Assisted Living Facility (ALF) Core Services

(a) The assisted living facility core services include the following:
(i) Meals, housekeeping, personal and other laundry services;
(A) Provision of mechanically altered diets and dietary supplements, if required.
(ii) A safe and clean environment;
(iii) Assistance with local transportation;
(iv) Assistance with obtaining medical, dental, and optometric care, in addition to social services;
(v) Assistance in adjusting to group living activities;
(vi) Maintenance of a personal fund account, if requested by the resident or
resident’s responsible party, showing any and all deposits, withdrawals, and transactions of the
(vii) Provision of appropriate recreational activities in/out of the assisted living facility;
(viii) Care of individuals who require any or all of the following services:
(A) Partial assistance with personal care; e.g. bathing, shampoos;
(B) Limited assistance with dressing;
(C) Minor non-sterile dressing changes;
(D) Stage I skin care – skin integrity intact;
(E) Infrequent assistance with mobility. The resident may use an
assistive device; e.g., wheel chair, walker, cane;
(F) Cuing guidance with ADLs for the visually impaired resident, or
the intermittently confused and/or agitated resident requiring occasional reminders to time, place and person;
(G) Care of the resident who can independently manage his own
catheter or ostomy, e.g, resident who can change his own catheter bags, able to clean and care for his ostomy;
(H) Care of the resident incontinent of bowel or bladder if the
condition can be managed independently;
(ix) Assessments completed by a Registered Nurse;
(A) Registered Nurse medication review every two (2) months or
sixty-two (62) days or whenever new medication is prescribed or the resident’s medication is changed;
(x) Twenty-four (24) hour monitoring of each resident.

(b) Resident Assessment and Services.
The staff/contract Registered Nurse (RN) shall conduct initial and, at a minimum
annually, an accurate, standardized, reproducible assessment of each resident’s functional
capacity, physical assessment and medication review.

(i) The completion of the ALF 102.
(A) The current version of the ALF 102 is the designated screening
tool. The form may be updated and /or revised periodically by the Program Division. Providers
will be notified of changes in the form. The following guidelines apply to the ALF 102:
(I) The ALF 102 is only valid if completed within forty-five
(45) days prior to admission and there is no change in the resident’s condition.
(II) The ALF 102 must be completed and signed by an RN.
(III) The ALF 102 may be completed telephonically; however, it
must be verified in person by an RN.
(IV) A new ALF 102 shall be completed at least annually, and
when there is a change in the resident’s condition.
(ii) Admission orders. A resident shall be admitted only if accompanied by a
history and physical completed by a physician or physician extender within ninety (90) days
prior to admission. The facility shall confirm the resident’s medication regimen and special treatment orders at the time of admission.
(A) Admission orders shall include an order for TB screening,
influenza and pneumococcal immunization status and orders for immunization if required, unless
contraindicated. The facility must develop and implement policies and procedures to ensure the following:
(I) Residents, or their legal representative are educated
regarding the risks and benefits of these immunizations.
(II) The immunizations are offered unless medically
contraindicated or the resident is currently immunized.
(III) If the resident is not vaccinated, the medical record must
reflect the reason, such as medical contraindication or refusal.
(iii) The Registered Nurse shall make an initial assessment of the resident’s
needs, which describes the resident’s capability to perform ADLs and notes all significant
impairments in functional capability.
(A) Initial assessment. A current assessment shall be maintained in
each resident’s file.
(B) The assessment shall include at least the following information:
(I) Medically defined conditions and prior medical history;
(II) Physical status;
(III) Sensory and physical impairments;
(IV) Nutritional status and requirements;
(V) Special treatments and/or procedures;
(VI) Mental and psychosocial status;
(VII) Discharge potential;
(VIII) Dental condition;
(IX) Activities potential;
(X) Rehabilitation potential; and
(XI) Medication regimen.
(1.) Documentation of resident’s ability to self-medicate.
(iv) Frequency of assessment. An assessment must be conducted:
(A) No earlier than one (1) week prior to admission;
(B) Immediately upon any significant change in the resident’s mental
or physical condition; or
(C) No less than once every twelve (12) months.
(v) Use of the assessment.
(A) The results of the assessment are used to develop, review, and
revise the resident’s individualized assistance plan.
(vi) Resident assistance plan.
(A) An RN shall develop an assistance plan for each resident.
(B) Each facility shall construct its own forms for such plans, which at
a minimum shall contain documentation of the following:
(I) Who will provide the care/services;
(II) What care/services will be provided;
(III) When will care/services be provided;
(IV) How the care/services will be provided;
(V) The expected outcome;
(VI) Resident participation in development of the assistance
plan to the extent of his ability to do so. A relative or other interested party may also participate; and
(VII) Dated signature of the RN, the facility manager, and the resident or the resident’s responsible party.
(vii) The assistance plan shall be reviewed and updated by the RN at least
annually or when a significant change occurs, with input from direct care-givers, the resident,
and others as designated by the resident.
(viii) The RN shall periodically evaluate results of the plan. The plan shall reflect
assessed needs and resident decisions (including resident’s level of involvement); support
principles of dignity, privacy, choice, individuality, independence, and home-like environment;
and shall include significant others who may participate in the delivery of services.