Variation in Assisted Living Regulations Within and Across States

Assisted living (AL) regulations have been long recognized as being highly variable across states. A new approach developed by our team, Health Services Regulatory Analysis, allows for a more granular identification of within-state variation in AL regulation. We identified 172 licensing classifications from the 50 states and DC representing 58 primary license types, 48 sub-types, and 66 designations that can modify a primary or sub-license. Over two-thirds (72%) of dementia-specific classifications require that all staff receive initial dementia training, compared to only one-third (33%) of general AL classifications. This trend is similarly reflected in cognitive-screening requirements, present in 67% of dementia-specific classifications and 42% of general AL classifications. Regulatory theory describes how licensing agencies respond to various forces and values. Within-state AL regulatory variation reflects a combination of oversight mandates, population-specific needs (e.g., people with dementia), historic policies, and provider influence, with implications for consumers, policy-makers and researchers. Part of a symposium sponsored by Assisted Living Interest Group.