Living by the Rules

What is the difference between a Level 1 and Level 4 assisted living facility? How do regulations for these facilities differ from nursing homes? A look at the rules behind this booming industry.

According to the Department of Health and Hospitals (DHH), almost 1 million people currently reside in assisted living and other forms of resident-centered care options around the country.

With so many assisted living communities to choose from, state regulations necessarily exist to protect the rights of residents to voice grievances and suggest changes in policies and services to either staff or outside representatives without fear of restraint, interference, coercion, discrimination or reprisal. Regulations require assisted living providers to have a formal process for receiving and responding to grievances in a timely manner.

“Regulations vary state by state,” explained David Schonberg, owner and operator of Schonberg and Associates. However, there are not national regulations for assisted living communities, only for nursing homes. While basic regulations must be met for every community in Louisiana — established by the Louisiana Department of Health and Hospitals — there are also many aspects that vary from community to community based upon the number of residents and the care level that is needed.”

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Assisted living communities are regulated by the Louisiana Department of Health and Hospitals under the “Adult Residential Care” licensure classification, which includes personal care homes, shelter care homes and assisted living communities (with individual apartments/units for residents).

Assisted living residences typically offer different levels of care at different costs. Residents may have to move to a higher level of care if the assisted living residence can no longer permanently meet their needs. Residents and/or families pay for services and according to the Department of Health and Hospitals: no financial assistance is available in Louisiana at this time.

“In Louisiana, we have state specific training requirements, especially for dementia care — eight hours per year,” said Daniel Ritter, executive director at Inspired Living at Kenner. “Caregivers do not need to be certified in the state of Louisiana, although we prefer it. Residents — as we like to call them, not patients — certainly do have rights and they are laid out in our state regulations.

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“Currently, the way our state regs are written, we do not have a staffing ration to follow like the nursing home industry,” Ritter continued. “Our regs are sort of grey in that area, stating that we simply must provide adequate staffing. Assisted living facilities in our state are not even required to staff a nurse, believe it or not, unless the facility is passing meds, meaning that the family contracts with a third party for their medication administration and management.”

Ritter explained that medication services can range from $300 to $400 a month. “Until August 2015, when our regs were finally rewritten, we couldn’t even pass medications, even though we staffed a nurse,” he said. “The Legislature and DHH finally gave in and rewrote the regs in our favor, to where our nurses can pass out meds if we choose, or we can continue to use a third party.”

There are many requirements that go into developing an assisted living facility.

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According to Schonberg, some of the most important ones include becoming licensed by the Louisiana Department of Health and Hospitals, and ensuring that the building meets all coding requirements and all the necessary programming and procedures are in place.

According to standards governing Adult Residential Care Providers (ARCP), under the Department of Health and Hospitals, there are four levels of adult residential care, and these levels differ in the services they are licensed to offer and the physical requirements.

Level 1 is an ARCP that provides adult residential care for compensation to two or more residents but no more than eight who are unrelated to the licensee or operator in a setting that is designed similarly to a single-family dwelling.

A Level 2 ARCP provides care for compensation to nine or more residents but no more than 16 who are unrelated to the licensee or operator in a congregate setting that does not provide independent apartments equipped with kitchenettes.

A Level 3 is an ARCP that provides care for compensation to 17 or more residents, under the same aforementioned requirements, while a Level 4 ARCP differs only from a Level 3 by its inclusion of intermittent nursing services.

Located on the Northshore in Covington, Christwood’s Longleaf is licensed by the Department of Health and Hospitals as a Level 3 and Level 4 Adult Residential Care Provider, offering a full range of assisted living support with a focus on memory care. The company’s services range from assistance with bathing and grooming to medication administration, along with a memory care program.

“Our designation as a Level 4 Adult Residential Care assisted living provider — having a licensed nurse onsite 24 hours a day and staffing levels that exceed state regulations — assures that our residents receive the best possible care and service,” said Tami Perry, Christwood resident health services director. “We also have a nurse navigator who works with our residents and their families to achieve the best possible outcomes and quality of life.”

In addition to minding a host of regulations, Ritter said facilities are looking toward an increasingly competitive marketplace.

“At the end of the day, more and more assisted living facilities will be popping up, due to the high demand to meet the needs of the baby boomers,” Ritter said. “With that being said, the newer communities are going to offer better amenities and cutting-edge technology, better dining options, fixed/all-inclusive pricing options, and better staffing models. Older assisted living communities will have to spend quite a bit of money to remain relevant and compete in what is going to be a very competitive industry.”

To Do

Don’t Be Afraid to Ask

Things to consider when searching for an assisted living center.

In addition to looking at things like where a community is located, the types of care and residential services they offer, the size of the apartments, the range of rents, the amenities, and, most importantly, the “feel” you experience when you take a tour, Daniel Ritter, executive director of Inspired Living at Kenner, suggests getting answers to some important questions, including:

Hidden fees: Are all the care charges ‘a la carte’ or inclusive?

Is medication management included?

Does the facility have nursing staff 24 hours a day? Are they actually in the building or just “on call?”

Do they offer ‘anytime dining,’ or are meals available during set hours?

How many daily options are there for dining?

Should you expect rate increases or do they offer ‘forever’ pricing where you can lock in your rate?

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