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Alternative Housing > Assisted Living

Assisted Living–Quick Links:

By JoAnn Thibault

Assisted Living Residence or Assisted Living Facility or Community means any entity, however organized, whether conducted for profit or not for profit, which meets all of the following criteria:

(a) provides room and board; and

(b) provides, directly by employees of the entity or through arrangements with another organization which the entity may or may not control or own, Personal Care Services for three or more adults who are not related by consanguinity or affinity to their care provider; and

(c) collects payments or third party reimbursements from or on behalf of Residents to pay for the provision of assistance with the Activities of Daily Living (dressing, bathing, toileting) or arranges for the same.

Definitions of Terms used in Assisted Living Facilities

Learn exactly what is offered, included, and not serviced within the Assisted Living Facility before you make your decision. Below are some definitions of terms of an ALF.

Bathing Facility means a room equipped with a showerhead and/or a bathtub to enable one person to take a shower or a bath.

Cooking Capacity means each Resident must have access to a refrigerator, sink, and heating element.

Instrumental Activities of Daily Living (IADL) means those tasks related to meal preparation, housekeeping, clothes laundering, shopping for food and other items, telephoning, use of transportation and other similar tasks related to environmental needs.

Legal Representative means Guardian, Conservator or attorney in-fact under a Power of Attorney, where legally appropriate.

Personal Care Service means assistance with one or more of the Activities of Daily Living and Self-Administered Medication Management (SAMM), either through physical support or supervision. Supervision includes reminding and/or observing Residents while they perform activities.

Resident Services means assistance with Activities of Daily Living (ADL), assistance with Instrumental Activities of Daily Living (IADL), Self-Administered Medication Management, or other similar services, but not including concierge services, recreational or leisure services. Assistance is either through physical assistance or supervision.

Resident means an adult who resides in an Assisted Living Residence and who receives housing and Resident Services and when the context requires or permits, such individual’s Legal Representative.

Residency Agreement means the contract between a Certified Assisted Living Residence and a Resident or adult who seeks to reside in such Residence on either a temporary (e.g. respite) or more permanent basis, which clearly describes the rights and responsibilities of the Resident and Sponsor, including all requirements in M.G.L. c. 19D, § 2 and 651 CMR 12.08(2). The Residency Agreement shall be signed by the Sponsor or the Sponsor’s authorized agent and by the Resident, or their Legal Representative.

Self-Administered Medication Management (SAMM) means the following:

(a) When assisting a Resident to self-administer medication the individual performing Self-Administered Medication Management must:

1. remind Residents to take medication;

2. check the package to ensure that the name on the package is that of the Resident;

3. observe the Residents while they take the medication; and

4. document in writing the observation of the Residents’ actions regarding the medication (e.g. Resident took medication at x time, Resident refused medication at x time, Resident not in Unit at x time).

If requested by the Resident, the individual performing Self-Administered Medication Management may open prepackaged medication and/or open containers, read the name of the medication and directions to the Resident and respond to any questions the Resident may have regarding the directions on the label.

(b) The Residence may assist a Resident with Self-Administered Medication Management from a medication container that has been removed from its original pharmacy-labeled packaging or container by another person (i.e. by the Resident’s family). Such assistance is not required of the Residence. If this service is to be provided, the Residence and Resident shall have a full written disclosure of the risks involved and consent by the Resident. The individual performing Self-Administered Medication Management shall:

1. remind Residents to take medication;

2. check the package to ensure that the name on the package is that of the Resident;

3. observe the Residents while they take the medication; and

4. document in writing the observation of the Residents’ actions regarding the medication (e.g. Resident took medication at x time, Resident refused medication at x time, Resident not in Unit at x time).

The individual performing Self-Administered Medication Management may open prepackaged medication and/or open containers.

