Author: Prairie State Legal Services
Last updated: March 2009
What It Is: “Assisted Living Facilities (ALFs) and “Shared Housing Establishments” (SHEs) offer alternatives to nursing homes for elderly persons who are at risk if living alone but do not require nursing care. Residents live in their own apartments but are provided certain mandatory services, including meals, housekeeping, laundry and assistance with activities of daily living. Residents generally pay for these facilities with their own resources. Medicaid will not pay for them.
Where To Apply: The Illinois Department of Public Health must license ALFs and SHEs. For a list of ALFs and SHEs in Illinois, see the IDPH website at the end of this Section.
Who May Be Eligible: Any adult person who needs assistance to accomplish some basic activities of daily living, but who does not require nursing care. Persons can be excluded from residency if they have certain conditions or need a certain level of assistance.
In January 2001, the Illinois Department of Public Health (IDPH) began requiring Assisted Living Facilities (ALFs) and Shared Housing Establishments (SHEs) to have a license. They are required to offer certain “mandatory services,” including secure housing, laundry, housekeeping, three meals per day, an emergency response system and assistance with some “activities of daily living.”
“Activities of daily living” means eating, dressing, bathing, toileting, transferring or personal hygiene.
The license is required even if the facility does not offer the mandatory services directly but arranges for them under contract.
You should not confuse these types of facilities with Supportive Living Facilities (SLFs) which are discussed in the next Section.
An Assisted Living Facility (“ALF”) is a residence for at least 3 unrelated adults, at least 80% of whom must be age 55 or older. It must meet certain requirements relating to services, care and physical environment.
A Shared Housing Establishment (“SHE”) is a residence for 16 or fewer persons, at least 80% of whom are age 55 or older. An SHE must meet the same requirements relating to services and residential care as those for ALFs. However, an SHE has somewhat different requirements relating to physical environment and staffing.
Most residents generally pay the cost for care from their own financial resources or with long-term care insurance. Medicaid will not pay for an ALF or an SHE.
The level of care provided by an assisted living facility (ALF) is very similar to the level of care provided by a supportive living facility (SLF). The primary difference between the two is that Medicaid can pay for an SLF but there is no source of public payment available for care in an ALF.
ALFs come in all shapes and sizes, from single family homes with only a few residents to large communities with hundreds of residents. They can be freestanding or part of a retirement community or a continuing care community. They can be independent or affiliated with a nursing home.
Choices vary from studio, single or double rooms, to suites or apartments and are usually within a multi-unit residential setting. You may have your own living quarters or you may choose to share quarters with a spouse or roommate.
To live in a facility, you must be an adult. There is no other age requirement, except that for the ALF or SHE to be licensed, at least 80% of the residents must be 55 or older.
In order for you to be accepted for residency or remain in residence at an ALF or SHE:
You cannot be accepted for residency, and your residency can be terminated if any of the following circumstances exist:
If any of the above exclusions apply to you, the facility may nevertheless decide to let you stay there if you become terminally ill and qualify for licensed hospice care.
Many of the above exclusions will not apply if you are quadriplegic or paraplegic, or if you have neuro-muscular diseases (such as muscular dystrophy and multiple sclerosis) or other chronic diseases and conditions, and:
Before you can be admitted to a facility, a doctor must complete a comprehensive assessment of your condition. The assessment will include an evaluation of your physical, cognitive, and psychosocial condition, and must test for tuberculosis. At the time of admission, the assessment must reflect your current condition and must not have been done more than 4 months beforehand. It is your responsibility or that of representative to
have doctor’s assessments and reassessments completed.
After you move in, a doctor must perform a new comprehensive assessment every year, or whenever staff has observed a significant change in your condition.
Based on the assessment, the facility must develop a service plan with which both you and the facility must agree. It will serve as a basis for the service delivery contract between you and the facility. The facility must respect and accept your choices regarding the service plan. The plan may provide for the disconnection or removal of any kitchen appliance.
The service plan must be reviewed, and revised if necessary, annually or immediately after a significant change in your condition, preferences or service needs.
