Significant new regulations for assisted living that just began rolling out this summer have created significant challenges for providers in Kentucky, but the end result will be more options for residents and the ability for them to age in place, according to senior living experts.
In 2022, Senate Bill 11 was adopted to “modernize and strengthen oversight and care” of assisted living residents by transitioning services from a certification model to a licensure model. At the time, senior living advocates called the effort “long overdue” and said it placed Kentucky on par with most other states, moving assisted living from a social model to a basic healthcare model.
Under the law, personal care — the basic health services model — merged with assisted living’s social model — which prohibited the provision of health services — under one broad assisted living community licensure category. Apartment-style personal care homes that meet assisted living building standards are being relicensed as assisted living communities.
Seventy-nine personal care homes have converted to assisted living licensure so far, according to a spokeswoman for the Kentucky Center for Assisted Living.
“This transition gives the opportunity for the use of certified medication aides within certain levels of assisted living, helping address certified workforce challenges,” the KCAL spokeswoman told McKnight’s Senior Living, adding that the association has collaborated closely with the regulatory agency to ensure that all communities are meeting the new regulations.
Now there are three levels of assisted living licensure:
- Assisted Living Communities (ALC), a social model that excludes basic health and health-related services. Such communities cannot arrange on-site providers for medical services, although residents may arrange for those services for themselves.
- Assisted Living Communities-Basic Health (ALC-BC), which provide basic health services, including licensed nurses and certified medication aids for medication management and administration. Such communities also provide and coordinate care services.
- Assisted Living Communities-Dementia Care (ALC-DC) provide care in a secured dementia care unit, along with all of the services provided under the ALC-BC license.
Under the licensure categories, care will adjust to a resident’s needs rather than being defined by location. Providers can choose how much care to offer within the broader definition of assisted living, and staffing requirements are based on the care level provided.
For assisted living communities with memory care, additional staff training is required to align with recommendations of the General Assembly’s Alzheimer’s and Dementia Workforce Assessment Task Force. The language in the Kentucky bill was strongly influenced by the Minnesota assisted living statute, which was recommended as a model by the Alzheimer’s Association.
The regulation change created a new class of technical support worker that required the Kentucky Board of Nursing to react quickly and set up certified medication aide training programs to develop a supply of workers, according to LeadingAge Kentucky Executive Director Tim Veno.
“There were a lot of changes around medication management and medication storage that even exceeded what the personal care home requirements had previously,” Veno said.
Another significant change was moving the authority for assisted living inspections from the state Department of Aging and Independent Living to the Office of Inspector General within the state Cabinet for Health and Family Services, which required staff transitions, onboarding, applications for licensure and inspections.
Those inspections have just begun, and Veno said he’s waiting to see how those initial surveys go to best support LeadingAge Kentucky members. The reason for the licensure change, he added, was to improve resident care and services, and the industry is taking a wait-and-see stance on the inspection process and any changes providers might recommend to improve the process.
“These regulations are very complex. We hope as the OIG embraces this program, they give further guidance on confusing technical issues with the regulations,” Veno said, adding that the industry had input into those regulations. “We have a lot of anticipation that this will give residents more options, and it will allow many to remain in their assisted living and receive the services necessary without having to relocate to skilled nursing.”
