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Assisted Living in Utah: A Brief Overview for Consumers

Assisted Living in Utah: A Brief Overview for Consumers
by Mary Jane Ciccarello and Joanne Wetzler

What is Assisted Living?
The term "assisted living" describes a wide range of facilities that provide some type of long-term care to older or disabled persons who can no longer live independently. Assisted Living has become a very popular long-term care option in recent years, and assisted living facilities now provide a greater variety of services than ever before. In the past, assisted living residents generally needed no more than limited assistance with "activities of daily living," (ADLs), such as bathing, grooming, dressing, eating, toileting, and walking. Today, however, assisted living facilities provide or arrange for a significant amount of health care, from medication administration to physical therapy and wound care.

According to the National Center on Assisted Living, a provider association, in 2002 approximately 900,000 people lived in more than 36,000 assisted residences in this country. The majority of residents are between the ages of 78 and 85 and more than two-thirds are female. Approximately 25 percent need help with three or more ADLs (compared to 83 percent of nursing home residents), and 86 percent need or accept assistance with medication. At least half of residents have some degree of cognitive impairment. In Utah, there are currently approximately 4,000 residents in assisted living facilities throughout the state.

Federal laws do not address issues in assisted living to the same extent as in nursing homes, and there are few guidelines that states must follow when passing assisted living regulations. Assisted living rules vary from state to state, and even from facility to facility. Because of this lack of regulatory standards, it can be very confusing for potential residents and their family members to know what to expect when moving into an assisted living facility.
While the rights of nursing home residents are protected by federal law because nursing facilities certified to participate in the Medicare and Medicaid programs are required to comply with the provisions of the Nursing Home Reform Amendments of OBRA '87 (42 C.F.R. ¤ 483.10), there is no equivalent federal legislation for assisted living facilities and no comparable national system of resident rights and protections.

Fortunately, Utah has fairly comprehensive rules that govern the operation of assisted living facilities in this state. These rules, found in the Utah Administrative Code R432-270 and R432-6, provide a framework for consumers in determining whether a facility is following the minimum standards for operation. However, residents and their family members are not necessarily content to accept a minimum standard of care and need more information to ensure that a resident receives the highest quality of care available.

Assisted Living Facilities in Utah
Utah assisted living facilities must be licensed by the Utah Department of Health if two or more people live in a place where they receive assistance with activities of daily living from an unrelated caregiver. The licensing rules govern what is expected of facilities and facilities must abide by these rules in order to stay in business.

Facilities are divided into two types of licensing categories - Type I and Type II - depending on the level of assistance needed by the residents. Facilities are further classified as large, small, and limited capacity, depending on how many residents live in the facility. Regardless of the licensing category, facilities can only admit and retain those residents who meet admissions criteria and whose needs can be met by the individual facility. The Administrative Rules governing assisted living facilities in Utah can be found online at: http://www.rules.utah.gov/publicat/code/r432/r432-270.htm.

A Type I assisted living facility is defined as a residential facility that provides assistance with activities of daily living and social care to two or more residents who require protected living arrangements and who are capable of achieving mobility sufficient to exit the facility without the assistance of another person.

A Type II assisted living facility is defined as a residential facility with a home-like setting that provides an array of coordinated supportive personal and health care services available 24 hours per day to residents who have been assessed under Department rules to need any of these services. The staffing level and coordinated supportive health and social services must meet the needs of the resident. Type II facility residents require significant assistance from staff in more than two activities of daily living, may be independent or semi-independent, but not dependent; and they must be able to take life-saving action (including exiting the facility) in an emergency with only the limited assistance of one person.

Type I and Type II assisted living facilities cannot admit or retain a person who displays suicidal, sexually/socially inappropriate or assaultive behavior, poses a danger to self or others, has a chronic communicable disease (like active tuberculosis) if that disease can't be treated in the facility (or on an outpatient basis) or if the disease might be transmitted to other residents or guests through the normal course of activities, or requires inpatient hospital or long-term nursing care.

