The Idaho Board of Health and Welfare is authorized under Sections 39-3305 and 39-3358, Idaho Code, to adopt and
enforce rules to protect the health, safety, and individual rights for residents in residential assisted living facilities.
001. TITLE, SCOPE, AND RESPONSIBILITIES.
01. Title. The title of this chapter of rules is IDAPA 16.03.22, “Residential Assisted Living Facilities.”
02. Scope. The purpose of a residential assisted living facility is to provide choice, dignity, and
independence to residents while maintaining a safe, humane, and home-like living arrangement for individuals
needing assistance with daily activities and personal care. These rules set standards for providing services that
maintain a safe and healthy environment.
03. General Provider Responsibilities. The facility must ensure quality services by providing
choices, dignity, and independence to residents. The facility must have an administrator and staff who have the
knowledge and experience required to provide safe and appropriate services to all residents of the facility. The facility
must be operated consistent with the rules and statutes as it conducts its work.
04. General Department Responsibilities. The Department is responsible for monitoring and
enforcing the provisions of the statute and this chapter to protect residents in these facilities by providing information,
education, and evaluating providers to ensure compliance with statute and these rules. This responsibility includes
licensing facilities and monitoring the condition of facilities.
05. Exemptions. The provisions of these rules do not apply to any of the following:
a. The provisions of these rules do not apply to hospitals, nursing facilities, intermediate care facilities
for persons with intellectual disabilities, or any other health facility as defined by Title 39, Chapter 13, Idaho Code.
b. The provisions of these rules do not apply to any house, institution, hotel, congregate housing
project, retirement home, or other similar place that is limited to providing one (1) or more of the following: housing,
meals, transportation, housekeeping, or recreational and social activities, or that have residents independently
accessing supportive services from an entity approved to provide such services in Idaho and holding no legal
ownership interest in the entity operating the facility.
c. The provisions of these rules do not apply to any arrangement for the receiving and care of persons
by a relative, except when the caregiver is paid for the care through a state or federal program, in which case the
caregiver’s relative and the care setting must meet all applicable requirements.
002. WRITTEN INTERPRETATIONS.
This agency has written statements which pertain to the interpretations of the rules of this chapter or to the
documentation of compliance with the rules of this chapter. These documents is available for public inspection on the
program website http://assistedliving.dhw.idaho.gov.
003. ADMINISTRATIVE APPEALS, CONTESTED CASES, AND INFORMAL DISPUTE
RESOLUTION.
01. Administrative Appeals and Contested Cases. Administrative appeals and contested cases are
governed by IDAPA 16.05.03, “Contested Case Proceedings and Declaratory Rulings.” (3-20-20)T
02. Informal Dispute Resolution Meeting. If a facility disagrees with a finding of a core issue, it may
request an informal dispute resolution meeting with the Residential Assisted Living Facilities Program. The policy
and procedure for requesting informal dispute resolution is posted on the Residential Assisted Living Facilities
Program website at https://assistedliving.dhw.idaho.gov.
004. INCORPORATION BY REFERENCE.
The documents referenced in this rule, are incorporated by reference as provided by Section 67-5229(a), Idaho Code.
These incorporated documents are available for public review upon request at the Department of Health and Welfare,
450 West State Street, Boise, Idaho 83702, or when available online at the websites provided in these rules.
01. National Fire Protection Association (NFPA) Documents. a. National Fire Protection Association (NFPA) Standard 101, The Life Safety Code, 2018 Edition,
the occupancy chapters and all mandatory referenced documents contained therein under “Mandatory References.”
b. National Fire Protection Association (NFPA) Standard 99, Health Care Facilities Code, 2018
Edition.
009. CRIMINAL HISTORY AND BACKGROUND CHECK REQUIREMENTS.
01. Criminal History and Background Check. A residential assisted living facility must complete a
criminal history and background check on employees and contractors hired or contracted with after October 1, 2005,
who have direct resident access to residents in the residential assisted living facility. The Department check
conducted under IDAPA 16.05.06, “Criminal History and Background Checks,” satisfies this requirement. Other
criminal history and background checks may be acceptable provided they meet the criteria in Subsection 009.02 of
this rule and the entity conducting the check issues written findings. The entity must provide a copy of these written
findings to both the facility and the employee.
