State-by-State Regulations Define Licensure
Assisted living facilities are not considered medical facilities in the same way as nursing homes and are therefore not regulated at a federal level. This means that each state is responsible for establishing its own licensing requirements and terminology for senior care services. As a result, the concept of “levels of licensure” is defined differently depending on where the facility is located. For example, some states may use a simple two-tiered system, while others have more specialized licenses for specific care needs, such as memory care or residents requiring limited nursing services.
The Common Type A vs. Type B Model
In several states, such as Texas, assisted living facilities are categorized under a Type A and Type B licensing model. This distinction primarily relates to the residents' mobility and their ability to evacuate independently in an emergency.
Type A Assisted Living License
Facilities with a Type A license are for residents who are considered relatively independent. Key characteristics include:
- Mobility: Residents must be ambulatory, meaning they can move around independently, with or without an assistive device like a walker or wheelchair.
- Emergency Response: Residents must be capable of understanding and following instructions to evacuate in an emergency without direct, continuous staff assistance.
- Overnight Care: These residents do not require supportive care or assistance during overnight hours.
Type B Assisted Living License
Conversely, a Type B license permits facilities to provide care for residents with greater needs. This often includes individuals who may not be fully ambulatory. Features of Type B care include:
- Increased Assistance: Residents may need hands-on assistance with mobility, transferring (e.g., getting in and out of bed), using the restroom, and navigating the community.
- Emergency Evacuation: Staff assistance is required to evacuate Type B residents during an emergency due to their limited mobility or cognitive impairments.
- Overnight Care: These residents may need supportive care or assistance during overnight hours.
- Memory Care: Facilities with a Type B license can often provide specialized memory care for residents with dementia or cognitive decline.
Other Models of Licensure Across States
Beyond the Type A/Type B structure, many states employ their own systems for defining care levels through different licenses or certification types. These variations highlight the importance of local research.
- Virginia's Two Levels: In Virginia, the Department of Social Services licenses two primary levels: “Residential Living Care” (minimal assistance) and “Assisted Living Care” (at least moderate assistance).
- Florida's Specialty Licenses: Florida has a basic “Standard” license, but facilities can obtain additional specialty licenses for Limited Nursing Services (LNS) or Extended Congregate Care (ECC), which allow for a broader range of medical services.
- Maryland's Multi-Tiered System: Maryland uses a multi-level system, defining assisted living facilities by the level of care they provide: Level one (low care), Level two (moderate care), and Level three (high care).
How Care Levels are Assessed
To determine the appropriate licensure for a resident, facilities conduct assessments to evaluate their needs, focusing on Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). This formal evaluation process is typically overseen by a healthcare professional and is performed upon admission, as well as on an ongoing basis or after any significant change in a resident's health.
Type A vs. Type B Licensure Comparison
| Feature | Type A Assisted Living | Type B Assisted Living |
|---|---|---|
| Resident Mobility | Ambulatory; independent movement with or without assistive devices. | May require hands-on assistance with mobility and transfers. |
| Emergency Evacuation | Able to evacuate independently and follow instructions. | Requires staff assistance for safe evacuation. |
| Overnight Needs | Does not require supportive care during overnight hours. | May require assistance during overnight hours. |
| Level of Care | Generally lower, with reminders and minimal supervision for ADLs. | Higher level of care, including hands-on help with multiple ADLs. |
| Cognitive Status | Residents are typically aware and can follow directions. | May include residents with cognitive decline or dementia. |
Factors Determining a Resident's Level of Care
Several factors contribute to determining a resident's appropriate level of care and, consequently, the type of license a facility must have to accommodate them. These include:
- Physical Impairments: The extent to which physical conditions impact mobility, transfers, and daily activities.
- Cognitive Function: The presence of cognitive decline, dementia, or memory loss that may affect safety, decision-making, and the ability to follow directions.
- Activities of Daily Living (ADLs): The amount of assistance needed for tasks like bathing, dressing, eating, and toileting.
- Medical Needs: Requirements for medication management, skilled nursing services (where permitted), or other medical coordination.
- Behavioral Needs: The presence of any behavioral challenges that require specialized staff training and management.
Conclusion: The Importance of Local Regulations
Because assisted living is regulated at the state level, the question of what are the two levels of assisted living licensure has no single, national answer. For families and individuals seeking assisted living, it is crucial to research the specific regulations in their state of interest. Consulting with a senior care advisor or the local state's department of aging can provide the most accurate information. Choosing a facility with the appropriate license ensures that a resident receives the right level of support, promoting their health, safety, and independence.
For more detailed information on regulations across various states, the U.S. Department of Health and Human Services provides a state-by-state compendium on residential care and assisted living(https://aspe.hhs.gov/sites/default/files/private/pdf/110591/15alcom-PA.pdf).
