A Guide to State Regulations for Memory Care

In this article:

• Who regulates memory care?
• What do memory care regulations typically include?
• Do memory care communities need a license?
• A state-by-state guide to memory care regulations and reports

For many states, the same agency that regulates assisted living regulates memory care. Regulations generally require that a community or organization complies with a certain level of care. Most states penalize a community for violating state regulations, but penalties can vary from state to state. It is important to note that state regulations represent minimum requirements and are not an endorsement of a community.

In some cases, state memory care regulations may refer to a dementia care “unit” or “program.” A unit generally describes a separate building, or section of a building, where caregivers provide memory care services. A program, on the other hand, often refers to a combination of services, staff training, and other requirements beyond the physical space. Some states also use terms like dementia care, special care, or memory care without referring to a unit or program.

In some cases, regulations for memory care are robust and outline strict care requirements. Other times, memory care regulations are just a small subset of state assisted living regulations. While stand-alone memory care communities exist, many are attached to an assisted living or residential care community.

Most states have regulations that address administrator training, what information a community must provide to consumers, and the physical environment of a community. According to a 2017 study, only 17 states have regulations that pertain to staffing levels, and 14 address pre-admission for dementia. According to Paula Carder, director of the Institute on Aging at Portland State University, most states rely on assisted living regulations to cover dementia care policies and practices. However, 16 states regulate memory care separately from assisted living communities.

“Sixteen states license or certify dementia care units within residential care/assisted living settings. All states had at least one dementia care requirement, though only four states had requirements for all five of the topics reviewed,” she notes in a study published in the Gerontologist.

What is the difference between memory care regulations and other care-providing communities?

In many cases, memory care regulations are a smaller subset of broader regulations that pertain to assisted living and personal care homes. Common state regulations for assisted living typically cover:

Is memory care the right fit?

• Licensing
• Inspections
• Staff training requirements
• What must be covered in the initial service agreement
• Which medical services can be provided by staff members who aren’t registered nurses

Additionally, many states have specialized requirements for communities that provide memory care, such as:

• Basic living unit features
• Staff-to-resident ratios
• Staff training
• Behavior management methods
• Whether a dementia diagnosis is necessary for residence

How are nursing homes with memory care units regulated?

Many options for memory care services are geared toward seniors with Alzheimer’s or other forms of dementia who do not require 24-hour assistance with activities of daily living. Seniors with dementia who do require that level of assistance typically need skilled nursing services that can only be provided in a nursing home setting.

Nursing homes are held to a different set of state standards than stand-alone memory care communities or memory care programs or units which operate within assisted living environments. Nursing homes that accept Medicare or Medicaid are federally regulated by the U.S. Department of Health and Human Services via the Centers for Medicare and Medicaid Services.

Yes and no — before opening, memory care communities must have a license from the appropriate state agency. However, depending on the state, regulations may license a memory care community using terminology that may not refer specifically to memory care by name. Examples include:

• Alzheimer’s Special Care Units (Arkansas)
• Specialty Care (Alabama)
• Assisted Living Type II (Utah)

Inspections and deficiencies

The regulating and licensing process also includes inspections to determine if communities comply with their state’s requirements. During inspections, the agency in charge of regulating memory care will note any deficiencies.

• Inspections. The agency in charge of licensing the memory care community inspects or surveys communities on a routine basis. Inspections usually occur annually, as well as if someone files a complaint or there is an accident resulting in injury or death.
• Deficiencies. Also called violations or citations, deficiencies are noted during community inspections. A deficiency can often provide insight into a community’s quality of care. For each deficiency found during a survey, a provider must submit a plan of correction that includes a timeline explaining how they will respond to the issue. States can suspend or revoke a license and impose penalties for failure to comply with state requirements.

A Place for Mom only refers families to appropriately licensed facilities. We generally conduct a licensing and violation audit every 6 months, as well as additional audits as needed to confirm licensing status of communities. Our dedicated Senior Living Advisors are also here to help you and your family navigate the ins and outs of finding a memory care community. Their services are free to you and have helped thousands of families.

Memory care questions? Get expert help

Our state-by-state guide to memory care regulations can help simplify the process of researching licenses and inspections. Each state page includes information on which agency regulates memory care and a summary of how to obtain records.

Note: Each state agency shares licensure information and inspection survey results differently. In many states, you can verify a provider’s license(s) and read their inspection reports online. However, in other states, you must request to have this information mailed to you. You may also request the latest survey or inspection report directly from individual communities.

• Alabama
• Alaska
• Arizona
• Arkansas
• California
• Colorado
• Connecticut
• Delaware
• District of Columbia
• Florida
• Georgia
• Hawaii
• Idaho
• Illinois
• Indiana
• Iowa
• Kansas
• Kentucky
• Louisiana
• Maine
• Maryland
• Massachusetts
• Michigan
• Minnesota
• Mississippi
• Missouri
• Montana
• Nebraska
• Nevada
• New Hampshire
• New Jersey
• New Mexico
• New York
• North Carolina
• North Dakota
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• Rhode Island
• South Carolina
• South Dakota
• Tennessee
• Texas
• Utah
• Vermont
• Virginia
• Washington
• West Virginia
• Wisconsin
• Wyoming

The information contained in this article is for informational purposes only and is not intended to constitute medical, legal, or financial advice or to create a professional relationship between A Place for Mom and the reader. Always seek the advice of your health care provider, attorney, or financial advisor with respect to any particular matter, and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not endorse the contents of the third-party sites.

Sources

Carder, P. C. (2017, August 1). State regulatory approaches for dementia care in residential care and assisted living. The Gerontologist.