02. Scope of a Criminal History and Background Check. The criminal history and background
check must, at a minimum, be fingerprint-based and include a search of the following record sources: (3-20-20)T
a. Federal Bureau of Investigation (FBI);
b. Idaho State Police Bureau of Criminal Identification;
c. Sexual Offender Registry;
d. Office of Inspector General List of Excluded Individuals and Entities; and
e. Nurse Aide Registry.
03. Availability to Work. Any direct resident access individual hired or contracted with on or after
October 1, 2005, must self-disclose all arrests and convictions before having access to residents.
a. If a disqualifying crime as described in IDAPA 16.05.06, “Criminal History and Background
Checks,” is disclosed, the individual must not have direct resident access to any resident.
b. The individual is only allowed to work under another employee who has a cleared criminal history
and background check that meets the criteria in this rule. The cleared employee must keep the individual waiting for
clearance in line-of-sight when the individual has direct resident access until the criminal history and background
check is completed and the results are obtained by the facility, unless:
i. The individual has completed an alternative criminal history and background check that includes a
search of the record sources listed in Subsection 009.02 except for Subsection 009.02.a. in this rule;
ii. The facility determines there is no potential danger to residents; and
iii. This alternative criminal history and background check is only in effect until the required criminal
history and background check that meets the criteria in this rule is completed. The results must state whether the
individual was cleared or denied based on the completed fingerprint-based background check.
04. Submission of Fingerprints. The individual’s fingerprints must be submitted to the entity
conducting the criminal history and background check within twenty-one (21) days of their date of hire.
05. New Criminal History and Background Check. An individual must have a criminal history and
background check when:
a. Accepting employment with a new employer; and
b. The individual’s last criminal history and background check was completed more than three (3)
years prior to their date of hire.
06. Use of Previous Criminal History and Background Check. Any employer is allowed to use a
previous criminal history and background check that meets the criteria in this rule if:
a. The individual has received a criminal history and background check within three (3) years of their
date of hire;
b. Prior to the individual being granted unsupervised direct resident access, the employer obtains and
retains the individual’s previous criminal history and background check results;
c. The employer completes a state-only background check of the individual through the Idaho State
Police Bureau of Criminal Identification, within thirty (30) days of obtaining the previous criminal history and
background check results; and
d. No disqualifying crimes are found.
07. Employer Discretion. The new employer, at its discretion, may require an individual to complete a
criminal history and background check at any time, even if the individual has received a criminal history and
background check within three (3) years of their date of hire.
010. DEFINITIONS AND ABBREVIATIONS A THROUGH E.
01. Abuse. A non-accidental act of sexual, physical, or mental mistreatment or injury of a resident
through the action or inaction of another individual.
02. Accident. An unexpected, unintended event that can cause a resident injury.
03. Activities. All organized and directed social and rehabilitative services a facility provides,
arranges, or cooperates with.
04. Activities of Daily Living. Self-care actions necessary to sustain an individual in daily living,
including bathing, dressing, toileting, grooming, eating, communicating, and managing medications.
05. Administrator. An individual licensed by the Idaho Bureau of Occupational Licenses as a
Residential Assisted Living Facility Administrator.
06. Administrator’s Designee. A person authorized in writing to act in the absence of the
administrator who is knowledgeable of facility operations, the residents and their needs, emergency procedures, the
location and operation of emergency equipment, and how the administrator can be reached in the event of an
emergency.
07. Adult. A person who has reached eighteen (18) years of age.
08. Advance Directive. A written instruction, such as a living will or durable power of attorney for
health care, recognized under state law, whether statutory or as recognized by the courts of the State, related to the
provision of medical care when the individual is unable to communicate.
09. Advocate. An authorized or designated representative of a program or organization operating
under federal or state mandate to represent the interests of a population group served by a facility.
10. Ambulatory Person. A person who, unaided by any other person, is physically and mentally
capable of walking a normal path to safety, including the ascent and descent of stairs.
11. Assessment. Information gathered that identifies resident strengths, weaknesses, risks, and needs,
to include functional, social, medical, and behavioral needs.
