Following the recommendations of a commission established by the legislature in 2004, the Massachusetts Department of Elder Affairs adopted final revised assisted living regulations in August. The new regulations may be viewed here. A redline against the prior version is available here. Certified assisted living facilities have until December 10 to come into compliance with the new regulations. Some operational changes may be required, and facilities’ residency agreements and operating plans will have to be revised.
While some of the revisions are limited to improved wordsmithing and correctives to situations that have arisen in the past, a number of changes appear to medicalize some services provided by ALFs. At first blush, this is puzzling. After all, with the adoption of the assisted living statute in Massachusetts in 1994, the Commonwealth took the position that assisted living services are not health care services; now, the changes to the regulations are a tacit recognition that assisted living facilities house care that encompasses health care services. The policy and fiscal question raised by this admission is whether the Commonwealth — and other states — should assume once more the financial responsibility for services provided to some assisted living residents (beyond the limited avenues currently open to such funding, such as Massachusetts’ group adult foster care program) as they do for care provided to some nursing facility residents, through the Medicaid program.
Leaving the policy question aside, it is clear that the industry welcomes at least some of these higher standards. In fact, the industry supported legislation in the last session that would have done some of the same things (see this old press release) as it helps high-quality providers, and providers of specialized services (e.g.,dementia units) differentiate themselves from others in the industry.
Stay tuned as ALFs learn more about the new regulations at Elder Affairs training sessions next month, and as they work on revisions to operating plans, residency agreements, and facility staffing and operations.