- PHYSICAL PLANT STANDARDS: Assisted living facilities must be designed, constructed and maintained in a manner that is safe, clean, and functional for the type of care and treatment to be provided. The physical plant standards for assisted-living facilities, which include support services, care and treatment areas, construction standards, building systems and waivers, are set forth
4-007.01 Support Areas: The assisted-living facility may share the following support service areas among detached structures, care and treatment areas, or with other licensed facilities.
4-007.01A Dietary: If food preparation is provided on site, the assisted-living facility must dedicate space and equipment for the preparation of meals. Food service physical environment and equipment must comply with the Food Code. Locations providing food services for 16 or fewer residents, or used only for training or activity purposes, must comply with the Food Code, except that:
- Instead of a three compartment food preparation and handwashing sink, a two-compartment sink may used for clean-up, dishwashing, and handwashing;
- Instead of a final rinse cycle temperature of not less than 160 degrees Fahrenheit, an automatic dishwasher may have a final rinse cycle temperature not less than 150 degrees Fahrenheit;
- Instead of storage space for food items and cooking and serving utensils no less than six inches above the floor, such space may be no less than four inches above the floor; and
- Service sink and indirect waste plumbing connections are
4-007.01B Laundry: If the assisted-living facility provides laundry services, such service may be provided by contract or on-site by the facility.
4-007.01B1 Contract: If contractual services are used, the facility must provide and utilize areas for soiled linen awaiting pickup and separate areas for storage and distribution of clean linen.
4-007.01B2 On-site: If on-site services are provided, the facility must have areas dedicated to laundry.
4-007.01B2a If personal laundry areas are provided, the areas must be equipped with a washer and dryer for use by residents. In new construction, the facility must provide a conveniently located sink for soaking and hand washing of laundry.
4-007.01B2b When the facility launders items for more than one resident together, the bulk laundry area must be divided into separate soiled (sort and washer areas) and clean (drying, folding and mending areas) rooms. In new construction, the facility must provide a conveniently located sink for soaking and hand washing of laundry and a housekeeping room.
4-007.01C Waste Processing: The assisted-living facility must provide areas to collect, contain, process, and dispose of waste produced within the facility in such a manner as to prevent the attraction of rodents, flies, and all other insects and vermin, and to minimize the transmission of infectious diseases.
4-007.01D Cosmetology and Barber: When provided, cosmetology and barber services must be in conformance with the Nebraska Cosmetology Act, Neb. Rev. Stat. §§ 71-340 to 71-3,238, and the Barber Act, Neb. Rev. Stat. §§ 71-201 to 71- 248.
4-007.01E Pharmaceutical: When provided, pharmacy services must be in conformance with Neb. Rev. Stat. §§ 71-1,142 to 71-1,147.61.
4-007.02 Care and Treatment Areas: The assisted-living facility must not share the following care and treatment areas among detached structures or with other facilities operated by another licensee:
4-007.02A Equipment and Supplies: The facility must have space for equipment and supplies required for the care of residents as specified in the resident service agreements.
4-007.02B Alzheimer’s, Dementia, and Related Disorders: In a facility or a distinct part of a facility that provides services to residents with Alzheimer’s, dementia, and related disorders there must be personalized resident bedrooms, private and group activity areas, separate dining areas, features that support resident orientation to their surroundings, secured storage for equipment and supplies, call and security systems, and an area for medication storage and distribution.
4-007.02C Outpatient Areas: Areas for the care and treatment of residents not residing in the facility must:
- Not interfere with residents living in the facility; and
- Have a toilet room that is easily accessible from all program
4-007.03 Construction Standards: All assisted-living facilities must be designed, constructed, and maintained in a manner that is safe, clean, and functional for the type of care and treatment to be provided. The standards for such facilities are set forth below.