12. Authentication. The process or action of proving or showing authorship to be true, genuine, or
valid.
13. Authorized Provider. An individual who is a nurse practitioner, clinical nurse specialist, or
physician assistant.
14. Behavior Plan. A written plan that decreases the frequency, duration, or intensity of maladaptive
behaviors, and increases the frequency of adaptive behaviors.
15. Call System. A signaling system whereby a resident can contact staff directly from their sleeping
room, toilet room, and bathing area. The system may be voice communication, or an audible or visual signal, and may
include wireless technology. The call system cannot be configured in such a way as to breach a resident’s right to
privacy at the facility, including in the resident’s living quarters, in common areas, during medical treatments, while
receiving other services, in written and telephonic communications, or in visits with family, friends, advocates, and
resident groups.
16. Chemical Restraint. A medication used to control behavior or to restrict freedom of movement
and is not a standard treatment for the resident’s condition.
17. Cognitive Impairment. When a person experiences loss of short or long-term memory, orientation
to person, place, or time, safety awareness, or loses the ability to make decisions that affect everyday life.
18. Complaint. A formal expression of dissatisfaction, discontent, or unhappiness by, or on behalf of, a
resident concerning the care or conditions at the facility. This expression could be oral, in writing, or by alternative
means of communication.
19. Complaint Investigation. A survey to investigate the validity of allegations of noncompliance
with applicable state requirements. Allegations will be investigated by the Licensing Agency as described in Section
39-3355, Idaho Code.
20. Core Issue. A core issue is any one (1) of the following:
a. Abuse;
b. Neglect;
c. Exploitation;
d. Inadequate care;
e. A situation in which the facility has operated for more than thirty (30) days without a licensed
administrator overseeing the day-to-day operations of the facility;
f. Inoperable fire detection or extinguishing systems with no fire watch in place pending the
correction of the system;
g. Surveyors denied access to records, residents, or facilities. (
21. Criminal Offense. Any crime as defined in Section 18-111, Idaho Code, 18 U.S.C. Section
22. Deficiency. A determination of noncompliance with a specific rule or part of a rule.
23. Dementia. A chronic deterioration of intellectual function and other cognitive skills severe enough
to interfere with the ability to perform activities of daily living.
24. Department. The Idaho Department of Health and Welfare.
25. Developmental Disability. A developmental disability, as defined in Section 66-402, Idaho Code,
means a chronic disability of a person which appears before twenty-two (22) years of age and:
a. Is attributable to an impairment, such as an intellectual disability, cerebral palsy, epilepsy, autism,
or other conditions found to be closely related or similar to one (1) of these impairments that requires similar
treatment or services, or is attributable to dyslexia resulting from such impairments;
b. Results in substantial functional limitations in three (3) or more of the following areas of major life
activity: self-care, receptive and expressive language, learning, mobility, self-direction, capacity of independent
living, or economic self-sufficiency; and
c. Reflects the need for a combination and sequence of special, interdisciplinary or direct care,
treatment, or other services which are of life-long or extended duration, and individually planned and coordinated.
26. Direct Resident Access. In-person access with any resident who resides at the facility, or any
access to the residents’ personal belongings or information.
27. Director. The Director of the Idaho Department of Health and Welfare or their designee.
28. Electronic Signature. The system for signing electronic documents by entering a unique code or
password that verifies the identity of the person signing and creates an individual “signature” on the record.
29. Elopement. When a resident who is cognitively, physically, mentally, emotionally, or chemically
impaired, physically leaves the facility premises or the secured unit or yard without personnel’s knowledge.
30. Exit Conference. A meeting with the facility administrator or designee to: (1) provide review,
discussion, and written documentation of non-core issues, and (2) to provide preliminary findings of core issues.
31. Exploitation. The misuse of a resident’s funds, property, resources, identity, or person for profit or
advantage. This includes charging a resident for services or supplies not provided or disclosed in the written
admission agreement and staff accepting gifts or money for extra services.
011. DEFINITIONS AND ABBREVIATIONS F THROUGH N.
01. Follow-Up Survey. A survey conducted to confirm that the facility is in compliance and has the
ability to remain in compliance.
