State-by-State: Assisted Living Regulations

by Hanna Trudo, Jonathan Jones and A.C. Thompson, ProPublica - October 29, 2013

ProPublica set out to compile the key rules and regulations governing assisted living in all 50 states and the District of Columbia. This information was gathered from state regulatory agencies, an examination of state codes and other records, and a 2013 review prepared by the National Center for Assisted Living, an industry trade group.

These are the categories included here: the qualifications required for those who run assisted living facilities; the frequency of inspections; fines for problem facilities; staffing requirements, and whether states offer performance records of the facilities to the public online. See more about the data. » | Related Story »

Frequency of Inspections

Every
5 years Every
4 years Every
3 years Every
2 years Every
yearTwice
per year

State	State Can Fine Facilities?	State Posts Inspection Data Online?	Administrators Required to Have High School Diploma, GED, or College Education?	Minimum Staffing Ratios?	Frequency of Inspections
Alabama B	Yes	Yes	Yes	Yes	No requirement for periodic inspections
Alaska A	Yes	No	No	No	Every two years
Arizona D	Yes	Yes	Yes	No	Every two years
Arkansas C	Yes	No	Yes	Yes	Every year
California E	Yes	No	Yes	No	Every five years
Colorado F	Yes	Yes	No	Yes	Every three years
Connecticut G	No	No	Yes	No	Every two years
Delaware H	Yes	Yes	Yes	No	Every year
Florida I	Yes	Yes	Yes	Yes	Every two years
Georgia J	Yes	Yes	No	Yes	Every two years
Hawaii K	Yes	No	No	No	Every two years
Idaho M	Yes	Yes	Yes	No	Every three years
Illinois N	Yes	No	Yes	No	Every two years
Indiana O	Yes	Yes	Yes	No	Every 15 months
Iowa L	Yes	Yes	No	No	Every two years
Kansas P	Yes	No	Yes	No	Every 15 months
Kentucky Q	Yes	No	Yes	No	Every two years
Louisiana R	Yes	No	No	No	Every year
Maine U	Yes	No	No	Yes	Every two years
Maryland T	Yes	Yes	Yes	No	Every 15 months
Massachusetts S	Yes	No	Yes	No	Every two years
Michigan V	Yes	No	No	Yes	Every two years
Minnesota W	Yes	Yes	No	No	No requirement for periodic inspections
Mississippi Y	No	No	Yes	Yes	Every two years
Missouri X	Yes	Yes	Yes	Yes	Twice per year
Montana Z	No	No	Yes	No	Every three years
Nebraska c	Yes	Yes	No	No	Every five years
Nevada g	Yes	Yes	Yes	Yes	Every year
New Hampshire d	Yes	No	Yes	No	Every year
New Jersey e	Yes	Yes	Yes	No	Every three years
New Mexico f	Yes	Yes	Yes	Yes	No requirement for periodic inspections
New York h	Yes	Yes	Yes	No	Every 18 months
North Carolina a	Yes	Yes	Yes	Yes	Every two years
North Dakota b	Yes	No	No	No	Every two years
Ohio i	No	Yes	Yes	No	Every 15 months
Oklahoma j	Yes	Yes	No	No	Every 15 months
Oregon k	Yes	Yes	Yes	No	Every two years
Pennsylvania l	Yes	Yes	Yes	No	Every year
Rhode Island m	Yes	No	No	No	Every year
South Carolina n	Yes	No	Yes	Yes	No requirement for periodic inspections
South Dakota o	No	No	Yes	No	Every year
Tennessee p	Yes	No	Yes	No	Every 15 months
Texas q	Yes	Yes	Yes	No	Every two years
Utah r	Yes	No	Yes	No	No requirement for periodic inspections
Vermont t	Yes	Yes	No	No	No requirement for periodic inspections
Virginia s	Yes	Yes	Yes	No	Every year
Washington u	Yes	Yes	Yes	No	Every two years
Washington, D.C. y	Yes	Yes	No	No	Every year
West Virginia w	Yes	No	Yes	Yes	Every year
Wisconsin v	Yes	Yes	Yes	No	Every two years
Wyoming x	No	Yes	No	No	Every three years

About the data

The rules and regulations proved not easy to decipher. There is, for instance, no single, standard definition of assisted living. As well, each state defines and licenses assisted living differently. Many states set different staffing and training requirements depending on a facility’s size, the levels of care offered, and other types of services. In addition, many states have also recently revised or are in the process of refining their rules and regulations. According to the National Center for Assisted Living, 18 states reported regulatory, statutory, or policy changes affecting assisted living and other residential care facilities in 2012.

States also vary in how much information about assisted living they post online. While some states post the entire inspection reports for individual facilities online, others post only a portion of the reports, a simple listing of violations, or the enforcement letters the state sent to individual facilities. Here, if a state is listed as “No” in this category, it means that the state does not post any information from either complaint or inspection reports on the Internet.

Most states require a high school diploma, a GED or some post-high school education as part of their qualifications to become an administrator of an assisted living facility. However, some states require high school diplomas for certain types of assisted living facilities, but not all. Similarly, some states, Alabama, Arkansas and Maine among them, set specific staffing ratios for certain types of assisted living facilities, such as those that offer specialty Alzheimer’s and dementia care, but not all.

When it comes to the frequency of inspections, our graphic reflects the maximum time each state allows between routine inspections conducted by the state regulatory agency. In some of these states, certain facilities may be inspected more frequently. Our data does not include state investigations prompted by complaints, reports of abuse, or other incidents.

We intend this information to be of assistance to families, legislators, and to all involved in caring for, or advocating on behalf of, the elderly. We invite informed readers to offer clarifications to existing regulations or updates as rules and regulations are modified in the months ahead.

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State-by-State: Assisted Living Regulations

About the data