Sykes Elder Law: Assisted living regulations take effect January 17

Certified as an elder law attorney by the National Elder Law Foundation under authorization of the Pennsylvania Supreme Court

Certified as an elder law attorney by the National Elder Law Foundation under authorization of the Pennsylvania Supreme Court


Assisted living facilities are everywhere, but what does “assisted living” mean anyway?

Regulations taking effect on January 17 attempt to answer that question for Pennsylvanians.

Until now, assisted living facilities have been regulated as “personal care homes,” a term so broad that it applied to facilities ranging from a small Mom-and-Pop home with four residents to facilities with dozens of staff serving scores of residents.
To be licensed as an “assisted living residence” (ALR for short) under the new regulations, facilities in Pennsylvania will now have to meet certain requirements. Only licensed facilities may use the term “assisted living” in any name or written material.

Services for residents

A key provision of the new regulations is the requirement that an ALR must provide certain services.

At a minimum, every ALR must provide, or arrange for, the following services:
• nutritious meals and snacks
• laundry
• housekeeping;
• recreational activities and socializing;
• basic cognitive support;

assistance with:
• performing “activities of daily living”
• taking of medication
• certain basic financial management needs

transportation on a regular weekly basis (within a reasonable local area) to:
• medical appointments
• social appointments

• supervision
• monitoring
• emergency response

Residents may opt out of meal, housekeeping, or laundry services, provided the resident’s contract with the facility states that the service will not be provided and adjusts the fees to account for the reduction in service.

An ALR must also provide, or arrange for, the following “supplemental health care services”:
• hospice
• occupational and physical therapy
• skilled nursing
• behavioral health services
• home health services
• escort services to and from medical appointments
• specialized cognitive support services

One important goal behind defining the services offered by all ALRs is to allow consumers to compare facilities and prices more transparently. For example, supplemental health care services are required to be “packaged, contracted and priced separately from the resident agreement.”

Facility and staff requirements

A licensed ALR must meet certain requirements in its physical site, staffing, and training.

Each resident must be provided his or her own “living unit,” consisting of “a private bathroom, living and bedroom space, kitchen capacity, which may mean electrical outlets to have small appliances such as a microwave and refrigerator, closets and adequate space for storage and a door with a lock, except where a lock or appliances in a unit under special care designation would pose a risk or be unsafe.”

Two residents may voluntarily agree to share one unit, but may not be required to share.

Each living unit must contain a certain square footage of space, excluding bathroom and closets. Existing facilities need to provide 160 square feet for single units and 210 square feet for double units. For new construction, the requirements are 225 square feet for singles, and 300 square feet for doubles.

The regulations require an ALR administrator to have a certain level of education and experience (or meet “grandfathering” requirements), and to be present at the facility an average of 36 hours per week. A licensed nurse must be in the facility, or on call, at all times.

A direct care staff person must be present in the facility and awake at all times. An ALR must employ sufficient direct care personnel to provide at least one our per day of assisted living services to each mobile resident, and two hours per day to each resident with mobility needs.

ALR personnel must meet various age and training requirements, and pass a criminal background check.


The regulations spell out strict timelines for the completion of medical evaluations, initial assessments, and preliminary support plans for new residents. These steps must be taken prior to admission, or in certain cases within 15 days after admission.

A contract between the resident and the facility must be completed prior to admission or within 24 hours after admission. A resident has the right to rescind the contract up to 72 hours after the contract’s initial dated signature. The regulations prescribe provisions that must be included in the contract, including a fee schedule, a list of the residence’s rules, complaint procedures, and a statement that the resident is entitled to at least 30 days notice of the facility’s request to change the contract.

Prior to admission, the facility must certify that the needs of a potential resident can be met by the services provided there. If those needs cannot be met, the resident must receive a written decision denying admission and stating the basis of the denial.

These are just some of the provisions of the new ALR regulations. Once implemented, these regulations will give more meaning to the term “assisted living” in Pennsylvania.

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