District of Columbia assisted living rules: what you must document about each resident

Who these rules cover

The District licenses one category: the assisted living residence, or ALR. The rules come in two layers. The Assisted Living Residence Regulatory Act of 2000 sets most of the substance, and 22-B DCMR Chapter 101, last amended in April 2020, adds detail. The chapter says each ALR "must comply with the Act and with this chapter". DC Health licenses and inspects ALRs.⁹

An ALR in the Medicaid Elderly and Persons with Physical Disabilities waiver must also follow Chapter 42 of Title 29 DCMR, the waiver rules.⁹

The assessment: three pieces, two deadlines

The Act says the resident assessment "shall form the basis for the development of the resident's service plan". It has three parts.¹¹

1. Medical, rehabilitation and psychosocial assessment

This is completed within 30 days before admission and is based on an examination by the resident's own licensed healthcare practitioner. It covers medical history, conditions that affect "self-care, cognition, behavior, and psychosocial activities", medications, diet, and precautions.²

2. Functional assessment

Also within 30 days before admission, on a standardized form, the ALR collects functioning in daily activities, needed support, symptoms, decision-making capacity, and behavior. The last item is where the social picture comes in:

"(6) Social factors, including: (A) Significant problems with family circumstances and personal relationships; (B) Spiritual status and needs; and (C) Ability to participate in structured and group activities and the resident's current involvement in such activities."D.C. Official Code § 44-108.03(6)

The 2020 rules require a registered nurse licensed in DC to perform these pre-admission assessments.⁴

3. Post move-in assessment

"A 'post move-in' assessment required by § 604 of the Act (D.C. Official Code § 44-106.04) shall be conducted by or on behalf of the ALR within seventy-two (72) hours of a resident's admission."22-B DCMR § 10113.5

The Individualized Service Plan (ISP)

An ISP is developed before admission and again after the post move-in assessment. A healthcare practitioner writes it, "using information from the assessment", with the resident "as a full partner".³ The Act lists what it rests on:

"(A) The medical, rehabilitation, and psychosocial assessment of the resident; (B) The functional assessment of the resident; and (C) The reasonable accommodation of resident and, if necessary, surrogate preferences."D.C. Official Code § 44-106.04(a)(7)

Reviews are done by an interdisciplinary team that includes the resident. The 2020 rules add process: at least seven days' written notice, an outline of the topics and proposed changes, a written reminder, and a signed statement that the resident was invited.⁴ Families have a defined place too:

"An ALR shall support the involvement of family and friends selected by the resident to participate in the development, review, and renegotiation of his or her ISP"22-B DCMR § 10113.2

When a resident's choice about "lifestyle, personal behavior, safety, and service plans" conflicts with the ALR's concerns, the Act calls for a shared responsibility agreement.¹⁰

Activities and social life

DC has no stand-alone activities rule for ALRs. The requirement sits in the standard of care and the residents' rights. Every ALR must offer or coordinate "recreational and social activities" in a way that promotes dignity and independence.⁶ Residents also have the right to an environment that:

"(2) Is creatively designed to counter loneliness, depression, dependence, boredom, and designed to manage difficult behavior; (3) Provides opportunities for socialization, social interaction, leisure activities, and spiritual and religious activities consistent with the preferences and background of the resident"D.C. Official Code § 44-105.02(b)

"Preferences and background" is as close as DC comes to asking for a life history. It is hard to plan activities that fit a background you have not written down.

Memory care

DC does not license a separate dementia or memory-care unit. Two rules apply instead. The resident agreement must state "the specific nature of any special care that it holds itself out to provide, such as specialty in Alzheimer's disease".⁷ And staff training must cover recognizing dementia, communicating with people with cognitive impairments, and caring for residents who wander or ask repeated questions, plus four hours of cognitive-impairment in-service training.⁸

What surveyors tend to look for

Based only on what the Act and the rules say to document:

• Pre-admission assessments dated within 30 days before move-in, performed by a DC-licensed RN, with the social factors section filled in.
• A post move-in assessment within 72 hours.
• An ISP that shows how preferences were accommodated, signed by the resident or surrogate and the ALR.
• Review notices, reminders and the signed invitation statement for each ISP review.
• Resident records holding the agreement, the functional assessment, the ISP and its revisions.

Gathering preferences and background well

The functional assessment asks narrow questions. The ISP and the rights section ask for more. Some habits that close the gap:

• Start with open questions in the first two weeks: "Tell me about your church or community." "What did you do on weekends?"
• Invite the family and friends the resident chooses, as 10113.2 already expects.
• Write down what brings comfort and what to avoid, including subjects that cause distress.
• Record faith and practice specifically, since spiritual status appears in the assessment and the rights.
• Revisit at each six-month ISP review.

How Porchlight can help

Porchlight helps you gather the preferences and background material in the resident's own words. A resident taps one large button on a tablet, a life question is read aloud and shown in large type, and the answer is recorded and transcribed. There are 800+ human-written questions organized by life chapter; any can be skipped, and nothing is scored. Staff can note profile facts, including topics to avoid, and receive a "Know Your Resident" briefing and weekly digest. Family get a private page to listen, reply and add questions and photos. The assessments, the ISP and compliance remain the ALR's responsibility.

Frequently asked questions

What does DC require in an assisted living resident assessment?

A medical, rehabilitation and psychosocial assessment and a functional assessment, both within 30 days before admission, and a post move-in assessment within 72 hours of admission. The functional assessment must include social factors: family and relationship problems, spiritual status and needs, and the resident's ability and current involvement in activities.

Does DC require a life history for assisted living residents?

Not by name. DC requires the social factors in the functional assessment, an ISP that reasonably accommodates resident preferences, and activities consistent with the resident's preferences and background.

How often must a DC assisted living ISP be reviewed?

30 days after admission and at least every 6 months after that, and more often if the resident's condition changes significantly. The resident gets at least seven days' written notice of a review, with at least one written reminder.

Can family take part in the ISP in DC?

Yes. 22-B DCMR 10113.2 requires the ALR to support the involvement of family and friends selected by the resident in developing, reviewing and renegotiating the ISP.

Does DC have special rules for memory care in assisted living?

There is no separate memory-care license. The resident agreement must state any special care the ALR holds itself out to provide, such as an Alzheimer's specialty, and staff training must cover dementia and cognitive impairment.