4-007.03A Codes and Guidelines
4-007.03A1 New Construction: New construction must comply with the following codes and guidelines to provide a safe and accessible environment that is conducive to the care and treatment to be provided:
- Building: Building Construction Act, Rev. Stat. §§ 71-6401 to 71-6407;
- Plumbing: Plumbing Ordinance or Code, Rev. Stat. § 18- 1915;
- Electrical: State Electrical Act, Rev. Stat. §§ 81-2101 to 81- 2143;
- Elevators: Nebraska Elevator Code, Rev. Stat. § 48-418.12 and Department of Labor Regulations, 230 NAC 1;
- Boiler: Boiler Inspection Act, Rev. Stat. §§ 48-719 to 48- 743;
- Accessibility: Nebraska Accessibility Requirements, State Fire Marshal Regulations, 156 NAC 1 to 12; and
- Energy: Nebraska Energy Code, Rev. Stat. §§ 81-1608 to 81-1626, for construction initiated on or after July 1, 2005.
4-007.03A2 All Facilities: All facilities must comply with the following applicable codes and standards to provide a safe environment.
- Fire Codes: Nebraska State Fire Code Regulations State Fire Marshal, 153 NAC 1; and
- Food Code: Rev. Stat. § 81-2,244.01, as published by the Nebraska Department of Agriculture, except for compliance and enforcement provisions.
4-007.03A3 Existing and New Facilities: Existing and new facilities must comply with the physical plant standards contained in 175 NAC 4-007. The facility must maintain all building materials and structural components so that total loads imposed do not stress materials and components more than one and one-half times the working stresses allowed in the building code for new buildings of similar structure, purpose or location.
4-007.03B Conflicts in Standards: In situations where the referenced codes and guidelines conflict with these regulations, the adopted rules and regulations of the Department and the Nebraska State Fire Marshal will prevail.
4-007.03C Interpretations: Floor area means dimension, sizes, and quantities; noted herein must be determined by rounding fractions to the nearest whole number.
4-007.03D Floor Area: Floor area means space with ceilings at least seven feet in height and does not include areas such as enclosed storage, toilets and bathing rooms, corridors and halls. The space beyond the first two feet of vestibules and alcoves less than five feet in width must not be included in the required floor area. In rooms with sloped ceilings, at least half of the ceiling must be at least seven feet in height with areas less than five feet in height, not included in the required floor area.
4-007.03E Dining Areas: Dining areas for residents must have an outside wall with windows for natural light and ventilation.
4-007.03E1 Dining areas must be furnished with tables and chairs that accommodate or conform to resident’s needs.
4-007.03E2 Dining areas must have a floor area of 15 square feet per resident in existing facilities and 20 square feet per resident in new construction.
4-007.03E3 Dining areas must allow for group dining at the same time in either separate dining areas or a single dining area, or dining in two shifts, or dining during open dining hours.
4-007.03E4 Dining areas must not be used for sleeping, offices or corridors.
4-007.03F Activity Areas: An assisted-living facility must have space for resident socialization and leisure time activities.
4-007.03F1 Activity areas must have furnishings to accommodate group and individual activities.
4-007.03F2 Activity areas must not be used for sleeping, offices, or as a corridor.
4-007.03G Bathing Rooms: An assisted-living facility must provide a bathing room consisting of a tub and/or shower adjacent to each bedroom or provide a central bathing room. Tubs and showers regardless of location must be equipped with hand grips or other assistive devices as needed or desired by the bathing resident.
4-007.03G1 In new construction where a central bathing room is provided, the room must open off the corridor and contain a toilet and sink or have an adjoining toilet room. A bathing room must not directly open into a dining/kitchen area.
4-007.03G2 Bathing Fixtures: The facility must have the following minimum number of bathing fixtures:
- One fixture per 16 licensed beds in existing facilities; and
- One fixture per eight licensed beds in new facilities and new construction.
4-007.03H Toilet Rooms: The assisted-living facility must provide toilet rooms with handwashing sinks for resident use.
4-007.03H1 Facilities must have a toilet and sink adjoining each bedroom or shared toilet rooms may be provided as follows:
- One toilet fixture per six licensed beds in existing facilities;
- One toilet fixture per four licensed beds in new facilities; and
- One toilet room adjoining each resident’s bedroom in new construction.
4-007.03I Resident Bedrooms: The assisted-living facility must provide resident bedrooms which allow for sleeping, afford privacy, provide access to furniture and belongings, and accommodate the care and treatment provided to the resident.