A Type II assisted living facility with approved secure units may admit residents with a diagnosis of Alzheimer's disease or dementia if the resident is able to exit the facility with limited assistance from one person, there is at least one staff member with documented training in Alzheimer's/dementia care in the secure unit at all times, the secure unit has an emergency evacuation plan that addresses the ability of the secure unit staff to evacuate the residents in case of emergency, and each resident admitted to a secure unit has an admission agreement that indicates placement in the secure unit. The secure unit admission agreement must document that an approved "wander risk management agreement" has been negotiated with the resident or resident's legally-recognized responsible person. The secure unit admission agreement must also identify discharge criteria that would initiate a transfer of the resident to a higher level of care than the assisted living facility is able to provide.

Assisted Living Staff
The number and type of staff in assisted-living facilities varies greatly. Staffing depends on many factors, including the number of residents and the types of services and amenities offered. The staff may be employed directly by the facility, or by agreements with outside agencies or private contractors. All personnel must be licensed, certified, or registered in accordance with Utah law.

Assisted living staff may include administrators, business and marketing directors, admissions coordinators, direct-care staff (including registered nurses, licensed practical nurses, and certified nursing assistants), food service personnel, activity directors, maintenance personnel and housekeepers. All direct care staff must be at least eighteen years old and have related experience. However, Utah rules allow personal care staff to receive "on the job" training. Regardless of the position, all assisted living staff must receive documented orientation to the facility and the job for which they are hired. Orientation must include the following: job description; ethics, confidentiality, and residents' rights; fire and disaster plan; policy and procedures; and reporting responsibility for abuse, neglect and exploitation. In addition to orientation, each employee must receive ongoing documented in-service training. The training must be tailored to include all subjects that are relevant to the employee's job responsibilities.

Facilities must establish personnel health policies that protect the health and safety of both staff and residents. Each staff member must have a health evaluation to make sure that they can safely care for residents in assisted living. The health evaluation must document any history of communicable diseases (including testing for tuberculosis) and/or conditions that may prevent a staff member from doing their duties as assigned.

Facilities must keep accurate and complete personnel records that include the following: employee application; date of employment; termination date; reason for leaving; documentation of cardiopulmonary resuscitation and first aid training; health inventory; food-handler's permit; tuberculosis skin test documentation; and documentation of criminal background screening.

Contracts and Agreements

Admission Agreements
Upon admission to an assisted living facility, the resident and facility enter into an admission agreement. The admission agreement is a legally binding contract between the resident and the facility that sets forth terms and conditions that largely govern what rights and responsibilities the resident has, as well as the rights and responsibilities expected of the facility. Many assisted living providers believe that important issues should be left to the individual facility's contract rather than rules, regulations or laws. Residents and their advocates must be aware that there are few standards facilities must follow when designing the admission agreement.

In Utah, the resident (or the resident's legally-recognized responsible person) must sign a written admission agreement prior to admission. The admission agreement must be kept on file by the facility and must specify at least the following:

* room and board charges and charges for basic and optional services;
* provision for a 30-day notice prior to any change in established charges;
* admission, retention, transfer, discharge, and eviction policies; conditions under which the agreement may be terminated;
* the name of the legally-recognized responsible party;
* notice that Licensing has the authority to examine resident records to determine compliance with licensing requirements; and
* refund provisions that address the following: thirty-day notices for transfer or discharge given by the facility or by the resident, emergency transfers or discharges, transfers or discharges without notice, and the death of a resident.

Making the attempt to understand the contents of the admission agreement can be intimidating, and the resident may feel that the facility knows best what should or shouldn't be included in the contract. If the document is too difficult to read and understand, a resident may agree to certain terms and conditions that put the resident at great risk for many problems. Examples of these problems are: receiving a room that is not the type the resident wanted; receiving a different meal plan; or added costs and charges that were not clearly disclosed by the facility. The most serious problem associated with admission agreements arises when a resident requires more complex care than the facility can safely provide. The admission agreement may not fully address this situation, and the resident may be at risk for either an improper discharge or retention in the facility with inadequate supervision and care.

