Advice Assisted Living

Policy & State Regulations for Assisted Living: Resource Guide & Overview


While you don’t need to become an expert in elder law to find the right care for an older adult, it’s important to understand the ways policy influences day-to-day life in senior living.

How your state — or the state where your loved one will reside — defines and regulates different categories of senior care (independent living, assisted living, skilled care in nursing homes, memory care and home care) can vary tremendously.

Regulatory oversight is complex and nuanced, especially in senior care, where a company’s objectives and your loved one’s personal healthcare needs are closely linked.

There’s no one-size-fits-all regulation, but there are resources to help consumers better understand what the expectations and guidelines are. And like the process, pricing, people and programs, there are many valuable aspects of policy to consider when making a decision about senior living for an older loved one.

When it comes to transparency in this category, we’ll take a closer look at areas like legal, financial, and “personal” policies in a community setting. And we’ll guide you through the high points — the “what you need to know” about policy in senior living — so you can make the most informed, well-rounded decision possible.

The Difference Between Public Policy and Regulatory Oversight

In a conversation with Benchmark’s Vice President and Deputy General Counsel, Brian Danaher, we discussed definitions:

  • What do we really mean when we say “policy” in senior living?
  • How do we distinguish between public policy and advocacy, versus regulations and regulatory oversight?

First things first, public policy is really about efforts to change the laws, says Brian. There are a number of organizations that represent senior living providers at a state and federal level. These groups — for example, Argentum, Leading Age, and the Alzheimer’s Association — are dedicated to education, advocacy, and public policy efforts to improve the lives of those who reside or work in senior care communities.

“When I think about public policy, Benchmark and other companies are a bit frustrated that some state laws don’t let us do more to enhance the lives of our residents,” says Brian. “So we work with our trade associations on actively trying to change the state regulations for assisted living, which will allow us to do more things for our residents,” he explains.

After new legislation is passed at the state or federal level, changes may trickle down to senior living communities and may have an impact on operations. Sometimes, these changes are evident to consumers, like receiving a letter about changes in regulations which may result in a name change for the community (for example, the community may shift from being called personal care instead of assisted living). Other times, the changes don’t affect resident care, but may affect office management procedures. The spectrum is broad and complex.

In terms of the regulatory landscape that affects how a community is run on a daily basis, Brian defines it this way: “Assisted living is regulated by state government agencies. Each state’s agency issues the regulations, sends someone out regularly to check on compliance (through state surveys), and we work daily to meet all their requirements and standards. So that’s the regulatory day-to-day world,” he says.

Where You Live Matters: Knowing Your State’s Senior Living Regulations

The most important starting point for understanding regulatory oversight in a prospective senior living community is the state where your senior loved one will reside.

“Assisted living, from a regulatory standpoint, is different state-by-state,” says Brian. “There’s no overall federal regulations, so what you have in Massachusetts is different from Rhode Island and from New Hampshire.”

The type of community —  assisted living, independent living, a nursing home, or a stand-alone hospice or memory care facility, for example — also influences the type of regulatory oversight.

One of the best and most comprehensive resources for state regulations for assisted living is NCAL’s State Regulatory Review. NCAL, the National Center for Assisted Living, is part of a larger advocacy organization, the American Health Care Association, or AHCA. AHCA represents nursing home providers.

When you follow the link to the NCAL State Regulatory Review, click on the state to download a PDF document that will provide all the relevant regulatory information you need.

The state documents will vary in length depending on what level of detail they provide, how extensive their regulations are and other factors. It includes information on:

  • Staffing requirements (such as staff-to-resident ratios)
  • Administration and staff training and education requirements
  • Procedures for how medications are provided
  • Facility/building requirements
  • And how their dementia care unit is defined and operated.

Here’s a preview of what the Massachusetts page looks like:

The state-by-state guide from is another helpful resource for understanding what your state requires and why the differences matter.

“For example, in some states, as many as 25 hours of training are required for caregiving staff while other states have no training requirements,” the article explains. “A community that looks dazzling may in fact be offering substandard care. And a community that looks a little rough around the edges could be a gem.”

As you review both guides — and as you make your first virtual or physical visits to the various communities you’re considering for a loved one — keep these questions in mind:

  • How much training is required for staff?
  • How often are communities inspected, and what do the inspectors look for?
  • Is there a minimum staffing ratio?
  • What are the rights of the resident?
  • Can my parent be evicted?

Understanding your loved one’s rights and the legal obligations of the community he or she may eventually call home makes a difference. And even after a transition to senior living, having these insights and knowledge will make you a more effective advocate.

Learn More About State Regulations for Senior Living:

For more information about state regulations for assisted living, check out these resources:

If you’re just starting this journey, consider taking this 5-minute survey to assess your situation and determine whether it’s the right time for senior living for you or your loved one.

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