Is Your Retirement Community Licensed?

Summary of senior homesWhether you are considering joining a retirement community yourself or looking for an assisted living facility for a loved one, it can be confusing to navigate the numerous housing and care options available for seniors. What causes this confusion is that there is no national standard as to what communities are called or how they are licensed. Even the term long-term care can be confusing. Long-term care could mean assisted living and nursing homes in one state while another state considers long-term care only applicable to nursing homes.

Here’s a helpful breakdown of the senior living terms that you will come across while searching for retirement or healthcare options and an overview of how these communities are licensed.

Retirement Communities

What is a retirement community?

A retirement community is a self-contained community that offers housing, services and amenities to its residents who are typically 55 years or older. Housing options include apartment-style living or free-standing cottages which may be rented or owned. Services that may be provided include meal service, housekeeping, maintenance or transportation. An entrance fee may be required to join the community.

How are retirement communities licensed?

If a retirement community advertises as “independent living,” this means that the community caters solely to seniors who are free from physical and mental impairments. These communities are not required to be licensed by the state because health care services, such as assistance with activities of daily living or skilled nursing, are not being offered.

When a community advertises itself as offering independent living and assisted living, this means the community likely has separate housing and care options for seniors requiring assisted living and, depending upon how the care is provided, will determine whether the community is licensed and subject to state inspection.
If assistance with activities of daily living is provided by retirement community staff, the community is licensed and subject to state inspection. However, if assistance is being provided by third-party caregivers, the community may not be required to hold a license.

If a retirement community does offer assisted living, how do I obtain the inspection records?

See our section on how to obtain inspection records.

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Continuing Care Communities

What is a continuing care community?

The past decade has seen a new type of retirement community—continuing care retirement communities (CCRCs). These communities are similar to the traditional retirement communities in that they offer housing, services and amenities to residents 55 years or older. The notable difference is that CCRCs are designed to provide healthcare services so residents may age in place; they will likely have an on-site nursing center or Alzheimer’s care unit.

How are continuing care communities licensed?

Depending upon the state, these continuing care communities may be licensed, as is the case for California, or just the assisted living and nursing center portion is licensed if the care is not provided by third-party caregivers.

If a continuing care community does offer assisted living, how do I obtain the inspection records?

See our section on how to obtain inspection records.

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Assisted Living Facility

What is an assisted living facility?

If a community advertises itself as solely assisted living, this means that the community caters exclusively to seniors who require assistance with activities of daily living, such as dressing, bathing or grooming. The services and amenities offered at these communities are designed to enhance the independence of their residents. Housing options are typically apartment-style living and services include dining, housekeeping, maintenance, transportation and scheduled activities.

How are assisted living facilities licensed?

Unless assisted living services are provided by third-party caregivers from an outside company (which may be licensed under a different government agency), assisted living facilities are required to be licensed by the state and subject to inspection. There is no standard as to how assisted living facilities are licensed across states. The District of Columbia only has one designation for assisted living facilities—Assisted Living Residence (ALR)—while Maryland recognizes three types of assisted living—Assisted Living Program-Low, Moderate, or High.

If a state has multiple assisted living licensing types, licenses are often tied to the type and number of residents the community is allowed to care for. SeniorHomes.com classifies any retirement community that provides assisted living services to more than 10 residents as an assisted living facility, while those facilities which serve less than 10 residents are classified as care homes. Some residents may only require assisted living services while others may require intermittent nursing services.

What typically distinguishes assisted living facilities from care homes that offer the same services are the number of residents served and the style of living; assisted living facilities provide apartment-style living while care homes are located in residential homes. While most states distinguish between these two communities in their licensing, some states, such as California, do not.

If an assisted living facility also provides skilled nursing care, it is possible the facility may be licensed as a nursing home rather than an assisted living facility.

How do I obtain assisted living facility inspection records?

See our section on how to obtain inspection records.

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Memory Care for Alzheimer’s and Dementia

What is a Memory Care facility?

Memory care communities are communities specifically designed to care for seniors who have Alzheimer’s or other memory-related diseases. If a retirement community has an Alzheimer’s facility, it will often be separate from the independent living and assisted living areas. The services and amenities offered are designed to enhance the residents’ quality of life and create a sense of safety and security.

How are Memory Care facilities licensed?

For most states, memory care communities are licensed as assisted living facilities; however some states do have specific license types for Alzheimer’s care. In Oregon, an Alzheimer’s Care Unit is a facility that only cares for seniors with Alzheimer’s Disease or other forms of dementia, while in Montana, an Assisted Living Facility-Category C serves residents who may be at risk for wandering.

How do I obtain memory care community inspection records?

See our section on how to obtain inspection records.

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Care Homes

What is a care home?

A care home is another name for retirement community that provides assisted living services or limited nursing care within a residential home setting. The number of residents served is typically 10 or fewer. Residents may have a private or shared room and can access the home’s common areas. Services include meals, housekeeping, maintenance, transportation and scheduled activities.

How are care homes licensed?

Unless assisted living services are provided by third-party caregivers, care homes are licensed by the state and subject to inspection. Many states have different licensing designations to distinguish care homes from larger assisted living facilities. For example, in Minnesota, Adult Foster Care Homes provide care for four or five adults while a Housing with Services Establishment (HWS) has a greater resident capacity.

How do I obtain care home inspection records?

See our section on how to obtain inspection records.

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Nursing Homes

What is a nursing home?

Nursing homes, also called skilled nursing facilities, are dedicated to caring for seniors with severe or debilitating physical or mental illnesses who are unable to care for themselves. While assistance with activities of daily living are provided, the facility’s primary focus is providing skilled nursing care. Many nursing homes have services such as on-site beauty salons or a full calendar of social activities that are designed to enhance the quality of life for their residents.

How are nursing homes licensed?

Nursing homes are required to be licensed and are subject to inspection. Oftentimes the same state agency that licenses assisted living facilities and care homes also licenses and inspects nursing homes. This local state agency inspects nursing homes on behalf of the national Center for Medicare & Medicaid Services.

How do I obtain nursing home inspection records?

Unlike assisted living facilities or care homes, whose inspection records may not be online depending upon the state, nursing home inspection records nationwide are available online via the Medicare.gov Nursing Home Compare search

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How Do I Obtain Inspection Records of Retirement Communities?

While all states are required to maintain inspection records of assisted living facilities, the accessibility of these records varies from state to state. Some states have the records available online while others are only accessible via a request to the state agency or from the community.

If you want to find out whether the inspection records are available online for a respective community, SeniorHomes.com has compiled a state-by-state overview of how states oversee the licensing of assisted living communities and where inspection records may be accessed online. For those states whose inspection records are not online, we have provided a link to the website so you may contact the agency for a copy of the records.

To verify whether the assisted living portion of the community is licensed, find out the specific name of the assisted living portion. Oftentimes communities have separate names for their independent living and assisted living communities.For example, if the community is called “The Village Retirement Community,” the independent living portion may be called “The Village Retirement Community” while the assisted living portion may be called “The Lodge at The Village Retirement Community.” Knowing the exact name of the community will help you avoid finding the wrong inspection reports or finding no inspection reports at all.

And don’t forget that when touring a community you are entitled to ask to see the inspection records. The community should comply with your request and if they don’t, then consider that a red flag and cross the community off your list of options.
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