements

North Dakota's training requirements are similar to many other states in that they call for ongoing training and continuing education.

All staff at ALFs must receive training annually on these topics:

• Fire and accident prevention
• Emergency response
• Physical and mental health
• Behavioral issues and strategies
• Infection control
• Resident rights

All ALF managers must complete 12 hours of continuing education annually. BCF employees receive in-service training annually that covers the following:

• Resident health needs
• Behavioral problems
• Infection prevention and control
• Resident rights
• Fire and accident prevention
• Safety

Any ALF staff member who provides resident activities must attend at least two relevant educational programs yearly. In addition, all ALF administrators are required to complete 12 hours of continuing education per year.

Background Checks for ALR Staff in North Dakota

There are no provisions in North Dakota’s regulations that mandate background checks for ALF employees. Contact your current or prospective home for their policies.

BCFs must check state registries and licensure boards for records of past inappropriate conduct or disciplinary actions before offering a position to a candidate.

Requirements for Reporting Abuse

If you know or suspect that anyone is abusing or neglecting a senior, please contact North Dakota's Vulnerable Adult Protective Services. For immediate assistance in urgent situations, contact your local law enforcement agency.