Assisted Living Services Agencies

Type of Staff. Agencies must employ a supervisor who is a RN and who is
responsible for: (1) coordinating and managing all nursing and assisted living aide
services provided to residents by direct service staff; and (2) communicating with the
service coordinator. Direct care staff are either certified nurse aides or home health
aides who assist with ADLs, self-administration of medications, and routine household
tasks. A licensed nurse, in addition to the supervisor, is required to perform nursing
services and quarterly assessments, as well as coordination, training, and supervision
of aides.

Managed residential communities must have a service coordinator who assists
residents and acts as a liaison with the assisted living services agency. Service
coordinators must: (1) ensure that all core services are provided to or are made
available to residents and assist residents to make arrangements to meet their personal
needs; (2) establish collaborative relations with provider agencies, support services, and
community resources; (3) establish a resident council; and (4) coordinate a resident
information system. In an assisted living services agency serving no more than 30
residents, one individual may serve as both the supervisor of assisted living services
and the service coordinator if the services agency and the managed RCH are owned by
the same company.

Staff Ratios. No minimum ratios. A supervisor must be available 20 hours a
week for every ten or fewer licensed nurses or assisted living aides and a full-time
supervisor must be available for every 20 licensed nurses or aides. A sufficient number
of aides must be available to meet residents’ needs. Twenty-four hour awake staff are
not required since needs vary among residents, but 24-hour staffing could be required if
indicated by residents’ service plans. An RN must be available on call 24 hours a day.
Residential Care Homes

Type of Staff. The licensee is responsible for daily operations. Certified
unlicensed staff are those who have completed Department-approved training to assist
with medication services. Program staff are employees who assist with personal care

Staff Ratios. At least one program staff person must be on-duty at all times for
every 25 residents. Facilities that provide medication administration must have at least
one certified unlicensed staff person on duty at all times.

Training Requirements

Assisted Living Services Agencies. All staff must complete a 10-hour
orientation program that includes the assisted living philosophy; facility policies and
procedures; and applicable regulations. Aides must pass a competency exam. Each
aide must have at least 6 hours of annual in-service continuing education on service
procedures and techniques for the population being served.

Residential Care Homes. New staff must receive an orientation that includes
information about safety and emergency procedures for staff and residents, facility
policies and procedures, and residents’ rights. The amount of required continuing
education is calculated based on a percentage of total annual hours worked (to a
maximum of 12 hours) per year. Continuing education topics include residents’ rights;
behavioral management; personal care; nutrition and food safety; and general health
and safety.

Provisions for Apartments and Private Units
Managed residential communities must provide private units that include a full
bathroom and access to facilities and equipment for the preparation and storage of
food. Units must be single-occupancy; sharing a unit is permitted upon the request and
mutual consent of residents.

Residential Care Homes. Apartment-style units are not required. Residents’
rooms may be single-occupancy or double-occupancy. Bathrooms must have one
separate shower or bathtub for every eight residents. One toilet may serve two resident
rooms, but no more than four residents.

Provisions for Serving Persons with Dementia

Dementia Care Staff. Staffing requirements are based on the licensure category
of the facility or program.
Dementia Staff Training. All licensed and registered direct care staff in
Alzheimer’s SCUs or programs must receive training annually that includes, but is not
limited to: (1) at least 8 hours of dementia-specific training completed within 6 months of
hire, and at least 8 hours of training annually; and (2) at least 2 hours annual training in
pain recognition and administration of pain management techniques. At least 1 hour of
training must be provided to all non-direct care staff within 6 months of hire.

Dementia Facility Requirements. No provisions identified.

Background Checks
No provisions identified for either licensure category.

Inspection and Monitoring
Assisted living services agencies are inspected every 2 years.
Residential care homes are inspected by the Department of Public Health. No
additional provisions identified.

Public Financing
The state pays for assisted living services and RCH services through several
Medicaid 1915(c) waiver programs and through the non-Medicaid state-funded
Connecticut Home Care Program for Elders.

The Department of Social Services provides an optional state supplement (OSS)
to help cover the room and board costs for eligible RCH residents. Only licensed
facilities can receive payment through the state supplement program, therefore
residents of managed residential communities who receive assisted living services are
not eligible.
The OSS amount is calculated individually, based on the per diem rate of the
licensed facility and the difference between the resident’s income and the Supplemental
Security Income federal benefit–$733 in 2015–less a personal needs allowance of
$29.95, which is retained by the resident.
There are no rules prohibiting a family member from supplementing or assisting a
resident with paying for their room and board at a facility.