People who require some assistance with their daily routines, but do not need the level of care provided in a nursing home, often utilize the term “assisted living” when beginning to look for a place to receive this type of service. In Pennsylvania, there are two types of facilities which will provide 24 hour supervision for adults and help with the tasks of daily living such as bathing, dressing, medication administration, meal preparation, etc.  An Assisted Living Residence (ALR) is one of these, and the other is a Personal Care Home (PCH).

These two names were used interchangeably for many years, but in 2011, new regulations took effect which separated these two types of care. One motive for this change may have been the desire to make public funds available to help pay for care in a facility which isn’t a nursing home.  Assisted Living Residences were to become the recipients of these funds, however, changes to public benefit programs (primarily Medical Assistance) to allow for payments to ALRs never materialized.  As a result, both types of care remain primarily private pay, and rather than adapt their buildings and services to meet the new ALR requirements, most facilities chose to remain under the PCH regulations.

To the casual observer, both types of care look very similar.  Let’s examine some of the regulations which distinguish an ALR from a PCH.

The extent of the services which are provided is one of the main differences between these two types of care. An ALR is designed to allow individuals to age in place, and the regulations define specific basic assisted living service packages.  In addition, since care needs may increase over time, an ALR is required to provide or arrange for the provision of supplemental services such as hospice, specialized cognitive support services, physical and occupational therapy, and skilled nursing services.  In PCH regulations, however, basic and supplemental services are not outlined.  While some supplemental services may be available, an individual with increased care needs may be asked to move from a PCH to another facility which provides a higher level of care.

In order to call itself an ALR, a facility must also meet certain requirements for the physical accommodations available in the building. Public spaces and living units must be of a certain minimum size; residents must be offered a small refrigerator and microwave for their living units; and each living unit must have a door that locks (except for special care units) as well as a bathroom with a toilet, sink, wall mirror, tub or shower, and emergency notification system.  No more than two residents can share a living unit in an ALR.  In a PCH, if the minimum size of public spaces is defined, they are smaller than those in an ALR.  Private refrigerators and microwaves would be the resident’s responsibility to provide, and living unit doors are not required to lock.  At least one toilet, sink, and wall mirror must be available for every 6 or fewer users (includeing staff) and at least one shower or tub for every 10 or fewer users.  No emergency notification system is required in a PCH, and up to four residents may share a bedroom.  Other differences include specifications about automatic external defibrillators, air conditioning, and the availability of beverages and snacks.

Staffing levels and staff training requirements also differ between these two types of care.   An ALR must have a licensed nurse on duty or on call at all times, and a registered dietician must also be on staff or under contract.  A PCH does not have these requirements, although they may choose to employ nurses and a dietician.  All direct care staff in an ALR must remain awake at all times when on duty, as well as in a PCH if the PCH has 16 or more residents.  In a small PCH with only 1-15 residents, only one direct care staff member must remain awake at all times.  With regard to staff training, workers in an ALR must have 18 hours of initial training prior to working unsupervised, plus an additional 4 hours of dementia training.  This is followed annually by 2 hours of dementia training and 16 hours of general training (including areas such as the signs and symptoms of infection and behavioral management techniques).  PCH regulations do not specify an initial training period, the annual training requirement is 12 hours, and specific dementia training is not mandated.  In addition, at least one staff member must be trained in CPR for every 35 residents in an ALR.  In a PCH, the ratio is 1:50.

Some of the regulations pertaining to activities, personal decision-making, and transportation services also vary between an ALR and a PCH. When evaluating these facilities, it is important to note that while a PCH might not be required to offer certain services or meet certain standards, they may voluntarily choose to exceed the state’s PCH regulations.  Each facility should be evaluated based on its own individual merits, and not just the fact that they have an ALR or a PCH license.  Both types of care are designed for people who are no longer able to remain at home and are in need of supportive services to maintain their health and safety.

Karen Kaslow, RN

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Long Term Care Guide