02. Governmental Unit. The state, any county, any city, or any department, division, board, or other
agency.
03. Hourly Adult Care. Nonresident daily services and supervision provided by a facility to
individuals who are in need of supervision outside of their personal residence(s) for a portion of the day. (7-1-20)T
04. Immediate Danger. Any resident is subject to an imminent or substantial danger. (3-20-20)T
05. Inadequate Care. When a facility fails to provide the services required to meet the terms of the
Negotiated Service Agreement, or provide for room, board, activities of daily living, supervision, first aid, assistance
and monitoring of medications, emergency intervention, coordination of outside services, a safe living environment,
engages in violations of resident rights, or takes residents who have been admitted in violation of the provisions of
Section 152 of these rules.
06. Incident. An event that can cause a resident injury.
07. Independent Mobility. A person’s ability to move about freely of their own choice with or without
the assistance of a mobility device such as a wheelchair, cane, crutches, or walker.
08. Legal Guardian or Conservator. A court-appointed individual designated to manage the affairs or
finances of another person who has been found to be incapable of handling their own affairs.
10. Licensing Agency. The Residential Assisted Living Facilities Program, a unit of the Division of
Licensing and Certification within the Department of Health and Welfare, that conducts inspections and surveys of
residential assisted living facilities and issues licenses based on compliance with this chapter of rules, in which
“Residential Assisted Living Facilities Program” and “Licensing Agency” are synonymous.
11. Maladaptive Behavior. Any behavior that interferes with resident care, infringes on any resident’s
rights, or presents a danger to the resident or others. Involuntary muscle movements are not considered maladaptive
behaviors.
12. Medication. Any substance used to treat a disease, condition, or symptom, which may be taken
orally, injected, or used externally, and is available through prescription or over-the-counter.
13. Medication Administration. The process where a prescribed medication is given by a licensed
nurse to a resident through one (1) of several routes.
14. Medication Assistance. The process whereby a non-licensed care provider is delegated tasks by a
licensed nurse, to aid a person who cannot independently self-administer medications. See IDAPA 23.01.01, “Rules
of the Idaho Board of Nursing,” Section 010.
15. Mental Disorders. Health conditions that are characterized by alterations in thinking, mood,
behavior, or some combination thereof, that are all mediated by the brain and associated with distress or impaired
functioning.
16. Mental Illness. Refers collectively to all diagnosable mental disorders.
17. Neglect. Failure to provide food, clothing, shelter, or medical care necessary to sustain the life and
health of a resident.
18. Negotiated Service Agreement. The plan reached by the resident or their representative and the
facility which outlines services to be provided and the obligations of the facility and the resident.
19. Non-Core Issue. Any finding of deficient practice that is not a core issue.
20. Nursing Assessment. Information gathered related to a resident’s health or medical status that has
been reviewed, signed, and dated by a licensed registered nurse, as described in Section 305 of these rules.
012. DEFINITIONS AND ABBREVIATIONS O THROUGH Z.
01. Outside Services. Services provided to a resident by someone that is not a member of facility
personnel.
02. Owner. Any person or entity having legal ownership of the facility as an operating business,
regardless of who owns the real property.
03. Personal Assistance. The provision by the staff of the facility of one (1) or more of the following
services :
a. Assisting the resident with activities of daily living;
b. Arranging for outside services;
c. Being aware of the resident’s general whereabouts; or
d. Monitoring the activities of the resident while on the premises of the facility to ensure the resident’s
health, safety, and well-being.
04. Personnel. Paid individuals assigned the responsibility of providing care, supervision, and services
to the facility and its residents. In this chapter of rules, “personnel” and “staff” are synonymous.
05. Physical Restraint. Any device or physical force that restricts the free movement of, normal
functioning of, or normal access to, a portion or portions of an individual’s body, except for the temporary treatment
of a medical condition, such as the use of a cast for a broken bone.
06. Portable Heating Device. Any device designed to provide heat on a temporary basis that is not
designed as part of a building’s heating system, is not permanently affixed to the building, and, if electrical, is not
hardwired to the building’s electrical service. This does not include the use of therapeutic devices such as heating
pads, heated mattress pads, and electric blankets, which require a physician or authorized provider’s order.
