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Comment on Assisted Living Applicants in Your Community

Licensure Requirement Goes Into Effect. On June 3, 2005, the NY Department of Health (DOH) sent letters and applications for licensure to all known interested parties. The letter (click here) clearly explains the law and the requirements for licensure. All presently licensed adult homes and enriched housing who want to become assisted living residences (ALR) enhanced assisted living residences (EALR) or special needs assisted living residences (SNALR) must have already submitted the application to comply with the law. Any unlicensed residence which operates, provides, conducts or offers assisted living or advertises itself as assisted living (or by a similar term) must be licensed as an adult home or enriched housing first. Thus, these residences must not only apply for assisted living licensure but must also apply for adult home/enriched housing licensure. The Department has the ability to impose a fine of $1000 per day for the operation of an adult home without an operating certificate.  In addition, operating an adult home without approval from the Department is a Class A misdemeanor. DOH has posted information on requirements for all assisted living residences in New York. Click here for more information.

State Task Force. The assisted living law mandated the establishment of a task force to advise the Department of Health on updating and revising the requirements and regulations applicable to adult care facilities and assisted living residences to better promote resident choice, autonomy and independence. The Task Force was charged to make recommendations (a) minimizing duplicative or unnecessary regulatory oversight; (b) ensuring that the indigent have adequate acceess to, and that there are a sufficient number of enhanced assisted living residences; (c) develping affordable assisted living; (d) promoting resident choice and independence; (e) the evaluation tool; and, (f) specific standards. To date, the Task Force has accomplished (e) and (f) and is focusing on the other tasks. The Task Force, has ten members.  They include six providers (three of whom are members of the Empire State Association of Adult Homes and Assisted Living Facilities and one who is the head of the Association), two representatives of the Alzheimer’s community, one representative from AARP and Cynthia Rudder, former ED of LTCCC. DOH has posted information on its Website describing requirements for the new levels of assisted living: basic assisted living, enhanced assisted living (for those individuals who want to “age-in”) and special needs assisted living (e.g., Alzheimer’s).  See, click on Long Term Care, then Assisted Living and you will find information on admission and discharge, staffing, resident rights and admission agreements.

LTCCC's Assisted Living Committee. LTCCC’s committee on assisted living has been discussing these issues in detail with Cynthia Rudder. The subcommittee will work with Cynthia to make sure that the rights of consumers are protected. Any LTCCC member wanting to join this committee that will be working on these issues over the next few months should contact Richard Mollot. Cynthia, after she met with LTCCC’s assisted living committee, made many suggestions to the Task Force, DOH and the State Office on Aging (SOFA). See below.

Screening and Assessment. It is vital that (1) the screens and assessments place individuals appropriately; (2) assessments are consistent; and (3) consumers do not have to be rescreened or reassessed for admittance if they choose another residence. Given the other major developments affecting long term care delivery, particularly the state's development of a single point of entry for long term care (POE) and the U.S. Supreme Court's Olmstead decision (holding that individuals must be cared for in the least restricitive environment possible), these issues will become even more important in the future. Screening and assessment for assisted living must be coordinated with any POE implemented by the state so that consumers are not unduly burdened. Thus, the screen should be separated (to determine eligibility) from the assessment for development of a service plan and be conducted by an independent clinician. In addition, the screen and assessment for enhanced residents must be conducted by a registered nurse. Forms for screening and assessment should be uniform to facilitate oversight. [See our page on POE and access to long term care for more information on those issues.]

Other Recommendations from LTCCC. LTCCC’s assisted living committee has raised other issues as well. Even though the law did not mandate it, there must be a minimum number of slots mandated for enhanced assisted living certification.Enhanced certification will permit residents of assisted living to “age-in-place.”  If the number of slots is very limited, residents who think they will be able to remain if they grow more frail may find that they have to leave because their community has used up all of its slots. In addition, if an assisted living resident needs enhanced care and the residence has a certificate to provide such care, the resident must be permitted to remain in his or her room when receiving the enhanced care. An individual should not be compelled to move to another unit to receive additional help or care.  To force someone to move in order to get the care they need goes against the fundamental principles of assisted living.  Staffing, training, and disclosure requirements must be made stronger:


  • There must be some additional minimum staffing requirement to that required for basic assisted living (ALR) for enhanced assisted living (EALR) and special needs assisted living (SNAL). It is not enough to permit operators to decide for themselves when staffing meets the needs of their residents, especially those requiring additional care.
  • There must be an RN on-site for at least one shift a day with LPNs for the other two shifts in EALR. Residents of EALRs are more medically fragile than the general population of assisted living and need ongoing monitoring and assessment by RNs on-site who know them. 
  • There must be a full-time staff member supervising in EALR and/or SNAL – separate from administrator for ALR.  
  • There must be more than one full time case manager required for residences with more than 45 residents.


  • There must be more specific training requirements for EALR and SNAL.
  • Direct care supervisors must be higher level than aides with minimal hours of training – LPNs or perhaps CNAs with 100 hours of training.
  • Qualifications for all levels of staff in SNALs must require experience with the special needs of their residents.
  • Administrators should be licensed and have to take a test, similar to the requirement for nursing home administrators.

Admission Agreement – Disclosures

  • There must be a requirement that the number of enhanced or special needs residents that can be cared for by the residence will be given to all consumers and prospective residents. 
  • The facility must disclose the details of any guiding belief or value to which it subscribes that would have the effect of restricting a resident in their choice of personal belief, actions, communications, relationships or self-expression.

The Department of Health has adopted the final regulations. Many of the suggestions from LTCCC were adopted.

If you want to make sure these protections are enforced, join LTCCC and its committee and send emails, letters or faxes to DOH. See our Citizen Action Center for the latest actions you can take to make your voice heard in support of consumers.

LTCCC has also conducted research in this area. With a grant from the Fan Fox and Leslie R. Samuels Foundation, LTCCC published an in-depth study of assisted living in New York State. In addition to explaining the different licensed and unlicensed models in New York State, the study makes suggestions for financing of assisted living, gives ideas for providers and consumers about issues related to resident choice and decision-making and makes the case for assisted living regulation.


Last Updated: March 31, 2008