Negotiated Risk Agreements
Negotiated risk agreements release a facility from liability arising from its failure to meet at least one aspect of a resident's needs. While providers often assert that such agreements offer assisted living residents additional rights in the form of choice in their daily lives, they may be used as well by providers to waive resident rights. Many advocates argue that there are no good reasons for such agreements. Rather, good care planning can achieve the results a resident needs without waiving any rights a resident might have. Washington and Oregon now prohibit such agreements. In Utah, they are commonly used and a sample form is provided on the website of the Department of Health.

Quality of Life

Living Units
There are several types and sizes of assisted living units, ranging from full-size one-bedroom apartments to studio apartments. Assisted living units tend to be smaller than average apartments. This space limitation can make for a difficult transition for a resident who is used to his or her own home. Some facilities allow residents to bring in their own furnishings, provided space permits.

Most assisted living units are rented, not owned. As with any rental property, the rent often depends on such factors as the size of the living area and the type of services and amenities provided. Some assisted living facilities charge fees in addition to rent. There may be a one-time non-refundable entrance fee, or additional fees for services not included in the basic rent. These services may range from extra meals or extra housekeeping to transportation costs from the facility to a doctor's office. In Utah, both Type I and Type II facilities must provide each resident with a separate living unit. Two residents may share a unit if they make the request in writing and both residents agree to the living arrangement.

Meals and Mealtimes
Many times, what determines a resident's overall satisfaction with a facility is the resident's satisfaction with the quality of meals and meal service. In most states, the facility is responsible for menu planning and mealtimes. Facilities in Utah must provide three meals a day, seven days a week (plus snacks) to all residents and must keep a one-week supply of nonperishable food and a three day supply of perishable food to prepare the planned menus. There can be no more than a 14-hour interval between the evening meal and breakfast, unless a nutritious snack is available in the evening.

All menus must be approved and signed by a certified dietitian. Meals must be served in a designated dining area suitable for that purpose, or in resident rooms upon request by the resident. However, residents are encouraged to eat their meals in the dining room with other residents. The cost of meals may be included in the resident's rent, but some facilities may charge an extra fee for snacks or meal delivery service. Even though the facility is responsible for planning and preparation, the resident and his or her family must make sure that the facility is providing nutritionally adequate meals.

Recreation, Activities and Socialization
Though the main focus of assisted living is providing assistance with residents' activities of daily living, an important factor to consider is the availability of recreational and social programs and activities. The quality of group and individual activities can vary greatly among facilities. Ideally, the facility has a recreation therapist on staff to manage these programs and activities. These staff members may be specially trained in the development and implementation of programs geared towards the special needs of residents.

In Utah, residents are encouraged to maintain and develop their fullest potential for independent living through participation in activity and recreational programs. The facility must provide opportunities for the following: socialization activities; independent living activities to foster and maintain independent functioning; physical activities; and community activities to promote resident participation in activities away from the facility.

Pets
Upon approval of the administrator, family may bring residents' pets to visit. The facility may even allow residents to keep household pets such as dogs, cats, birds, fish, and hamsters if permitted by local ordinance and by facility policy.

Disaster and Emergency Preparedness
The facility is responsible for the safety and well-being of residents in the event of an emergency or disaster. The facility must develop and coordinate plans with state and local emergency disaster authorities to respond to potential emergencies and disasters. The plan must outline the protection or evacuation of all residents, and include arrangements for staff response or provisions of additional staff to ensure the safety of any resident with physical or mental limitations.

Quality of Care

Resident Assessments
Before accepting a resident, the facility must obtain sufficient information about the person's ability to function in the facility through the following: an interview with the resident and the resident's legally-recognized responsible person, and the completion of the resident assessment. A signed and dated assessment must be completed for each resident prior to admission and at least every six months thereafter. The facility must use a resident assessment form that is approved and reviewed by the Department to document the resident assessments. For these forms and other pertinent licensing information, see http://health.utah.gov/pcra.

The initial and six-month resident assessment must be completed and signed by a licensed health care professional who must state that the resident meets the admission and level of assistance criteria for the facility. The facility must revise and update each resident's assessment when there is a significant change in the resident's cognitive, medical, physical, or social condition and update the resident's service plan to reflect the change in condition. If the Licensing Department determines that the facility knowingly and willfully admits or retains residents who do not meet licensing criteria, then the Department may, for a time period specified, require that resident assessments be conducted by an individual who is independent from the facility.

