North Dakota assisted living and basic care rules: what you must document about each resident

North Dakota's rules are shorter than most states'. That makes this a shorter page, and we would rather say so than pad it. The important thing is to know which license you hold, because the two carry very different documentation duties.

Who these rules cover

Assisted living facilities are defined in NDCC 50-32-01 as buildings with at least five living units that provide or coordinate "individualized support services to accommodate the individual's needs and abilities to maintain as much independence as possible." Residents are tenants under a lease. The statute excludes facilities licensed as basic care.¹

Basic care facilities are licensed under NDCC 23-09.3 and provide room and board plus health, social and personal care for five or more residents, including "leisure, recreational, and therapeutic activities." The rules for both settings name the Department of Health and Human Services as the licensing department in statute.¹⁴

Assisted living: a tenancy evaluation and a service list

North Dakota's assisted living licensing chapter, NDAC 75-03-34, covers definitions, licensing, revocation, complaints and enforcement. It requires a written agreement with each tenant covering rent, services, payment terms, refunds, rate changes, tenancy criteria and unit inspections.² It does not contain assessment or care-plan rules.

The statute adds a few documentation duties:

Before a facility unit is rented, the facility or landlord shall evaluate the tenant's ability to meet the facility's tenancy criteria.NDCC 50-32-05(1)

Each tenant record must include the initial evaluation to meet tenancy criteria, the signed tenancy agreement, a medication administration record if applicable, and "an itemized list of services provided for the tenant." Facilities must also run a consumer satisfaction survey at least every 24 months and share the results with tenants.¹

That is the full list. The North Dakota assisted living rules do not require you to document preferences, routines, life history or interests. Many facilities do it anyway because good service depends on it, and because residents on Medicaid waiver services may have a separate person-centered plan through that program. Check with the Department if you are unsure what applies to a particular resident.

Basic care: the assessment

Basic care is where North Dakota's documentation rules live.

An assessment is required for each resident within fourteen days of admission and as determined by an appropriately licensed professional thereafter, but no less frequently than quarterly.NDAC 33-03-24.1-12(1)

An appropriately licensed professional completes it in writing. It must include:

• A review of health, psychosocial, functional, nutritional and activity status.
• Personal care and other needs.
• Health needs.
• The capability of self-preservation.
• "Specific social and activity interests."³

That last item is the closest North Dakota comes to a preferences or life-history requirement. It asks for interests, specifically. The resident record rule also requires basic demographic information, including religion and marital status, and an admission note.³

Basic care: the care plan and progress notes

A care plan, based on the assessment and input from the resident or person with legal status to act on behalf of the resident, must be developed within twenty-one days of the admission date and consistently implemented in response to individual resident needs and strengths.NDAC 33-03-24.1-12(3)

The plan must be updated as needed, and at least quarterly. The record must also hold a quarterly progress note covering the resident's "current health condition, level of functioning, activity involvement, nutritional status, psychosocial interactions, and needs."³ Activity involvement and psychosocial interactions are therefore things staff are expected to observe and write down four times a year.

Basic care: activity services

There must be a planned and meaningful activity program to meet the needs and interests of the residents and encourage self-care and continuity of normal activities.NDAC 33-03-24.1-19

The program must be developed from "the activity needs and interests of each resident identified through the initial and ongoing assessments." It needs a posted monthly group calendar based on those interests, activities during the day, in the evening and on weekends, and help for residents to take part in social, recreational and religious activities in the facility and the community.³

"Continuity of normal activities" is worth noticing. It points toward what the resident did before moving in, not only what is on offer now.

Memory care units in basic care

A basic care facility or unit that admits or retains only residents with Alzheimer's, dementia, special memory care needs, or traumatic brain injury needs written approval from the Department, and may not advertise that care without it. The added requirements include:

• Residents' freedom "to control their schedules and activities and have access to food any time and eat where they choose."
• A person-centered care plan, written after the functional assessment and based on input from the resident or designee.
• Review of that plan quarterly and whenever the resident's needs change.
• At least eight hours of staff training within three months of hire, including "strategies for addressing social needs and providing options for meaningful activities" and person-centered care, plus four hours annually.³

What surveyors tend to look for

Based only on the text of the rules:

• Assisted living: a tenant record with the pre-rental evaluation, the signed agreement, the itemized services list, a MAR where applicable, and the most recent satisfaction survey.
• Basic care: a written assessment within 14 days that covers social and activity interests; a care plan within 21 days showing resident input; quarterly reassessments, care-plan updates and progress notes that mention activity involvement; and an activity calendar you can trace back to assessed interests.
• Memory care units: the Department approval, person-centered care plans reviewed quarterly, and training records.

Gathering interests and life history well

Whether or not your license requires it, knowing a resident's story is what lets staff offer "continuity of normal activities." A few habits help:

• Use the first two weeks. In basic care the assessment is due at day 14. Ask open questions: "Tell me about the farm." "What did your mornings look like?" "Who did you play cards with?"
• Include family. They often know the routines, church, clubs and music that mattered.
• Write down comforts and things to avoid. A favorite chair, a radio program, a loss that is still raw.
• Use it every quarter. The quarterly progress note and care-plan review are natural times to add what you have learned.

How Porchlight can help

Porchlight helps you gather and keep the interests, routines and life-story material an assessment and care plan draw on, 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 spoken answer is recorded and transcribed. More than 800 human-written questions are organized by life chapter; the resident or staff can pick a topic, skip any question, 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 Monday email digest. The assessment, the care plan and compliance remain your team's responsibility.

Frequently asked questions

Do North Dakota assisted living facilities have to do a resident assessment?

Not in the way most states require. NDCC 50-32-05 requires an evaluation of the tenant's ability to meet the facility's tenancy criteria before a unit is rented, and a tenant record with that initial evaluation, the signed tenancy agreement, a medication administration record if applicable, and an itemized list of services. The licensing rules do not require a care plan or a preferences or life-history section.

What is the assessment deadline in a North Dakota basic care facility?

An assessment is required within 14 days of admission under NDAC 33-03-24.1-12, completed in writing by an appropriately licensed professional, and repeated as that professional determines but no less often than quarterly. The care plan must be developed within 21 days of admission.

Does North Dakota basic care require documenting a resident's interests?

Yes. The assessment must include a review of health, psychosocial, functional, nutritional, and activity status, and specific social and activity interests. The activity program must then be developed from the interests identified in the initial and ongoing assessments. The rules do not use the words life history or personal preferences.

What rules apply to memory care in North Dakota?

A basic care facility or unit that serves only residents with Alzheimer's, dementia, special memory care needs, or traumatic brain injury must have written department approval under NDAC 33-03-24.1-24. It must write a person-centered care plan after the functional assessment, based on input from the resident or designee, review it quarterly and on any change in need, and train staff in areas that include meaningful activities and person-centered care.