Effective July 1, 2015, Massachusetts assisted living residences (ALRs) are subject to new regulations of the Executive Office of Elder Affairs (EOEA). The ALR regulations were last revised in 2006. The new regulations are intended to enhance the safety of the residents in the state's 236 facilities. Changes to the regulations address controlled substances, screening and assessment, training, and incident reporting. Among other things, ALRs are now required to develop detailed safety and evacuation plans to protect residents in the event of a disaster.
In an effort to promote residents' right to self-determination, ALRs are now required to document, upon admission, whether residents have advance directives in place for finances and health care. ALRs must also distribute information about a full range of end of life treatment options to residents with serious advancing illness or for whom palliative care would be helpful. These regulations will enhance residents' rights to control their personal finances and health care. They will also ensure that ALR residents have access to a full range of palliative care options.
Several of the new requirements apply specifically to so-called memory care units, known as "Special Care Residences," which serve the most vulnerable ALR residents - those with cognitive impairment. For example, providers must provide structured activities for memory impaired residents, address the residents' physical safety needs, and provide a secure outdoor space for their residents.
The proposed regulations included a provision that prohibited ALRs from allowing residents with "Skilled Nursing Care" needs to age in place. During EOEA's public comment period, the National Academy of Elder Law Attorneys, along with other advocates and consumers, unanimously opposed this proposed change. Among other things, the proposed regulation was unlikely to benefit ALR residents but risked confusing and intimidating residents and their families. To the extent that it infringed on the rights of ALR residents to contract for services and age in place to the same extent as persons living in private homes, the proposed regulation ran afoul of the state's ALR statute and regulations, as well as the Americans with Disabilities Act. Fortunately, it was deleted from the final regulations.