Service Plans
The services provided or arranged by the facility must be in accordance with each resident's individualized service plan. The plan must be consistent with the resident's unique cognitive, medical, physical, and social needs, and be developed within seven calendar days of the day the facility admits the resident. The resident assessment is used to develop, review, and revise the service plan for each resident. The service plan must be prepared by the administrator or a designated facility service coordinator, and must be periodically revised as needed.

The service plan must include a written description of the following:

* services provided;
* who will provide the services, including the resident's significant others who may participate in the delivery of services;
* how the services are provided;
* the frequency of services; and
* changes in services and reasons for those changes.

Resident Records
Assisted living facilities must keep an accurate and complete record for each resident. The record must include the resident's personal information and important family and medical contact information. The record must also include the admission agreement, the resident assessment, and the resident service plan.

Medical Care
Regardless of the type of facility, each person admitted to an assisted living facility must have a personal physician or a licensed practitioner prior to admission. The facility must notify a physician or other health care professional when the resident requires immediate medical attention.

The facility must assist residents in arranging access for services for medically related care including physician, dentist, pharmacist, therapy, podiatry, hospice, home health, and other services necessary to support the resident.

The facility must arrange for care by notifying the resident's legally-recognized responsible person; for transportation to and from the practitioner's office; or for a home visit by a health care professional.

If needed, Type I residents can receive intermittent care or treatment in the facility from a licensed health care professional either through contract or by the facility, if permitted by facility policy. The facility must develop written policies and procedures defining the level of nursing services provided by the facility.

Type I and Type II assisted living facilities cannot provide skilled nursing care, but must assist the resident in obtaining required services. Whether a nursing service is skilled depends on the complexity or specialized nature of the prescribed service, and whether the service can be safely or effectively performed only by (or under the close supervision of) licensed health care professional personnel.

A Type I assisted living facility must employ or contract with a registered nurse to provide or delegate medication administration for any resident who is unable to self-medicate or self-direct medication management.

A Type II assisted living facility must employ or contract with a registered nurse to provide or supervise nursing services to include: a nursing assessment on each resident; general health monitoring on each resident; and routine nursing tasks, including those that may be delegated to unlicensed assistive personnel.

First Aid
There must be one staff person on duty at all times who has appropriate training in basic first aid, the Heimlich maneuver, certification in cardiopulmonary resuscitation and emergency procedures to ensure that each resident receives prompt first aid as needed. The facility must have a first aid kit available at a specified location in the facility, as well as a current edition of a basic first aid manual approved by the American Red Cross, the American Medical Association, or a state or federal health agency.

Medications
In Utah, a licensed healthcare professional (usually a nurse) must assess each resident to determine what type of assistance (if any) is needed with medication administration. This assessment must be documented and must include the level and type of assistance required.

Many residents living in assisted living facilities are able to self-administer their own medications. Some residents are not able to take their own medications for one reason or another. They may need help with opening the medication bottles and taking out the medication, or they may need help figuring out what pills to take at what time. Facility staff can help if the resident is able to self-direct the medication administration. Usually, the resident must demonstrate that he or she can correctly identify the medications (for example, by color or shape) and have the ability to question changes in their own medication routines. The resident must be aware of what the medications look like and know when they should be taken, but the facility staff can assist by reminding the resident to take the medication, opening the bottles, or reminding the resident when the prescription needs to be refilled.

Some facilities may allow family members to help the resident with their medications. (The designated person cannot be a staff member.) The medication must be in a package set up by a health care practitioner, such as a doctor or a pharmacist. The family member must also document that the medication was given. Most importantly, the designated family member must sign a waiver indicating that they agree to assume all responsibility for administering the medications and refilling the prescriptions when needed. This is an especially important concern, and families should make sure that they understand the implications of the waiver.

If the resident is unable to self-administer or self-direct the medications, the assisted living facility staff may then be in charge of administering the medications. In some facilities, the person assisting the resident with their medications may not be a nurse or other trained, licensed health care professional. Utah rules allow facilities to hire a licensed healthcare professional to "delegate" the medication responsibilities to facility employees who are not nurses.