07. PRN. Indicates that a medication or treatment prescribed by a medical professional to an individual
may be given as needed.
08. Pressure Injury. Any lesion caused by unrelieved pressure that results in damage to the underlying
tissue(s).
09. Provisional License. A license which may be issued to a facility not in compliance with the rules
pending the satisfactory correction of all deficiencies.
10. Publicly Funded Program. Any program funded in whole, or in part, by an appropriation of the
U.S. Congress, the Idaho Legislature, or other governmental body.
11. Punishment. The use of an adverse consequence with a resident, the administration of any noxious
or unpleasant stimulus, or deprivation of a resident’s rights or freedom.
12. Relative. A person related by birth, adoption, or marriage.
13. Repeat Deficiency. A deficiency found on a licensure survey, complaint investigation, or follow
up survey that was also found on the previous survey.
14. Reportable Incident. A situation when a facility is required to report information to the
Residential Assisted Living Facilities Program, including:
a. Any resident injury of unknown origin (i.e., an injury, the source of which was not observed by any
person and could not be explained by the resident);
b. Any resident injury of significant or suspicious nature (i.e., an injury that includes severe bruising,
fingerprint bruises, laceration(s) larger than a minor skin tear, sprains, or fractured bones);
c. Resident injury resulting from accidents involving facility-sponsored transportation (i.e., falling
from the facility’s van lift, a wheelchair belt coming loose during transport, or a collision);
d. Resident elopement of any duration;
e. Any injury resulting from a resident-to-resident incident;
f. An incident that results in the resident’s need for assessment or treatment outside of the facility; or
g. An incident that results in the resident’s death.
15. Resident. An adult, other than the owner, administrator, their immediate families, or employees,
who lives in a residential assisted living facility.
16. Residential Assisted Living Facility. A facility or residence, however named, licensed in the state
of Idaho, operated on either a profit or nonprofit basis for the purpose of providing necessary supervision, personal
assistance, meals, and lodging to three (3) or more adults not related to the owner.
17. Room and Board. Lodging, meals, and utilities.
18. Scope. The frequency or extent of the occurrence of a deficiency in a facility.
19. Self-Administration of Medication. The act of a resident taking a single dose of their own
medication from a properly labeled container and placing it internally in, or externally on, their own body as a result
of an order by an authorized provider.
20. Story. A level of rooms in a building.
21. Substantial Compliance. The status of a facility that has no core issue deficiencies.
22. Substantial Evening Meal. An offering of three (3) or more menu items at one time, one (1) of
which is a high-quality protein such as meat, fish, eggs, or cheeses. The meal should represent no less than twenty
percent (20%) of the day’s total nutritional requirements.
23. Supervision. A critical watching and directing activity which provides protection, guidance,
knowledge of the resident’s general whereabouts, and assistance with activities of daily living. The administrator is
responsible for providing appropriate supervision based on each resident’s Negotiated Service Agreement or other
legal requirements.
24. Survey. A review conducted by a surveyor to determine compliance with statutes and rules. There
are two (2) components to a survey: (1) health care and (2) fire, life, and safety.
25. Surveyor. A person authorized by the Department to conduct surveys or complaint investigations
to determine compliance with statutes and rules.
26. Therapeutic Diet. A diet ordered by a physician or authorized provider as part of treatment for a
clinical condition or disease, to eliminate or decrease specific nutrients in the diet (e.g., sodium), to increase specific
nutrients in the diet (e.g., potassium), or to provide food the resident is able to eat (e.g., a mechanically altered diet).
27. Toxic Chemical. A substance that is hazardous to health if inhaled, ingested, or absorbed through
skin.
28. Traumatic Brain Injury (TBI). An acquired injury to the brain caused by an external physical
force, resulting in total or partial functional disability or psychosocial impairment. The term applies to open or
closed-head injuries resulting in impairments in one (1) or more areas.
29. Unlicensed Assistive Personnel (UAP). Staff, with or without formal credentials, employed to
perform nursing care services under the direction and supervision of licensed nurses
30. Variance. Permission by the Department to do something contrary to rule.