Assisted Living Service Plan Requirements

In Utah, ALFs must perform an assessment before a new resident moves in, and again every six months during their residency. The assessment must be signed by a licensed health care professional. Within seven days of moving in, the assisted living facility must write an individualized service plan based on their assessment. This service plan should meet the resident's cognitive, medical, physical and social needs and is intended to describe which services must be delivered, and who, when, how often and by whom they'll be provided. This service plan is updated whenever needs or conditions change.

Assisted Living Admission Requirements

Type I ALFs must admit residents who are mobile and capable of evacuating without assistance in the case of an emergency. Residents in type I ALFs must not need daily care beyond limited help with a maximum of two activities of daily living. The residents must arrange any regular medical care they require with a third party.

Type II ALFs may admit residents who are independent or semi-independent and who need assistance with any amount of activities of daily living, provided the facility can meet the medical and service needs of the resident.

Neither facility is allowed to admit a resident who requires skilled nursing care or hospital care, or anyone who is a danger to themselves, staff or residents. Residents may not have active tuberculosis or any other communicable disease unless it can be adequately treated in the ALF or on an outpatient basis by a third party.

If residents need hospice care, they may be admitted only if they meet all other laws and regulations of that facility. In the event that a type I or type II ALF is no longer able to meet the resident's needs, they may release them and recommend care in a more advanced facility.

Assisted Living Scope of Care

Both type I and type II ALFs are required to offer personal care, housekeeping, laundry, maintenance, activity programs, medication administration and assistance in arranging medical and dental care. Facilities may employ nursing staff who provide assessment, health monitoring and medication administration.

Type II ALFs are mandated to provide residents with substantial support with activities of daily living, nursing services and additional supervision or coordination. Residents in type II ALFs must receive a services plan that includes specified intermittent nursing service and support services that promote independence and self-sufficiency. These ALFs must employ or contract a registered nurse who is responsible for supervising assessments, performing general health monitoring and delegating routine nursing tasks.

Assisted Living Medicaid Policy

ALFs in Utah accept Medicaid to pay for services delivered to residents via the New Choices Waiver Program. The waiver program only provides coverage for seniors:

• Over the age of 65 who have been previously covered by another Medicaid waiver program
• Have been covered by Medicaid and living in a nursing home for at least 90 days and want to relocate to an ALF
• Have been residing in an ALF for at least 180 days

Utah does not provide a Supplemental Security Income payment to residents of ALFs. However, room-and-board costs may be negotiated privately with residents, and family supplementation is allowed.

Assisted Living Facility Requirements

Residents of both type I and type II ALFs are required to have their own private unit unless they have requested in writing to share with another resident. In the event that a resident wishes to share a unit, that unit must not be shared by more than two individuals.

Units must have a living space, sleeping space and optional kitchen space. In type I ALFs, there must be one toilet for every six residents and one shower or bathtub for every 10 residents if the units do not have private bathrooms. In type II ALFs without a private bathroom, a toilet and sink must be available for every four residents and a bathtub or shower for every 10 residents. If residential units don't have a private bathroom, there must be one bathroom per floor that has enough space to allow staff to assist and is fully equipped with a shower or tub, sink and toilet.

Medicaid waiver participants must be offered apartment-style units.

Medication Management Regulations

A licensed health professional is required to assess all residents upon move-in to determine their need for medication assistance and categorize them into one of the following:

• The resident may self-administer medications
• The resident may self-administer medications with assistance (reminders, help opening containers, reminders to refill prescriptions)
• Family members may administer medications
• Facility staff may administer medications

Staff administering medications must be licensed and under the delegation and supervision of a licensed health care professional. Medications must be reviewed by a pharmacist or other licensed health care professional at least once every six months.

Family members or a designated caregiver who is assisting with medications must sign a waiver that indicates they are willing to assume the responsibility of filling prescriptions, administering medications and documenting the administration.

Staffing Requirements

In a type I ALF, a registered nurse must be available as needed to oversee the administration of medications for residents who are unable to self-administer. Additionally, the assisted living facility must employ an administrator who is responsible for recruiting, hiring and training an appropriate number of licensed and unlicensed staff, including direct care staff and a licensed nurse (either employed or contracted). The administrator is required to be on the premises for a sufficient number of hours to effectively manage staff and must designate, in writing, another employee aged 21 or older to act in the administrator's absence. There are no minimum staff ratios in type I ALFs.

Type II assisted living facilities are subject to the same staffing requirements as type I ALFs, and in addition, they must employ certified nurse aids, one of whom must be on duty 24 hours per day. A licensed nurse must also be contracted or on staff to delegate and oversee nursing duties. There are no minimum staff ratios in type II ALFs.

Staff Training Requirements

Both type I and type II ALFs must provide all staff with an orientation that includes the following:

• Job descriptions
• Ethics
• Confidentiality
• Resident's rights
• Fire and disaster plans
• Policies and procedures
• Reporting responsibility for abuse, neglect and exploitation

In-service training must also be offered and must be tailored to meet the specific subjects that are relevant to the employee's job. Training may include:

• Nutrition and food preparation
• Housekeeping standards
• Personal and social care
• Medication assistance
• Accident prevention
• Communication skills that enhance residents' dignity
• First aid
• Residents' rights and reporting requirements
• Needs of residents with Alzheimer's disease or other dementia

Background Checks for ALR Staff in Utah

All staff at both type I and type II are required to undergo criminal background checks.

Requirements for Reporting Abuse

Utah is concerned about elder abuse and the Department of Human Services Aging and Adult Services Division has a 24 hour online reporting tool or you may call 1-800-371-7897 during business hours. You may also file a specific complaint against a facility at the Utah Department of Health Licensing Bureau.