1. Does Medicare pay for assisted living?
   Original Medicare does not pay for room, board, or custodial care in assisted living. It may cover certain medical services like physician visits, DME, and short-term skilled nursing after a qualifying hospital stay. Medicaid and waiver programs are state-specific.
    

2. What insurance do assisted living facilities need?
   Most facilities carry General Liability, Professional Liability, Abuse & Molestation, Property with Business Income, Workers’ Compensation, Commercial Auto/Hired & Non-Owned Auto, Cyber/Privacy, Directors & Officers (D&O), Employment Practices (EPLI), and an Excess/Umbrella layer. The exact mix depends on license type, services provided, and census/acuity.
    

3. Are staffing ratios mandated for assisted living?
   There is no federal minimum staffing ratio for assisted living; requirements are set by each state and can vary by license type, unit (e.g., memory care), and time of day. Document how you determine staffing levels and how you adjust for acuity and changes in condition.
    

4. Do we need an RN on staff?
   Many states require an RN on staff or on call, based on services and resident acuity, rather than 24/7 on-site. Keep written RN delegation protocols, competency records, and a plan for when clinical needs exceed your license scope.
    

5. Who can administer medications? Can unlicensed staff do it?
   Medication administration is state-regulated. Some states allow RN delegation to trained, competent unlicensed staff under written policy, documented training, and supervision. Use an eMAR, audit high-risk meds, and keep delegation and competency files current.
    

6. When can we discharge or evict a resident?
   Permissible reasons and timelines are defined in state code. Common triggers include needs beyond license scope, nonpayment, safety risks, or significant behavioral issues. Provide required notices, care conferences, and a safe, documented discharge plan.
    

7. What incidents must we report to regulators?
   States generally require prompt reporting of abuse/neglect/exploitation, serious injuries, elopements, deaths, fires, and other sentinel events. Reporting windows vary widely (immediate, 24 hours, 72 hours, etc.). Keep a written policy with time-stamped documentation of who was notified and when.
    

8. Do we have to report to Adult Protective Services (APS)?
   In most states, assisted living personnel are mandated reporters. When you suspect abuse, neglect, or exploitation, report to APS and your licensing authority within the required timeframe, and document every step.
    

9. Why are fire/life-safety and emergency preparedness such a big deal?
   Regulators closely scrutinize suppression systems, alarms, drills, and emergency plans—especially in memory care. Deficiencies increase liability and downtime after an event. Keep inspection logs, drill records, and vendor contracts ready.
    

10. What training is required for dementia/memory care?
    States that recognize “special care” or memory-care units often require extra staff training, activity programming, and environment/safety policies. Maintain training matrices, competency checks, and documentation of person-centered interventions.
     

11. What level of care can we legally provide—and what’s outside scope?
    Your license defines what you may accept/retain (e.g., catheter care, injections, bed-bound residents, hospice waivers). When needs exceed license scope, escalate promptly: physician/family communication, care-plan changes, and discharge planning.
     

12. California-specific: we’re an RCFE—what’s unique?
    California RCFEs operate under Title 22 and related guidance. There are detailed rules for admissions/assessments, staffing, medication assistance, hospice waivers, and resident rights. Keep LIC forms updated and follow DSS timelines for incident reporting.
     

13. Texas-specific: what should ALFs know?
    Texas Health & Safety Code and 26 TAC Chapter 553 govern licensing, operations, and physical-plant standards for Type A and Type B facilities. Medication administration, staffing, and incident reporting are explicitly defined—follow those timelines and keep logs.
     

14. Arizona-specific: what should ALFs know?
    Arizona regulations outline licensing, scope of services, personnel requirements, training, and incident reporting. Policies should reflect RN delegation, medication services, and memory-care safeguards, with documentation ready for surveyors.
     

15. What liability limits should we carry?
    A common baseline is $1,000,000 per claim / $3,000,000 aggregate for both General Liability and Professional Liability, with an Umbrella above to address severity risk. Cyber, Abuse & Molestation, D&O, EPLI, and Crime limits should reflect bed count, acuity, contracts, and your loss history.
     

16. How are premiums calculated for assisted living facilities?
    Pricing is influenced by bed count and acuity mix, services (e.g., memory care, med administration), state and location, building construction and protections, claims history, coverage limits/deductibles, and risk controls. Strong policies, training, and clean loss runs can improve terms.
     

17. Which claims are most common?
    Frequent claims include falls, medication errors, elopement, resident-on-resident incidents, abuse allegations, water/fire property losses, cyber incidents, and transport accidents. Many of these may be covered depending on policy forms and endorsements; documentation quality materially impacts outcomes.
     

18. What documentation matters most after an incident?
    Time-stamped incident reports, care plans and recent updates, physician/family communications, staffing rosters, maintenance logs, training/competency files, and—when applicable—alarm/drill logs or eMAR audit trails. Good documentation shortens investigations and may reduce severity.
     

19. Does our policy cover agency or contract staff?
    Often yes, but it depends on the policy language and contract terms. Require certificates of insurance and hold-harmless/indemnification provisions; verify Professional Liability and Workers’ Comp for agencies.
     

20. What should be in our abuse-prevention program?
    Background checks, reference verification, clear reporting pathways, annual training for mandatory reporters, two-person assists for high-risk care, and a non-retaliation policy. Track all training and incident timelines to show compliance.
     

Note on coverage language:
Coverage responses and availability vary by policy form, endorsements, limits, deductibles, and state regulations. Items above may be covered depending on your specific insurance program.