Assisted Living Service Plan Requirements

Before admittance, residents must submit to a thorough assessment of needs and preferences to create their service plan. Medications, medical history, any professional medical diagnosis, behaviors or symptoms that necessitate special care, mental illness, personal care needs, food and daily routines, and activity and service preferences must all be considered when developing the service plan. An initial assessment is conducted before admittance, and then a full assessment must be completed within 14 days of the resident moving in. Limited assessments are conducted if there is a change with the resident's condition or it appears the current service plan is not meeting the resident's needs.

Assisted Living Admission Requirements

Residents who require a nursing home level of care can only be admitted to assisted living facilities with a registered nurse on staff. Residents who require frequent evaluations by a registered nurse are also ineligible for an assisted living facility unless they are receiving hospice care or the evaluations are related to an illness that will resolve within 14 days.

Assisted living communities must consider their ability to serve the needs of residents when choosing who to admit and may not retain anyone who endangers other residents.

Assisted Living Scope of Care

Assisted living facilities are responsible for the residents in their care and must abide by the resident care plan to promote the safety and well-being of each resident. Assistance with ADLs, intermittent nursing services and health support services are not required but, if assisted living facilities choose to offer ADL assistance, they must meet minimum standards and provide assistance for mobility, personal hygiene, transferring, toileting, bathing, dressing and eating. Health services and intermittent nursing services that assisted living facilities may choose to provide include:

• Blood glucose testing
• Puree diets
• Calorie-controlled diabetic diets
• Dementia care
• Mental health care
• Medication administration
• Administration of health care treatments
• Diabetic management
• Non-routine ostomy care
• Tube feeding
• Nurse delegation

Intermittent nursing services must be provided by staff with the proper licensing and credentials. Assisted living facilities that provide these services must closely monitor residents for physical, mental or emotional changes and respond appropriately.

Third-party providers can be arranged by the resident to provide services onsite but the assisted living facility is not required to supervise the caregiver. Services provided by the assisted living facility must be coordinated with third party caregivers and the community is required to observe the resident for any changes in functioning.

Assisted Living Medicaid Policy

The Washington state Medicaid program has programs and waivers that can provide financial assistance to seniors in assisted living facilities. These include the Medicaid Personal Care (MPC) program, the Community First Choice Option (CFCO) and the Community Options Program Entry System waiver. Not all assisted living facilities accept payment for services from these programs, so it's important to speak with any prospective facility to understand what may be covered.

Assisted Living Facility Requirements

Washington law does not require private rooms or apartments but no more than two residents can occupy any unit and both must agree to the arrangement. Assisted living facilities who obtained their license before July 1, 1989, can house up to four residents in one unit. Each facility must provide at least one toilet and sink per eight residents and one bathing fixture per 12 residents. The bathroom must be placed on the same level as the sleeping room for the resident it is designated to serve.

Assisted living communities that wish to accept coverage for assisted living services by the Washington State DSHS Aging and Disability Services Administration must provide Medicaid-eligible residents with apartment-like units. Each unit should have a private bathroom with a sink, toilet and bathing facilities. The entry door must be lockable and the unit must include a kitchen with a refrigerator, microwave or stove top and a counter or table for preparing food. A living area must be provided with wiring for a telephone and television service where available.

Medication Management Regulations

Assisted living communities must offer medication administration options that include full administration, self-administration or assisted administration of medication. Some communities are licensed to allow a family member to administer medication provided the family member can produce a written medication or treatment plan.

Staffing Requirements

Every assisted living community must have an administrator and registered nurses are required for communities that offer nursing level care services. There are no staff-to-resident ratios, but there must always be one staff member onsite who is over the age of 18 and is certified in first aid and cardiopulmonary resuscitation.

Staff Training Requirements

Training requirements for administrators and long-term care workers include:

• First aid and CPR certification within 30 days of employment. Card must remain valid throughout employment.
• 2-hour orientation before providing care.
• 3 hours of safety training before providing care.
• 70 hours of basic training within 120 days of hire.
• 12 hours of continuing education each year.
• HIV/AIDS training within 30 days of employment. This is included in basic training.
• Nurse delegation and core diabetes training (must be a registered nurse assistant or certified home care aide) before accepting delegated tasks.

Employees who provide services to residents with special needs must undergo specialty training.

Background Checks for Assisted Living Staff in Washington

All staff within an assisted living facility must undergo a thorough background check. Fingerprint background check authorizations must be submitted for all employees who have unsupervised access to residents. Being convicted of a disqualifying crime, pending charges of a disqualifying crime and those found to have abused a vulnerable person are ineligible for hire at assisted living facilities.

Requirements for Reporting Abuse

The Aging and Long-Term Support Administration handles reports of abuse at residential facilities for the Washington State Department of Social and Health Services. You can reach their 24-hour hotline at 1-800-562-6078 or visit the Residential Care Services Online Incident Reporting page to file a report online.