All persons involved in the development of the service plan must sign and date it. The service plan must be developed by:
Service plans must address all of the following:
“Negotiated Risk” refers to a process by which you or your representative negotiate with the facility what risks each are willing and unwilling to assume with respect to services and the living environment. The facility must explain to you or your representative the risks of these decisions and the potential consequences of assuming these risks. See the sub-section below on “Negotiated Risk Agreements.”
You or your representative have complete ability to direct your own care and to negotiate the terms of your own care. You also have the right to refuse certain services or approaches that would otherwise be recommended based on the physician’s assessment, provided that you have received clear information regarding the risks and benefits of such a choice and the choice does not put other residents or staff at risk. The service plan must document any disclosure of the risks of refusing services or approaches.
Each facility must provide all “mandatory services” and may provide “optional services.” In doing so, the facility may not prevent your doctor from also providing services to you.
These are the services that each facility must provide for you:
• Three (3) meals per day, prepared by the facility or an outside contractor;
• Housekeeping services including, but not limited to, vacuuming, dusting and cleaning your unit;
• Personal laundry and linen services, either provided or arranged by the facility;
• Security provided 24 hours each day including but not limited to locked entrances or building or contract personnel;
• An emergency communication response system, which is a procedure in place 24 hours each day by which you can notify building management or an emergency response vendor, or others able to respond to your need for assistance and;
• Assistance with those activities of daily living that you need (eating, dressing, bathing, toileting, transferring or personal hygiene).
A facility is not required to provide medication-related services, but if they do, they must follow the rules described below. The fee schedules outlining the cost of these services must be included in the resident contract.
Before admission to a facility that does not provide medication administration as an optional service, their staff must advise you to consult a physician to determine whether you should obtain a vaccination against pneumonia or the flu, or both.
A facility that does provide medication administration as an optional service must annually (and at certain times of year prior to admission) administer a vaccination flu shot to each resident. However, you have the right to refuse this vaccine. Also, the facility should not administer the shot if it would be harmful to your health.
A doctor, pharmacist or registered nurse must approve the facility's medication policies. Those policies must address:
A facility staff member can remind you to take pre-dispensed medication, observe you taking it or applying it yourself and document whether or not you took the medication.
Supervision of self-administered medication
Facility staff under the direction of a licensed health care professional can help you with the medication by reading the label to you; checking the prescribed dosage against the label; confirming that you have taken the dosage as prescribed; or documenting whether you have taken or refused to take the medication. If you are physically unable to open the container, the staff may open the container for you.
A licensed health care professional employed by the facility can administer routine insulin and vitamin B- injections, oral medications, topical treatments, eye and ear drops or nitroglycerin patches. Non-licensed staff may not administer any medication.
The facility must maintain a drug reference guide, no older than 2 years from the copyright date and keep it available and accessible for use by employees.
If the facility stores any medication, the storage must meet the following requirements. The medication must be:
The facility must maintain a separate medication record for each resident receiving medication administration. The record must include the:
Many ALFs provide a range of optional services at an additional cost. These optional services may include transportation to the doctor, money management or banking, beauty shop, postage or mailing, help with shopping, meals for visitors and guests and premium meals on-site at restaurants. These services are required to be described in the contract with current pricing so that the resident knows generally what to expect.
If you are a quadriplegic or paraplegic, or have a neuro-muscular disease, such as muscular dystrophy and multiple sclerosis, then the facility must:
Residents suffering from Alzheimer’s or dementia are subject to additional evaluations prior to admission. The facility must determine whether it can provide secure, appropriate care and has appropriate staff and skills. The regulations describe the required assessments.
If the facility offers a special program for Alzheimer’s and dementia patients, it must meet additional standards in order to maintain its license. The special care provided must be disclosed to a resident upon request. As part of those standards, the facility must:
As a resident, you have all rights guaranteed under the Constitutions of the United States and the State of Illinois. In addition, you have the right to:
The facility can release your records only with your written consent or that of your representative and must specify the circumstances under which your record may be released, except as specified by law.
As a resident, you have the following additional rights provided by statute:
The State Ombudsmen work for the Illinois Department on Aging. Their purpose is to advocate on behalf of senior residents. The State Ombudsmen will only act with the senior's permission.
When the facility reasonably believes that you have been a victim of abuse, neglect or financial exploitation, the facility must remove the perpetrator (if an employee or volunteer) from direct contact with residents.