Hospice in Assisted Living
Hospice care provides medical, psychological, emotional, and spiritual care to people who are dying and their families. Hospice care focuses less on treatment of illness and more on the resident's comfort and emotional health at the end of life. Although hospice care is generally thought of as something that is provided at home, hospice care also can be provided in an assisted living facility.

Paying for Hospice Care in Assisted Living
Hospice care may be covered under Medicare, Medicaid, private insurance plans, HMOs, and managed care organizations. A person may still be eligible for hospice services if she is still seeking curative care for a life-threatening condition, but it is likely that Medicaid, Medicare, and private insurers or HMOs will not pay for both curative and hospice care. When hospice care is provided in an assisted living facility, the hospice care should not replace anything that the facility otherwise is obligated to do. Instead, the hospice agency should provide services that supplement and improve the facility services.

Discharge From a Facility
In Utah, a resident can remain in an assisted living facility provided the facility's construction can meet the resident's needs, the resident's physical and mental needs are appropriate to the assisted living criteria, and the facility provides adequate staffing to meet the resident's needs.

A resident may be discharged, transferred, or evicted if the facility is no longer able to meet the resident's needs because the resident poses a threat to health or safety to self or others, or the facility is not able to provide required medical treatment.

A resident may also be discharged, transferred or evicted if the resident fails to pay for services as required by the admission agreement, the resident fails to comply with written policies or rules of the facility, the resident wishes to transfer, or the facility ceases to operate.

The facility has to notify the resident's legally-recognized responsible person within 24 hours of significant changes or deterioration of the resident's health, and ensure the resident's transfer to an appropriate health care facility if the resident requires services beyond the scope of the facility's license. No matter what the reason, the facility must provide sufficient preparation and orientation to a resident to ensure a safe and orderly transfer or discharge from the facility.

Notice of Transfer or Discharge
Prior to transferring or discharging a resident, the facility must give a transfer or discharge notice to the resident and the resident's legally-recognized responsible person. The notice of transfer or discharge must be in writing (with a copy placed in the resident file) and be phrased in a manner and in a language the resident can understand. The notice must be either hand-delivered or sent by certified mail, and made at least 30 days before the day on which the facility plans to transfer or discharge the resident. However, the notice may be made as soon as practicable before transfer or discharge if the safety or health of persons in the facility is endangered, or an immediate transfer or discharge is required by the resident's urgent medical needs.

The notice of transfer or discharge must:

* detail the reasons for transfer or discharge;
* state the effective date of transfer or discharge;
* state the location to which the resident will be transferred or discharged; and
* state that the resident may request a conference to discuss the transfer or discharge.
The notice must also contain the following information:
* for facility residents who are 60 years of age or older, the name, mailing address, and telephone number of the State Long Term Care Ombudsman;
* for facility residents with developmental disabilities, the mailing address and telephone number of the agency responsible for the protection and advocacy of developmentally disabled; and
* for facility residents who are mentally ill, the mailing address and telephone number of the agency responsible for the protection and advocacy of mentally ill individuals.

Contesting a Transfer or Discharge
The resident or the resident's legally-recognized responsible person may contest a transfer or discharge. If the transfer or discharge is contested, the facility must provide an informal conference, except where undue delay might jeopardize the health, safety, or well-being of the resident or others.

The resident or the resident's legally recognized responsible person must request the conference within five calendar days of the day of receipt of notice of discharge to determine if a satisfactory resolution can be reached. Participants in the conference include the facility representatives, the resident or the resident's legally-recognized responsible person, and any others requested by the resident or the resident's legally-recognized responsible person.

Paying for Assisted Living

Facility Pricing Options
There are different ways that facilities can charge residents for the services they receive. One way is referred to as the "all-inclusive" method. This means that rent and any additional services are included in a set monthly fee.

Another method charges residents a flat rate for a certain set of basic services, and then charges an additional fee for extra services. With this " a la carte" type of pricing option, residents pay only for those services they receive. For example, in addition to the basic monthly rent, a facility may have a schedule of charges based on resident usage of services or facilities. These additional charges may include personal laundry, television, transportation costs, and medical supplies, as well as assistance with personal care needs such as bathing, grooming, and dressing.

