According to the American Health Care Association/National Center for Assisted Living, over 818,000 Americans reside in assisted living facilities, with half of the residents age 85 and older.  The Joint Commission reports that 34% of assisted living residents have Alzheimer’s disease or other forms of dementia.  The demand for assisted living options continues to grow.  Consumers expect data on quality of care to make the best decisions for themselves or family members, and facilities can use quality data to attract residents and defend against potential claims and litigation.

The Joint Commission

Several organizations offer accreditation, standards, and guidelines in the assisted living industry.  The Joint Commission offers the Assisted Living Community Accreditation program, and as of July 2023 expanded that certification to include the Memory Care Certification for Assisted Living Communities.  The Joint Commission Assisted Living standards include, but are not limited to:

• Environment of Care
• Emergency Management
• Human Resources
• Infection Prevention and Control
• Information Management
• Leadership
• Life Safety
• Medication Management
• National Patient Safety Goals
• Provision of Care
• Performance Improvement
• Record of Care
• Rights of Individual
• Waived Testing

Facilities that achieve the AL accreditation are eligible to obtain the new Memory Care Certification, which was developed in collaboration with the Alzheimer’s Association.  The standards reflect best practices in safety and quality for memory care.  Providers will be recognized on The Joint Commission’s Quality Check website and on the Alzheimer’s Association Community Resource Finder.

Industry Associations

The Quality in Assisted Living Collaborative is a partnership among the National Association for Regulatory Administration (NARA), Argentum, the American Seniors Housing Association (ASHA), LeadingAge, and the National Center for Assisted Living (NCAL).  The goal of the collaborative is to “identify, define and develop model guidance for assisted living.”  The group is building a set of best practices, with the first release being infection prevention and control guidelines in late 2023.  The group expects the recommendations will assist operators, policymakers, and consumers.

In addition to these organization’s assisted living guidelines, each state establishes and enforces licensing and certification for assisted living communities.  NCAL publishes an annual State Regulatory Review to summarize each state’s requirements for assisted living licensure or certification.

Demonstration of compliance with quality standards allows a facility to instill confidence with residents and families as well as providing a defense in claims and lawsuits.  In assisted living, critical areas of documentation include:

• Admission and discharge criteria/agreements to ensure a resident is receiving the appropriate level of care as well as outline general financial and physical plant matters.
• Service plans which are updated as the resident’s needs change.
• Assessments to evaluate appropriateness of residency that should occur during any acute changes in condition as well as annually. Necessary actions due to changes in the resident’s condition should have been established through well documented admission criteria and service plans.
• Nursing care documentation requirements vary based on state regulations and facility policies.
• Interactions with family including the information provided as well as the responses of family member.
• Staffing regulations also vary by state but should include training, qualifications, and scheduling.
• Outside services including home health or hospice.

Excelas’ experience in internal audit and record review assists facilities in preparing for the accreditation/certification process and in defending allegations.  Our staff has extensive experience in the unique documentation requirements for skilled nursing, assisted living, and independent living communities.