In addition, the facility must:
When the facility investigates, its report must contain at least the following:
You may designate a representative through the Illinois Power of Attorney Act or through the guardianship process under the Probate Act of 1975. In the alternative, if you are deemed competent, you can sign a special IDPH form for the designation of a representative. Both the facility and IDPH must recognize the authority of your representative, your legally appointed guardian, your agent designated by a Power of Attorney for Health Care or a surrogate decision maker appointed in accordance with the Health Care Surrogate Act (See Chapter 3 of this Handbook). If you are not able to communicate your own needs in any manner, your representative must live in the facility and have a prior relationship to you.
A contract between you and the facility must be titled: “assisted living establishment contract” or “shared housing establishment contract,” as applicable. It must be printed in no less than 12 point type. You or your representative are entitled to a copy of the contract, and the facility must keep an extra copy on the premises throughout the duration of your stay.
The contract must include the following contents either in the contract itself or through supporting documents or attachments:
In addition, the contract must include:
Once you have a contract, it is automatically renewed from year to year, unless properly terminated. Any modifications to the contract must be in writing and signed by both parties. However, the contract may be terminated immediately at any time upon agreement of the parties.
Under certain circumstances, the facility may want you or your representative to sign a “negotiated risk agreement.” A "negotiated risk" is broadly defined as an agreement between a resident and an assisted living facility regarding the services that the resident requires and the risks that the resident is willing to take.
1. The facility can notify a resident unsteady on her feet of the dangers involved in wearing high heel shoes or in exploring the neighborhood, and the resident can nonetheless choose to accept the risk.
2. The resident chooses to accept the risk of not taking certain recommended medication or treatment.
3. The diabetic chooses to accept the risk of eating chocolate cake.
The agreement must describe the following:
The facility must also sign the agreement. Such agreements must be limited to your individual care and personal environment, and cannot waive any of your resident rights, as discussed above.
The negotiated risk agreement may be negotiated or renegotiated at any time during your stay in the facility. When a physician’s assessment is conducted as discussed above, all current negotiated risk agreements must be renegotiated as necessary. Any agreement may result in a reevaluation of the service delivery plan.
Advocates have noted problems with these agreements, in that:
Negotiated risk agreements release facilities from liability in carrying out their responsibilities to provide adequate care. You may not get any real benefit from the agreement. These agreements may be illegal or unenforceable under existing law. If you are forced to enter into one, you should always ask that someone knowledgeable about such matters, such as an attorney or the Ombudsman (or designee) be present when you discuss the terms of the Agreement.
Under the following circumstances, you or your representative may terminate residency immediately after notice to the facility:
Otherwise, you or your representative can terminate residency by providing 30 day’s written notice to the facility.
A facility can terminate your residency only for the following reasons:
The facility must provide to you or to your representative (or both), and to the Ombudsman, a 30 day written notice of involuntary residency termination. The facility must use a specific IDPH form notice that must contain all of the following:
If you or your representative cannot read English, the facility must provide the notice in a language you can read. In the alternative, the facility must provide a translator who has been trained to assist in the appeal process.
The facility does not need to give a 30 day notice in situations where there is imminent danger of death or serious physical harm to a resident.
Before it can actually terminate your residency, the facility must try to resolve the problem with you or with your representative. The facility must document those efforts in your file. These efforts may occur before or during the 30 day notice period, but must occur before the termination of the residency. The facility does not need to provide these efforts in situations where there is imminent danger of death or serious physical harm to a resident.
If you want to appeal any decision to terminate your residency, you or your representative need to make a “request for a hearing” to IDPH. Any request for a hearing postpones an involuntary termination of residency until IDPH renders a decision. During this time period, the facility cannot terminate or reduce any service for the purpose of making it more difficult or impossible for you to remain there.
If you want assistance or representation in any appeal at IDPH, you should contact the Ombudsman’s Office and your local legal services office, such as Prairie State Legal Services.
At the hearing, the IDPH hearing officer has the power to hear only the following issues:
Following a hearing, the IDPH hearing officer will render a decision. The decision will state whether or not you can stay at the facility or it may provide other relief. The decision of IDPH is reviewable in the courts. If you want to appeal the IDPH decision, you should file suit in Circuit Court no later that 35 days from the date of the IDPH decision.
