Montana assisted living rules: what you must document about each resident

Montana's assisted living rules are mostly functional. The required needs assessment is a checklist of cognition, senses, daily living tasks, mood, health and medications. Preferences and interests show up in the service plan and the activities rule, not in the assessment itself. That is a useful thing to know plainly: Montana does not require a social history or life story, but it does expect your plans and your activity calendar to reflect who the resident is.

Who these rules cover

Montana licenses assisted living facilities under Title 50, Chapter 5 of the Montana Code, and DPHHS sets the minimum standards in ARM 37.106, Subchapter 28. Every facility holds one or more category endorsements (the categories themselves are set in 50-5-226, MCA), and the paperwork changes with the category:

• Category A: the base endorsement. Residents get a service plan.
• Category B: residents who receive ongoing health care services from a licensed health care professional. They get a health care plan.
• Category C: residents with severe cognitive impairment. They get an expanded health care plan and pre-admission disclosures.
• Category D: a separate endorsement with its own rules, not covered in detail here.

The needs assessment: done before move-in

Montana is unusual in requiring the first assessment before the resident arrives.²

“Prior to admission, the facility shall conduct an initial resident needs assessment to determine the prospective resident's needs.”ARM 37.106.2821(3)

The rule lists what the assessment must document: cognitive patterns (short- and long-term memory, recall, decision making), sensory patterns, activities of daily living, mood and behavior patterns, health problems and accidents, weight and nutrition, skin problems, current medications, and any restraints or assistive devices. Mood and behavior includes sadness or anxiety, wandering and socially inappropriate behavior.

There is nothing on that list about routines, interests or personal history. The application procedure in the same rule asks for basic facts such as marital status and religious affiliation "if volunteered," and that is the closest the intake paperwork comes to biography.

“The resident's needs assessment shall be reviewed and updated annually or at any time the resident's needs change significantly.”ARM 37.106.2821(6)

The service plan (category A)

The service plan is where preferences become a written requirement. Montana defines a service plan as a written plan developed with the resident or legal representative³

“which reflects the resident's capabilities, choices and, if applicable, measurable goals and risk issues.”ARM 37.106.2805(27)

The timing is tight:⁴

“an initial service plan shall be developed for all category A residents within 24 hours of admission. The initial service plan shall be reviewed or modified within 60 days of admission to assure the service plan accurately reflects the resident's needs and preferences.”ARM 37.106.2822(1)

That 60-day review is the practical window for learning preferences. On day one you know what the assessment told you. By day 60 you are expected to know how this person actually likes to live. The plan must describe each service (what, who, when, where, how often), changes and the reasons for them, and desired outcomes where they apply. It is reviewed annually or on a significant change, and a copy goes to the resident or legal representative and into the resident file.

The health care plan (category B)

For category B residents, a licensed health care professional completes a written health care assessment within 21 days of admission.⁵ Two items on its required list go beyond physical care: psychosocial well-being and activity pursuit patterns. The resulting health care plan must include, among other things,

“the resident's needs and preferences for themselves;”ARM 37.106.2875(3)(c)

The category B plan is reviewed quarterly and revised on a change of condition, and it must be readily available to the staff who provide the care.

Activities and social programming

Montana's activities rule is short and concrete. A planned, diversified program of individual or group activities must be offered daily, on or off site, to meet residents' individual needs and well-being, and should "promote and encourage self care and continuity of normal activities." The link to the service plan is explicit:⁶

“The activities program shall be developed based on the activity needs and interest of residents as identified through the service plan.”ARM 37.106.2831(2)

The facility must also provide or arrange transportation to social, religious or community events the resident chooses to attend (according to facility policy), post a monthly group activities calendar, and keep past calendars on file for at least three months.

"Continuity of normal activities" is worth reading closely. It asks you to keep a resident's ordinary life going after move-in, which you can only do if you have written down what that life looked like.

