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BACKGROUND: Assisted living facilities provide housing and care to persons unable to live independently, and who often have complex medical needs. Disease outbreaks have prompted increasing health department activities in assisted living, and illustrate challenges of maintaining adequate resident protections in these facilities.
METHODS: Laws and regulations governing assisted living facilities for the 50 states were abstracted using a structured tool. Selected state health departments were queried regarding outbreaks identified in assisted living facilities. This information was summarized in a recent journal publication by CDC. Ongoing activities include dialogue and information sharing among states and CDC as part of broader efforts to prevent healthcare-associated infections among long term care residents.
RESULTS: From 2010 to 2013, 12 states identified approximately 1600 respiratory, gastrointestinal or other outbreaks occurring in assisted living facilities, with influenza or norovirus infections predominating. Reporting requirements, definitions and methods used to track outbreaks varied. Policy options for addressing identified infection control gaps in assisted living facilities include specification of appropriate levels of on-site care; requiring facility implementation of infection control plans that includes regular staff training; assessing infection control practices as part of facility inspections; and strengthening of staff sick leave and immunization practice policies and outbreak reporting requirements. North Carolina and Virginia have been invited to share their experiences in working with assisted living facilities in a number of these domains.
CONCLUSIONS: There is wide variation in how assisted living facilities are regulated in the United States. State oversight may provide an opportunity to ensure safe healthcare delivery, and minimize risks of infections, outbreaks of disease, and other forms of harm among assisted living residents. Health department experience is growing in this area; states may benefit from learning from efforts to implement or expand prevention, oversight and reporting activities.