Jill ScheweAssisted living (AL) regulations, statutes, and policies in 33 states were updated between 2020 and 2022, according to the National Center for Assisted Living’s (NCAL) 2022 edition of the Assisted Living State Regulatory Review.

“States continue to demonstrate their ability to respond to the evolving assisted living environment, foster quality improvement, support transparency for consumers, and maintain resident safeguards,” said LaShuan Bethea, NCAL Executive Director.

What is the Assisted Living State Regulatory Review?

The 2022 NCAL State Regulatory Review is a state-by-state report of assisted living regulations, recent legislative activity, and an overview of key regulatory topics that our members and stakeholders find important. For every state and the District of Columbia, this report provides information on topics such as how state agencies license assisted living (including those units with Alzheimer’s or other dementias), recent legislative and regulatory updates affecting AL, and requirements for resident agreements, admission, and termination, staffing and training—among other topics.

Historically, NCAL has published this report annually, but because of the public health emergency with COVID-19, the report is now available again after a two-year hiatus.

Why is this a valuable resource for AL providers?

Since regulations for AL are established and enforced at the state level, there is not a great resource for people to access individual state AL regulations. NCAL has created such a document with this publication. It is exciting to not only have the information in one place but also to be able to use it in multiple ways, including cross-referencing information between states and following state regulation activity.  

What are some of the key themes/takeaways in this report?

It was no surprise to see that 65 percent of the states reported regulatory or legislative changes in 2020, 2021, or 2022 that impact AL residents, staff, and facility structures. These legislative changes affected a variety of requirements, including licensure, staff training, infection control, and residents’ rights.
With such significant activity in state regulatory changes, now:

  • Forty-six states and the District of Columbia (92 percent) require a consumer disclosure, agreement, and/or bill of rights for residents.
  • All 50 states and the District of Columbia require a form of resident assessment and, at minimum, provide activities of daily living (ADL) for residents.
  • Forty-nine states and the District of Columbia (98 percent) have provisions around, and allow, providing medication management to residents.
  • Forty-five states and the District of Columbia (90 percent) have minimum educational and/or training requirements for AL administrators/directors.

It is clear from the trends we have seen over the years that state regulations continue to increase in AL. States are making changes as they determine how to best serve their specific resident populations in the years ahead, and we anticipate this trend will continue.

Where can I access the report?

The full report can be found on the NCAL website at www.ahcancal.org/Assisted-Living/Policy/Pages/state-regulations.aspx.

Who should I contact with questions?

For further questions, email ncal@ncal.org.

Jill Schewe, LALD, is the director of policy and regulatory affairs for the National Center for Assisted Living (NCAL). ​