Other Charges
In addition to monthly rent and service charges, some facilities may charge a security deposit. Others may charge a non-refundable entrance or "community fee." Some deposits might not be refundable, even if the resident moves elsewhere, or never moves in at all. Many facilities charge an additional fee if payment for the services are received late. Fees may vary from a set fee to an additional charge for each day beyond the date payment was due. Some facilities charge an annual percentage rate assessed daily on unpaid rent.

Payment Options
Regardless of the source, the costs involved can make paying for assisted living prohibitively expensive for many people. Today, there are a few public assistance programs available for eligible residents, but the majority of residents in assisted living must continue to pay for services with their own private money.

Private Payment
Assisted living is largely a private-pay business. Residents pay for assisted living expenses from private money sources including income from pensions and retirement, as well as money from savings and investment accounts. Some families help with covering the costs associated with assisted living. In other cases, residents use the proceeds from the sale of real estate and personal property. In addition, the expenses of assisted living facility residents may be deductible as health-related expenditures for income tax purposes.
Long term care insurance may pay for at least some of the expenses if the facility qualifies as an institution under the policy and the policyholder needs some assistance with ADLs.

Medicare
Medicare may be a source of payment for certain expenses related to assisted living. Medicare is a federal health insurance program for people 65 and over and certain disabled people under 65. Generally, Medicare does not cover assisted living costs. However, Medicare may pay for short-term services contracted through a home health care or hospice agency and provided to the resident at the assisted living facility.

The Medicare home health care benefit generally requires a need for skilled nursing care, or physical or speech therapy. Nursing care is considered "skilled" if a nursing service requires the expertise of a licensed nurse. For example, treatment of a wound or administration of an injection are skilled nursing services that qualify for Medicare reimbursement. On the other hand, bathing a resident, or helping a resident get dressed, are services that do not qualify for Medicare reimbursement.

Medicaid Payment for Personal Care Services
Medicaid is a program where the federal and state governments work together to pay for healthcare services of eligible people. Traditional Medicaid does not pay for the "room and board" part of assisted living. However, states may offer reimbursement for personal care services provided in the assisted living facility as part of their Medicaid plan. This type of reimbursement plan is not currently available to assisted living residents in Utah. In early 2006, Utah Medicaid will be offering this type of Medicaid payment under a federally approved home and community based waiver program. To qualify for benefits under the Medicaid waiver program, a person must meet both the financial and medical eligibility requirements for nursing home Medicaid. Once eligible, Medicaid dollars will pay for the personal services part of a resident's assisted living costs, but the resident will still be personally responsible for payment of the room and board costs.

Utah's Current Long Term Care and Medical Case Management Program
Since 2000, Utah Medicaid has been offering a long term care and medical case management program in several counties. This demonstration project, known as Flexcare in Salt Lake, Tooele, and Davis Counties, Weber MACS Plan in Weber and Morgan Counties, and Molina Independent Care in Washington, Kane, Iron, Beaver, and Garfield Counties, has been a wonderful payment resource for approximately 700 people. Participants must be medically and financially eligible for nursing home Medicaid and must meet several other criteria. Once eligible, a participant may use the Medicaid dollars to pay an assisted living facility for room and board costs as well as other personal services. This program will be phased out in early 2006 once the Medicaid waiver program mentioned above goes into effect.

If Problems Arise
Ideally, a facility should strive to fulfill every obligation required by law. Many facilities provide excellent service and care but, even under the best circumstances, problems may arise. These problems can involve anything from payment issues to the quality of healthcare and services.

Resident Self-Advocacy
A resident first should talk to an employee on duty at the time the problem occurs - preferably the person or persons directly involved. If no one is available, or the resident is not comfortable talking directly to the persons involved, the resident should contact the facility administrator. Many times, the issue can be resolved at this level, and residents often find that prompt and direct communication can resolve issues in the simplest and most effective way.