4-007.03I1 Resident Bedrooms:
- Must not be located in any garage, storage area, shed or similar detached buildings;
- Must be a single room located within an apartment, dwelling, or dormitory-like structure;
- Must not be accessed through a bathroom, food preparation area, laundry or another bedroom;
- Must be located on an outside wall with an operable window and a minimum size of six square feet per resident. Such window must be provided an unobstructed view of at least ten feet;
- Must contain at least 45 cubic feet of enclosed storage volume per resident in dressers, closet, or wardrobes; and
- Which contain multiple beds must allow for an accessible arrangement of furniture, which provides a minimum of 3 feet between
4-007.03I2 Existing or New Facility: Resident bedrooms in existing and new facilities must have at least the following floor areas:
- Floor areas for single resident rooms must be 80 square feet;
- Floor areas for multiple bed resident rooms must be 60 square feet per occupant with a maximum of four beds; or
- Floor area for apartments or dwellings must have 120 square feet for one resident plus 100 square feet for each additional
4-007.03I3 New Construction: Resident bedrooms in new construction must have at least the following floor areas:
- Floor areas for single resident rooms must be 100 square feet;
- Floor areas for multiple bed resident rooms must be 80 square feet per bed with a maximum of 2 beds; or
- Floor area for apartments or dwellings must have 150 square feet for one resident plus 110 square feet for each additional resident.
4-007.03J Examination Rooms: If provided, each examination room must have a minimum floor area of 80 square feet and a minimum of 3 feet clear dimension around 3 sides of the examination table or chair. A handwashing sink equipped with towel and soap dispenser must be in the room.
4-007.03K Areas Used by All Residents: Existing licensed facilities, new facilities and new construction must comply with the following:
- The facility corridors and doors must be wide enough to allow passage and be equipped as needed by the residents with safety and assistive devices to minimize resident injury;
- All stairways and ramps must have handrails;
- Doors to resident rooms must provide privacy yet not create seclusion or prohibit staff access for routine or emergency care;
- The facility must provide space for administrative offices, and storage space for such things as records, supplies and equipment; and
- The facility must provide an outdoor area for resident usage. It must be equipped and situated to allow for resident
4-007.04 Building Systems: Assisted-living facilities must have building systems that are designed, installed and operated in such a manner as to provide for the safety, comfort, and well being of the resident.
4-007.04A Water and Sewer Systems: The assisted-living facility must have and maintain an accessible, adequate, safe and potable supply of water. Where an authorized public water supply of satisfactory quantity, quality, and pressure is available, the facility must be connected to it and its supply used exclusively.
4-007.04A1 The collection, treatment, storage, and distribution potable water system of a facility that regularly services 25 or more individuals must be constructed, maintained, and operated in accordance with all provisions of the Nebraska Safe Drinking Water Act and Title 179 Regulations Governing Public Water Systems.
4-007.04A2 The collection, treatment, storage and distribution potable water system of a facility that serves less than 25 individuals on a regular basis must be maintained and operated as if it were a public water system in accordance with the Regulations Governing Public Water Systems, 179 NAC 2-002, 3 and 4. The facilities must report to the Department the result of all tests that indicate the water is in violation of the standards set out in 179 NAC 2-002 or 3. The facilities must construct all water wells in accordance with 178 NAC 12, Water Well Construction, Pump Installation, and Water Well Decommissioning Standards.
4-007.04A3 The water distribution system must be protected with anti-siphon devices, and air-gaps to prevent potable water system and equipment contamination.
4-007.04A4 The facility must maintain a sanitary and functioning sewage system.
4-007.04B Hot Water System: The hot water system must have the capacity to provide continuous hot water temperatures as required by these regulations.
4-007.04C Heating and Cooling Systems: The assisted-living facility must provide a heating and air conditioning system for the comfort of the resident and capable of producing temperatures in resident care and treatment areas as follows:
4-007.04C1 In existing and new facilities the systems must be capable of producing a temperature of at least 70 degrees Fahrenheit during heating conditions and a temperature that does not exceed 85 degrees Fahrenheit during cooling conditions.
4-007.04C2 In new construction the systems must be capable of producing a temperature of at least 75 degrees Fahrenheit during heating conditions and a temperature that does not exceed 80 degrees Fahrenheit during cooling conditions.