The facility must offer you and your representative “residency termination and relocation assistance.” That assistance includes information on available alternative placement. You must be involved in planning the move and must choose among the available alternative placements (except when an emergency situation makes your involvement impossible). Emergency placements are deemed temporary until your input can be sought in the final placement decision. You cannot be forced to remain in a temporary or permanent placement.
IDPH may offer assistance to the facility and to you in the preparation of residency termination and relocation plans. This assistance is to assure a safe and orderly transition and to protect your health, safety, welfare and rights. In non-emergencies, and where possible in emergencies, the facility must design and implement the transition plan before any transfer or residency termination.
Another way to have your residency terminated is if the facility closes, or if any part of the facility closes that requires termination of your residency. In that event, the owner of any facility must give 90 days notice before voluntarily closing the facility or before part of it. The closure notice must state the proposed date of closing and the reason for closing. The facility must give this notice to IDPH as well as to you, to your representative and to another member of your family, where practicable.
The facility must offer to help you find alternative placement and must advise you on available alternatives. Where you are unable to choose an alternative placement and you are not under guardianship, the facility must notify IDPH of the need for relocation assistance. The facility must comply with all applicable laws until the date of closing.
Most notably, ALF’s and SHE’s are not required to have nurses on staff. However, the facility must have a sufficient number of qualified staff to meet the 24 hour scheduled and unscheduled needs of residents. This includes all mandatory services; services specified in the residents’ service plans; crisis intervention; and evacuation of residents during emergencies. The staff must participate in certain specified ongoing training to serve the resident population. All direct care staff must be at least 16 years old.
The facility must have on duty at all times at least one direct care staff person who has obtained cardiopulmonary resuscitation (CPR) training specific to adults. The staff person must have current certification in CPR and have the ability to perform CPR.
SHEs must have at least one staff member on site at all times, except in situations, such as taking a resident to the emergency room or planned or unplanned trips to the grocery store, that would require the staff person to be away from the facility for a brief period of time. In such situations, arrangements must be made to monitor the safety of the residents in accordance with the service delivery plan.
ALFs must have at least one staff member awake, on duty and on site 24 hours per day.
Each ALF must have a full-time manager. A SHE must have a manager who may oversee no more than three facilities if they are located within 30 minutes driving time during non-rush hour and if the manager can be immediately contacted by an electronic communication device. The manager must meet specific qualifications set forth in the law. The manager must designate an individual capable of acting in an emergency to act whenever the manager is absent from the facility.
In terms of building construction, ALFs and SHEs must conform to applicable building, fire and life safety codes. They must meet the accessibility standards of the Americans with Disabilities Act. The facilities also must be in compliance with applicable State codes and ordinances with respect to its water supply and sewage system.
In addition, facilities must comply with the following requirements:
Each apartment must have:
Facilities do not have to furnish the apartments, but if they do, they must provide at a minimum:
If you live in an ALF, your apartment must also have:
If you live in an SHE, the facility must satisfy these requirements:
The facility must:
The facility does not have to provide food service. If it provides its own food service or does so through a contract with a food service provider, the facility must meet the following requirements:
The Assisted Living and Shared Housing Act can be found at 210 ILCS 9/1 et. seq.
The Illinois Department of Public Health regulations governing assisted living and shared housing can be found at 77 Illinois Administrative Code Part 295.
To see a list of ALFs and SHEs in Illinois, go to the following website:
Assisted Living/Shared Housing Licensed Establishments
For more information regarding ALFs and SHEs, call the Department of Public Health’s Division of Assisted Living: 217-782-2913.
You can also call the Illinois Department on Aging’s Senior HelpLine at 1-800-252-8966 (Voice and TTY).
The Illinois Department on Aging has a Long Term Care Ombudsman Program that protects and promotes the rights and quality of life for people who reside in long term care facilities. This is done through regional ombudsmen who have a hands-on working relationship with the residents and staff of the facilities within their program areas. You can contact the Ombudsman Program whenever you need to:
To find the regional Ombudsman’s office near you, consult the following directory for names, addresses and phone numbers:
Long Term Care Ombudsmen
Legal information and forms are available.
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