Memory care: category C

Montana handles memory care through the category C endorsement for residents with severe cognitive impairment. Within 21 days of admission, the facility must complete a resident certification and a health care plan that meets the category B requirements and also⁷

“includes detailed assessment, therapeutic management and intervention techniques for the following behaviors and resident needs:”ARM 37.106.2895(1)

The listed needs are memory, judgement, ability to care for oneself, ability to solve problems, mood and character changes, behavioral patterns, wandering and dietary needs.

Before admission, a category C facility or unit must give the resident's legal representative a written disclosure covering its philosophy, admission and discharge criteria, the process used for resident assessment and care planning, staff training, the physical environment, "the frequency and type of resident activities," and⁸

“the level of involvement expected of families and the availability of support programs;”ARM 37.106.2896(1)(h)

A copy of that exchange is kept in the resident file. Secured or locked category C units have added staffing and space requirements under ARM 37.106.2898.

What surveyors tend to look for

Based only on what the rules ask facilities to document, a Montana resident file should be able to show:

• A needs assessment dated before admission, covering every listed domain, and updated at least annually.
• For category A, a service plan dated within 24 hours of admission and a review within 60 days that reflects preferences.
• For category B and C, a health care assessment and plan within 21 days, with quarterly reviews for category B.
• For category C, the signed pre-admission disclosure in the file.
• A daily activity program that traces back to interests recorded in service plans, a posted monthly calendar and three months of past calendars.

Gathering preferences and life history well

Because the needs assessment is functional, the preference work falls to the first two months. Some habits that make the 60-day review meaningful:

• Ask open questions in the first two weeks. "Tell me about your work." "Tell me what a good Sunday looked like." These uncover the routines that "continuity of normal activities" depends on.
• Bring family in early. Families often remember the habits and interests a resident is too tired to mention during move-in week.
• Write down comfort and avoid lists. What settles this person, and what subjects or situations upset them.
• Feed it into the activity calendar. The rule says activities come from interests identified in the service plan, so record the interests there, not only in an activity director's notebook.
• Revisit at every review. The annual update and, for category B, each quarterly review are natural points to add what staff have learned.

How Porchlight can help

Porchlight helps you gather and keep the preferences, routines and life-story material that a service plan and activity program draw on, in the resident's own words. A resident taps one large button on a tablet, hears a life question read aloud and sees it in large type, then talks; the answer is recorded and transcribed. More than 800 human-written questions are organized by life chapter, any question can be skipped, and nothing is scored. Staff can note profile facts, including topics to avoid, and receive a "Know Your Resident" briefing, a printable life-story biography and a Monday email digest. Family get a private page to listen, reply by voice and add questions and photos. The assessment and compliance stay with your community.

Frequently asked questions

When must a Montana assisted living facility assess a new resident?

Before admission. ARM 37.106.2821 requires an initial resident needs assessment prior to admission, reviewed and updated annually or whenever the resident's needs change significantly. Category B and C residents also need a health care assessment within 21 days of admission.

Does Montana require a life history or social history in assisted living?

No. The rules do not name a life history or social history. They do require the category A service plan to reflect the resident's needs and preferences, the category B health care assessment to cover psychosocial well-being and activity pursuit patterns, and the activities program to be built on residents' interests identified through the service plan.

How fast is the service plan due for a category A resident in Montana?

Within 24 hours of admission, based on the initial needs assessment. It must be reviewed or modified within 60 days to make sure it accurately reflects the resident's needs and preferences, then reviewed annually or on a significant change.

What does Montana require for memory care in assisted living?

Residents with severe cognitive impairment are served under a category C endorsement. Within 21 days of admission the facility develops a health care plan that adds detailed assessment and intervention for memory, judgement, self-care, problem solving, mood, behavior, wandering and diet. Before admission it must give the legal representative a written disclosure that includes its assessment process, activities and expected family involvement.

How often must Montana assisted living facilities offer activities?

Daily. ARM 37.106.2831 requires a planned, diversified program of individual or group activities offered daily, a posted monthly group activities calendar, and a record of past monthly activities kept on site for at least three months.