4-007.04C3 In new construction the central air distribution and return systems must be equipped with filters.
4-007.04C4 Airflow must move from clean to soiled locations. In new construction, air movement must be designed to reduce the potential of contamination of clean areas.
4-007.04D Ventilation System: All assisted-living facilities must provide exhaust and clean air to prevent the concentrations of contaminants which impair health or cause discomfort to residents and employees.
4-007.04D1 Existing facilities must have adequate ventilation.
4-007.04D2 New construction and new facilities must provide mechanical exhaust ventilation for windowless toilets, baths, laundry rooms, housekeeping rooms, kitchens, and similar rooms at five air changes per hour.
4-007.04E Electrical System: The assisted-living facility must have an electrical system that has sufficient capacity to maintain the care and treatment services that are provided and that properly grounds care and treatment areas.
4-007.04E1 New construction and new facilities must have ground fault circuit interrupters protected outlets in wet areas and within 6 feet of sinks.
4-007.04E2 All facilities must provide minimum illumination levels as follows:
- General purpose areas 5 foot candles;
- General corridors and resident living areas 10 foot candles;
- Personal care and dining areas 20 foot candles;
- Reading and activity areas 30 foot candles;
- Food preparation areas 40 foot candles;
- Hazardous work surfaces 50 foot candles;
- Examination task lighting 100 foot candles; and
- Reduced night lighting in corridors, resident toilet and bathing rooms.
Light levels are measured at 30 inches above the floor in multiple areas in the room being evaluated and the readings are averaged.
4-007.04F Call Systems: Call system(s) must be operable from resident rooms, care and treatment locations, and all toilet and bathing areas used by residents. The system must transmit a receivable (visual, audible, tactile, or other) signal to on-duty staff which readily notifies and directs the staff to the location where the call was activated.
4-007.04F1 New facilities and new construction with a capacity of more than 16 residents must be equipped with a call system or other call devices which may be worn.
4-007.04F2 Wireless call systems must have dedicated devices in all resident occupied central toilet and bathing locations to promptly summon staff to the location where the call was activated.
4-007.04F3 Existing facilities without a call system are not required to provide a call system.
4-007.05 Waivers: The Department may waive any provision of 175 NAC 4 relating to construction or physical plant requirements of an assisted-living facility upon proof by the licensee satisfactory to the Department (1) that the waiver would not unduly jeopardize the health, safety, or welfare of the persons residing in the facility, (2) that the provision would create an unreasonable hardship for the facility, and (3) that the waiver would not cause the State of Nebraska to fail to comply with any applicable requirements of Medicare or Medicaid so as to make the state ineligible for the receipt of all funds to which it might otherwise be entitled.
4-007.05A Unreasonable Hardship: In evaluating the issue of unreasonable hardship, the Department will consider the following:
The estimated cost of the modification or installation;
- The extent and duration of the disruption of the normal use of areas used by persons residing in the assisted-living facility resulting from construction work;
- The estimated period over which the cost would be recovered through reduced insurance premiums and increase reimbursement related to costs;
- The availability of financing; and
- The remaining useful life of the
4-007.05B Waiver Terms and Conditions: Any waiver may be granted under the terms and conditions and for such period of time as are applicable and appropriate to the waiver. Terms and conditions and period of waiver include but are not limited to:
- Waivers that are granted to meet the special needs of a resident remain in effect as long as required by the resident;
- Waivers may be granted for a period of time that ends at the time the conditions of approval no longer exist;
- Waivers may be granted to permit an assisted-living facility time to come into compliance with the physical plan standards for a period of one year. Upon submission of proof of ongoing progress, the waiver may be continued for an additional year; and
- An applicant or licensee must submit a request for waiver of any construction or physical plant requirements set forth in 175 NAC 4. An applicant for a waiver may construct a request for waiver form or obtain a form from the Department.
4-007.05C Denial of Waiver: If the Department denies an assisted-living facility’s request for waiver, the facility may request an administrative hearing as provided in the Administrative Procedure Act (APA) and the Department’s rules and regulations adopted and promulgated under the APA.