Louisiana adult residential care (assisted living) rules: what you must document about each resident

Who these rules cover

Louisiana does not issue an "assisted living" license by that name. Since August 15, 2015, it has licensed adult residential care providers (ARCPs) under La. R.S. 40:2166.1-2166.8 and LAC 48:I, Chapter 68, administered by the Louisiana Department of Health's Health Standards Section.³ There are four levels, and the rule itself gives the mapping to the old names:

The introduction to the chapter says an ARCP's services are designed to "accommodate the individual resident's changing needs and preferences" and to "encourage family and community involvement."³ All four levels follow the assessment and service plan rules below.

Screening and assessment: what and when

Louisiana splits intake into two steps.

Step 1, pre-residency screening. Before move-in the ARCP screens the applicant's physical and mental status (including a fall risk assessment), need for personal assistance, need for help with ADLs and IADLs, and ability to evacuate in an emergency. "The pre-residency screening shall be completed and dated before the residency agreement is signed."⁴

Step 2, the assessment. This is where preferences enter:

An assessment shall be initiated upon entry to the ARCP and completed within seven calendar days of the date that the resident moves into the ARCP to determine the service needs and preferences of the resident.LAC 48:I.6835.A

The assessment is kept in the resident's record. If the plan will include staff administration of medication or intermittent nursing services, a registered nurse completes the assessment for those services.¹

Seven days is short. It means the preferences part of the assessment has to happen in the resident's first week, often while they are still unpacking.

The person-centered service plan

Within 30 calendar days after the date the resident moves in, the ARCP designated staff in conjunction with the resident or the residents representative, if applicable, shall develop a PCSP using information from the assessment.LAC 48:I.6835.B

The PCSP must include the services needed to meet the resident's individual needs, their scope, frequency and duration, the monitoring to be provided, and who is responsible for each service.¹ Every plan, review and update is signed by the resident or representative and by ARCP staff, and by an RN when medication administration or nursing services are part of the plan.

Review is frequent:

A documented review of the PCSP shall be made at least every 90 calendar days and on an ongoing basis to determine its continued appropriateness and to identify when a resident’s condition or preferences have changed.LAC 48:I.6835.D

That last phrase matters for life-enrichment staff. A change in what the resident prefers is one of the things each 90-day review is meant to catch.

If the resident is on a Medicaid home and community-based services waiver that includes ARCP services, the waiver's comprehensive plan of care may be used in place of the PCSP, coordinated with any services beyond it.¹

Activities and social programming

Every ARCP must provide or coordinate, "to the extent needed or desired by each resident," a list of required services. Two of them are social:

• "opportunities for individual and group socialization including regular access to the community resources"
• "a recreational program"²

The rule does not prescribe what the recreational program must contain or tie it to individual interests. The phrase "needed or desired by each resident" is the hook: it is hard to show you offer what each resident desires without asking them.

Specialized dementia care programs

An ARCP may run a separate program for residents with Alzheimer's disease or a related disorder. If it does, it "shall provide a program of individualized care based upon an assessment of the cognitive and functional abilities" of the residents in the program, and it must disclose the program to the Department.⁵

An ARCP that advertises such a program must give the public a written description that covers, among other things, family involvement and support programs, assessment and care planning, and:

the activities that are specifically directed toward residents diagnosed with Alzheimer’s or a related disorder including, but not limited to, those designed to maintain the resident’s dignity and personal identity, enhance socialization and success, and accommodate the cognitive and functional ability of the resident;LAC 48:I.6851.E.8

This is a disclosure rule, not a documentation rule. Still, if you tell families your activities maintain each resident's "personal identity," you need to know that identity. For residents in a secured unit, the PCSP must also address why the resident is in the unit and how the ARCP is meeting their needs.⁵

All ARCP employees get dementia training within 90 days of hire and annually, and staff giving direct care in a specialized dementia program have additional hour requirements. See LAC 48:I.6867 for the full schedule.¹

What surveyors tend to look for

Based only on what the rule text asks ARCPs to document, expect a reviewer to check:

• A dated pre-residency screening completed before the residency agreement was signed.
• An assessment of service needs and preferences completed within seven calendar days of move-in and kept in the record.
• A PCSP developed with the resident within 30 days, using the assessment, with the required elements and signatures.
• Documented reviews at least every 90 days that show someone asked whether the resident's condition or preferences changed.
• Evidence of socialization opportunities and a recreational program.
• For dementia programs: individualized care based on a cognitive and functional assessment, and a written disclosure that matches what the program actually does.

How to gather preferences and life history well

• Plan the first week. With a seven-day assessment window, schedule the preferences conversation on day two or three, not day seven.
• Ask open questions. "Tell me about a typical day before you moved here." "What food reminds you of home?" "What did you do for fun when you were young?" Open prompts turn up routines and interests a checklist misses.
• Include family. The rules already expect family and community involvement. Relatives can fill in music, faith, work and hometown details before the 30-day plan.
• Record comfort and what to avoid. Note what calms the resident and any topics or situations that upset them, so every shift knows.
• Use the 90-day reviews. Louisiana reviews plans four times a year. Add one question each time: "Is there anything you'd like more of, or less of?"

How Porchlight can help

Porchlight helps you gather and keep the preferences, routines and life-story material that Louisiana's assessment and PCSP ask about, 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, they talk, 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 record profile facts, including topics to avoid. Family get a private page to listen, leave voice replies and add their own questions and photos. Staff get a "Know Your Resident" briefing with conversation starters, story highlights, a printable life-story biography and a weekly Monday email digest. The assessment, the PCSP and compliance remain the provider's responsibility.

Frequently asked questions

What is assisted living called in Louisiana?

Louisiana licenses adult residential care providers (ARCPs) at four levels under LAC 48:I, Chapter 68. The Louisiana Department of Health's own example maps Level 3 to what used to be called assisted living facilities; Level 4 can also provide intermittent nursing services.

How soon must a Louisiana ARCP assess a new resident?

A pre-residency screening is completed and dated before the residency agreement is signed. Then an assessment of the resident's service needs and preferences is started at entry and completed within seven calendar days of move-in.

When is the person-centered service plan due in Louisiana?

Within 30 calendar days after the resident moves in, developed with the resident or representative using information from the assessment. It gets a documented review at least every 90 calendar days and on an ongoing basis, including to identify when the resident's condition or preferences have changed.

Does Louisiana require a life history or social history?

No. The rules require the assessment to cover service needs and preferences and require a recreational program and socialization opportunities, but they do not name a life history. A specialized dementia care program must disclose activities designed to maintain residents' dignity and personal identity.

Can a Medicaid waiver plan replace the Louisiana service plan?

Yes, in part. If the resident is enrolled in a home and community-based services waiver that includes ARCP services, the waiver's comprehensive plan of care may be substituted for the person-centered service plan, and any extra services must be coordinated with it.