Each facility should have a resident or family council that serves to advocate for the rights of all facility residents. These councils meet regularly to address questions and concerns about facility issues. Many of these councils are instrumental in making changes that directly improve the quality of life in the facility.

Unfortunately, sometimes problems cannot be resolved by talking to the facility staff or administrator. If a resident is not satisfied with a facility's response, the resident can turn to certain agencies and resources for help.

Long Term Care Ombudsman Program
Assistance may be available from the local Long Term Care Ombudsman program. An "ombudsman" is someone who investigates reported complaints and helps to achieve settlements. Federal law (the Older Americans Act) requires each state to have a Long Term Care Ombudsman program, although ombudsman programs vary greatly from state to state. However, all Ombudsman programs operate independently from the long-term care facilities in which they visit and work.

In Utah, the Long Term Care Ombudsman program provides advocates for residents sixty years of age and older in any facility licensed by the Department of Health. Although Ombudsman representatives are impartial in investigation, they take the resident's perspective when resolving problems. They seek to resolve situations on terms acceptable to the resident. Ombudsman representatives provide information to facilities and residents, investigate complaints, work with family and resident councils, and train facility staff as well as the local community about various issues in long term care.

For more information on the Long Term Care Ombudsman Program in Utah, see the web site of the Utah Division of Aging and Adult Services, www.hsdaas.utah.gov.

State Licensing
The Department of Licensing has the authority to investigate complaints about facilities. Residents always have the right to report problems or complaints to the state licensing department.

When a complaint is made, the licensing agency must investigate within a certain amount of time. If violations in licensing requirements are found, the agency may require the facility to fix the problem, or risk losing their license or pay penalties.

Usually the facility is notified of the deficiency and given some time to correct the problem. The facility must outline a plan of action for correcting the problem. If the facility does not correct the problem as outlined, the facility may be subject to sanctions, such as fines or limitations on the facility's operation.

Residents must be aware that state facility licensing requirements are minimum standards. They in no way reflect the best practice that residents and advocates should strive towards.

Professional Licensing Boards
States establish professional licensing boards that set standards for health care personnel including registered nurses, licensed practical nurses, physical therapists, certified nursing assistants, social workers, physicians. These licensing agencies provide examinations and certifications to these groups, and also investigate complaints about individual healthcare workers. Residents can usually report complaints directly to their state's department of professional licensing. In Utah, the licensing of health care professionals is governed by the Department of Professional Licensing (DOPL).

Other Remedies
Other legal sources of protection for assisted living residents may include federal and state antidiscrimination laws, public housing laws and regulations, contract laws, consumer protection laws, and private rights of action. For more information, see Stephanie Edelstein, Resident Rights in Assisted Living: Sources and Resources, BIFOCAL, October 2005, Vol. 27, No. 1, 7-11.

Conclusion
Assisted living facilities offer a very attractive housing option for older and disabled adults in need of support with their ADLs but who are not in need of skilled nursing care. Assisted living facilities are often homey, friendly environments that provide meals, socialization, supportive care, and security. While Utah has administrative code rules that provide some general oversight, arrangements are to a great extent contractual between the resident and facility. As advocates for older clients, lawyers should advise clients on admission contracts, negotiated risk agreements, protective remedies, and the relationship between assisted living and public benefits like Medicaid. Assisted living is primarily paid for out of private funds-personal income, savings, investments, and long term care insurance, but some public benefits apply, like Medicare and Medicaid, and advocates must understand these issues to best advise their clients.

Useful Internet Resources

AARP - www.aarp.org

ABA Commission on Law and Aging - www.abanet.org/aging

Assisted Living Federation of American - www.alfa.org

Center for Excellence in Assisted Living -
http://www.theceal.org

Consumer Consortium on Assisted Living - www.ccal.org

National Center for Assisted Living -
www.longtermcareliving.com/planning_ahead/assisted/assisted1.htm

National Senior Citizens Law Center - www.nsclc.org

Utah Department of Health/Bureau of Licensing -
www.health.utah.gov/licensing

Utah Division of Aging and Adult Services - www.hsdaas.utah.gov

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This page contains a single entry from the blog posted on February 7, 2006 3:39 PM.

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