Comparing residential long-term care regulations between nursing homes and assisted living facilities

• Published in: Nursing outlook Vol. 68; no. 1; pp. 114 - 122
• Main Authors: Trinkoff, Alison M., Yoon, Jung Min, Storr, Carla L., Lerner, Nancy B., Yang, Bo Kyum, Han, Kihye
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2020
• Subjects: Assisted living; Assisted Living Facilities - standards; Government Regulation; Humans; Long-Term Care; Nursing; Nursing home; Nursing Homes - standards; Outcomes; Regulation; Staffing; United States; United States; Regulation; Assisted living; Staffing; Nursing home; Long-term care; Outcomes
• ISSN: 0029-6554; 1528-3968
• DOI: 10.1016/j.outlook.2019.06.015

•NHs followed a standard set of federal regulations, whereas ALF regulations varied widely across states, with differences in staffing and training requirements, inspections frequency, enforcement, and collection and dissemination of data (e.g., inspection reports).•Overall, state ALF regulations were less stringent than for NHs in all categories.•Because assisted living is overseen by states, there are no national level data available to measure and compare care quality across facilities, whereas for NHs there is a five-star rating system based on federal NH quality measures. Nursing homes (NHs) are federally regulated under uniform standards, whereas assisted living facilities (ALFs) use individual state regulations for staffing, training, and oversight of care quality and safety. To describe ALF staffing, training, inspection, and enforcement regulations for 50 U.S. states and the District of Columbia, and compare them to NH regulations. Publication of ALF quality and safety outcomes data also was assessed and compared to NHs. Regulatory data were compiled from administrative and regulatory data sources, state websites, and regulatory compendia. NHs followed a standard set of regulations, whereas ALF regulations varied widely. Overall, state ALF regulations were less stringent than NH in all categories. As ALF populations and acuity levels increase, staffing, training, nursing presence, and outcomes data requirements are warranted, and could be tailored from NH regulations to protect ALF quality and safety.