(c) The Residence shall through the Self-Administered Medication Management program assist Residents with any medication that is part of the Self-Administered Medication Management plan, including prescription and over-the-counter medication, whether such medication is taken according to a schedule or as necessary (PRN). Self-Administered Medication Management shall only be performed by an individual who has completed Personal Care Service Training as set forth in 651 CMR 12.07(3) or 651 CMR 12.07(6), a practitioner, as defined in MGL c. 94C, or a nurse registered or licensed under the provisions of MGL c. 112, s. 74 or 74A to the extent allowed by laws, regulations and standards governing nursing practice in Massachusetts. Central storage of Resident medications (the storage of medication for Residents in an area outside of the Resident’s Unit under the control of the Residence) is prohibited in an Assisted Living Residence. Residences shall provide a refrigerator to store medication in the Resident’s Unit if refrigeration is required.



Nursing Home vs. Assisted Living

Is it time for you or a loved one to move into alternative housing, but you are not sure what the differences are?  Read below the differences between two alternative housing options.  Nursing Home vs. Assisted Living.

Assisted living residences

otherwise known as Assisted Living Facilities are for older people who no longer feel comfortable or safe living alone, but do not need 24-hour nursing and medical care. While assisted living residences monitor the well-being of their residents and help coordinate health services by licensed outside agencies or providers, they do not provide these services directly and are not designed for people with serious medical needs. State law prohibits assisted living residences from admitting or retaining individuals who need skilled nursing care for more than 90 days in a 12-month period.

Assisted living residences combine apartment-like living with a variety of support services, including:

• meals.

• assistance with activities of daily living such as bathing and dressing.

• on-site staff to respond to emergencies and help with medications.

• housekeeping and laundry services.

• social and recreational programs.

• 24-hour security.

Assisted living residences have one or two-bedroom units with private bathrooms and entry doors that lock. Some units may also have a living or sitting room. In addition to a group dining area, assisted living residences typically provide either a private kitchenette or access to a communal cooking area. Units are usually furnished with a resident’s personal belonging and furniture.


• National Center for Assisted Living (NCAL) – Comprehensive consumer information on assisted living is available either online at or by calling 202-842-4444.

• Alzheimer’s Association – The Alzheimer’s Association’s “Assisted Living Consumer Guide” is used in evaluating an assisted living residence for someone with memory impairment. The guide is available online at or by contacting the Massachusetts Chapter of the Alzheimer’s Association at 617-868-6718.

Nursing Homes

Skilled Nursing Facilities, or Nursing Homes, may be independent or part of a senior continuing care community. 24-hour medical care is available, in addition to custodial care. Residents may be there temporarily for a period of rehabilitation, or may be there for long-term care. State regulations define the services that Skilled Nursing Facilities can provide.

A Nursing Home, also known as a Skilled Nursing Facility or SNF, has Registered Nurses who help provide 24-hour care to people who can no longer care for themselves due to physical, emotional, or mental conditions. A licensed physician supervises each patient’s care and a nurse or other medical professional is almost always on the premises. Most nursing homes have two basic types of services: skilled medical care and custodial care.

Skilled medical care includes services of trained professionals that are needed for a limited period of time following an injury or illness:

• An R.N. doing wound care and changing dressings after a major surgery, or administering and monitoring I.V. antibiotics for a severe infection.

• A physical therapist helping to correct strength and balance problems that have made it difficult for a patient to walk or get on and off the bed, toilet or furniture.

• A speech therapist helping a person regain the ability to communicate after a stroke.

• An occupational therapist helping a person relearn independent self-care in areas such as dressing, grooming and eating.

Skilled care may also be needed on a long term basis if a resident requires injections, ventilation or other treatment of that nature.

Custodial or personal care includes assistance with what are known as the activities of daily living, such as:

• bathing

• dressing

• eating

• grooming

• getting in and out of bed, or walking around

• toileting (incontinence care)

People who are able to recover from a disabling injury or illness, may temporarily need the custodial care as they are getting back the strength and balance to be independent again. For people who are losing their ability to function independently due to chronic disease and increasing frailty, custodial care may be a long-term need. In the most severe cases where a person is bed-bound, ongoing supervision by an RN is necessary along with the custodial care, to ensure proper hydration and nutrition and to prevent skin breakdown. If a custodial care resident becomes ill or injured, they may spend a period of time in skilled care, and then return to custodial care. Whether a resident is under skilled or custodial care is important in terms of who provides the care and who pays for the services provided.

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