A 10-state investigation of AD/ADRD-capable assisted living regulations using a comprehensive dementia care model

Introduction: State regulation is central in shaping dementia care practices in assisted living facilities. Yet, there is limited systematic evidence examining how regulatory requirements vary and affect residents across states. Additionally, regulatory frameworks governing the training requirements and staff presence of ALFs play a vital role in shaping ALFs' dementia care capacity. Methods: This article reports the results of a legal mapping study that evaluated the variation of assisted living facility (ALF) memory care regulations across 10 states. We compared the regulations of these 10 selected states to the "gold standard" Dementia Care Practice Recommendations, a comprehensive memory care model compiled by the Alzheimer's Association (Fazio et al., 2018). Results: Of the care model's nine recommendations, regulations aligned most to the following: 1. Supportive and Therapeutic Environment (84% average alignment across 10 states), 2. Information Education and Support (74% average), and 3. Ongoing Care (70% average). States with regulation in highest alignment to the care model included California, Missouri, and Minnesota. Regulations were least aligned with the following recommendations: 7. Person-Centered Care (55% average), 8. Detection and Diagnosis (51% average), and 9. Medical Management (50%). States with regulation in lowest alignment to the care model included Texas, Georgia, and Connecticut. Discussion: Overall, inconsistencies in state alignment to the Care Model also underscore the absence of a standardized enforcement mechanism across assisted living systems. Additional evidence is needed to link regulatory standards to actual measured changes in state-level care coordination practice in the ALF setting. Target areas for regulation change may also exist outside of mechanisms that govern the staff and services directly provided by ALFs. Methods of this study are building blocks from which researchers may systematically collect and analyze regulations data for future across-state LTSS studies.