Assisted living communities are highly regulated by Pennsylvania’s state government with on-site inspections occurring annually. A complete list of the state regulations is available at pacode.com, but below are some key state laws.

Assisted Living Service Plan Requirements

A medical evaluation is required 60 days prior to admission to an assisted living community. Occasionally this evaluation may be performed after the move-in date if extenuating circumstances are involved. The evaluation looks at the current health of the individual and gathers typical medical information such as allergies, current medications, and immunizations. A mobility and daily living assessment is also performed.

After living in the community for 30 days, the new resident is again evaluated by the administrator or an appointee of the administer (usually an RN or an LPN under the guidance of an RN). This time the assessment is used to create the support plan and must include medical history, dietary needs and supplemental care requirements. In addition, the resident is tested on their ability to manage the activities of daily living including building evacuation, lock manipulation and medication self-administration. Once a final support plan is drawn up, it must be signed by the resident or their representative and implemented within 30 days.

Assisted Living Admission Requirements

Seniors experiencing certain conditions or diseases are prohibited from admission in Pennsylvania unless the licensing agency permits an exception. These includereportable infectious diseases that require isolation and conditions needing advanced skilled nursing care.

Certain Assisted Living communities may have an SCU (Special Care Unit) on site. Proof of a memory impairment is required for residents in these units.

Assisted Living Scope of Care

There are two types of core services that an ALR provides in Pennsylvania. The independent core package contains 24-hour supervision, laundry, social activities and cognitive support. The enhanced core package includes all items in the first package along with daily activity aids, transportation help and medication administration or self-administration assistance.

Assisted Living Medicaid Policy

Pennsylvania does not cover room and board services of an assisted living residence in its Medicaid program or waiver programs. If the community accepts a resident that is eligible for SSI payments, the rent must not exceed the resident’s monthly income less any personal needs expenses.

Assisted Living Facility Requirements

The interior of an ALR should be well-lit with additional markings for the visually impaired, and handrails, ramps and other accessibility devices should be in good repair.

There should be a common dining area that provides breakfast, noon and evening meals. The resident may eat in their room if ill or if the community offers room service.

Individual rooms should be equipped with the necessities for daily living including:

• Fully equipped bathroom with a sink, toilet and shower or tub
• Exterior locking doors unless they pose a safety risk to the resident
• Individually controlled thermostats for heat and air conditioning
• Electrical outlets that support small appliances such as a microwave or a mini fridge
• Telephone jack
• Storage space

The common area should include a space for food preparation and cleanup, which residents may use, and it must be separate from the community meal kitchen.

Medication Management Regulations

A resident who has been assessed and approved may self-administer their own medications. These medications should be kept out of reach of others in a locked box in the resident's room. Staff can perform daily or periodic medication reminders if necessary.

All other residents’ medications are administered by a licensed staff member or student nurse (who is under the authority of an RN). All prescription medications in the AL community must be labeled with the following:

• Resident's name
• Medication name
• Date dispensed
• Dosage instructions
• Prescribing doctor

Staffing Requirements

Each AL residence must employ enough personnel to provide one hour of care to each resident per day and two hours of care to residents with mobility issues. There must be a licensed nurse on site or on call, and a registered dietician should be available to accommodate dietary restrictions. The administrator or director should be on-site a minimum of 36 working hours.

Staff Training Requirements

All staff should be trained in fire safety and emergency preparedness, and personnel may not provide direct care until they have completed 18 hours of general training with an additional 16 hours of annual training. All training records and training plans must be available for inspection.

Background Check for ALR Staff in Pennsylvania

The age requirement for all staff, except housekeeping and food service, is 18, and proof of a criminal history and background check must be kept on file.

Requirements for Reporting Abuse

Each resident shall be informed of their right to lodge complaints without the threat of retaliation. A poster detailing these rights should be publicly displayed, and all residents should understand how to file a complaint.

Instances of elder abuse or neglect should be reported to the Pennsylvania Department of Aging. The state hotline number is available 24 hours a day at 1-800-490-8505. The ALR staff is trained to look for instances of abuse and it is mandated by law to report any occurrences.